1328: Simultaneous Damage Control Surgery and Endovascular Procedure in Hybrid Emergency Department System

2020 ◽  
Vol 49 (1) ◽  
pp. 671-671
Author(s):  
Kaori Ito ◽  
Taichiro Tsunoyama ◽  
Tsuyoshi Nagao ◽  
Kahoko Nakazawa ◽  
Ayumi Tomonaga ◽  
...  
Keyword(s):  
Emergency Department ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Endovascular Procedure

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

scholarly journals Damage control in the emergency department, a bridge to life

2021 ◽  
Vol 52 (2) ◽  
pp. e4004801
Author(s):  
Laureano Quintero ◽  
Juan Jose Melendez-Lugo ◽  
Helmer Emilio Palacios-Rodríguez ◽  
Natalia Padilla ◽  
Luis Fernando Pino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hemodynamic Instability ◽  
Massive Hemorrhage ◽  
Severely Injured ◽  
Airway Injury ◽  
Hemostatic Resuscitation ◽  
Altered State Of Consciousness

Patients with hemodynamic instability have a sustained systolic blood pressure less or equal to 90 mmHg, a heart rate greater or equal to 120 beats per minute and an acute compromise of the ventilation/oxygenation ratio and/or an altered state of consciousness upon admission. These patients have higher mortality rates due to massive hemorrhage, airway injury and/or impaired ventilation. Damage control resuscitation is a systematic approach that aims to limit physiologic deterioration through a group of strategies that address the physiologic debt of trauma. This article aims to describe the experience earned by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia in the management of the severely injured trauma patient in the emergency department following the basic principles of damage control surgery. Since bleeding is the main cause of death, the management of the severely injured trauma patient in the emergency department requires a multidisciplinary team, which should perform damage control maneuvers aimed at rapidly control bleeding, hemostatic resuscitation and/or prompt transfer to the operating room, if required.

Massive transfusion in paediatric trauma: a single centre experience

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A10.3-A11
Author(s):  
Robert Hearn
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Massive Transfusion ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Blood Parameters ◽  
Major Haemorrhage ◽  
Blood Products ◽  
Paediatric Trauma

AimsTo report the occurrence of major haemorrhage in children following major trauma, the practice of blood products transfusion including monitoring of laboratory parameters in such patients and the outcomes.MethodsWe retrospectively analysed the local paediatric trauma database of all children following trauma call activation on arrival to the Emergency Department in a major urban trauma centre in London. We studies over a period of 15 months, May 2008–August 2009. We defined massive transfusion as packed red cells >40 ml/kg in the first 4 h or >80 ml/kg in the first 24 h.Results227 children presented to the accidents and emergency during this period following major trauma call activation. The median age at presentation was 10.2 years. 13 (5.7%) children had major haemorrhage. The median ISS WAS 35 (IQR 10–60). All but one were males. Three had penetrating trauma, one of whom made it to theatre but all died. Four had emergency damage control surgery. Abnormal results were seen in three patients, each having one abnormal result (INR=1.9 and APTT=86, low Hb=7.6, thrombocytopaenia =63). 8/13 patients received additional blood products such as Fresh Frozen Plasma (FFP), platelets and Cryoprecipitate. However, no patient received the ration of blood products RBC:FFP of 1:1 as practised in adult trauma. Two patients had no admission bloods done. Worsening coagulation parameters were seen in two patients when measure post-transfusion and the remaining 11 patients did not have routine monitoring of blood parameters post-transfusion. 8 (62%) patients died of which 7 died in the Emergency Department.ConclusionsMajor haemorrhage is associated with a very high mortality in severely injured children. There is a need for instituting a major haemorrhage policy in paediatric trauma and consideration of point-of-care testing of blood parameters.

Damage control surgery

2021 ◽  
Vol 21 (S1) ◽  
pp. 147-154
Author(s):  
C. Güsgen ◽  
A. Willms ◽  
R. Schwab
Keyword(s):  
Damage Control ◽  
Damage Control Surgery

scholarly journals Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Derek J. Roberts ◽  
◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Clinical Scenario ◽  
Cross Sectional ◽  
Iliac Vessel ◽  
Civilian Trauma ◽  
Definitive Surgery

Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

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