scholarly journals Place of preperitoneal pelvic packing in severe pelvic traumatisms: About 20 cases performed in a French military level one trauma center

2021 ◽  
Author(s):  
Hardy Julie ◽  
Coisy Marie ◽  
Monchal Tristan ◽  
Bourguoin Stéphane ◽  
Long Depaquit Thibaut ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Trauma Center ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Safe Procedure ◽  
Pelvic Packing ◽  
Preperitoneal Pelvic Packing ◽  
Arterial Bleeding ◽  
Lethal Triad ◽  
Overall Mortality

AbstractBackgroundThe overall mortality of hemodynamically unstable pelvic fractures is high. Hemorrhage triggers off the Moore lethal triad. Hemostatic management during the golden hour is essential. Combined with pelvic stabilisation, preperitoneal pelvic packing (PPP) is proposed to control venous and bony bleeding, while arterioembolisation can stop arterial bleeding. No international consensus has yet prioritized these procedures. The aim of this study was to analyse a serie of PPP in a military level one trauma center and propose an algorithm for hemodynamically unstable pelvic traumas regardless of the military facility.MethodFrom January 2010 to December 2020, every patient from our military institution with a hemodynamically unstable pelvic fracture underwent PPP combined with pelvic stabilisation. Before 2012 data were retrospectively collected from database (PMSI), after 2012 data were prospectively recorded in our polytrauma database and retrospectively analysed. The care algorithm applied focused on hemodynamic status of polytraumatised patients on admission. Primary criteria were early hemorrhage-induced mortality (<24h) and overall mortality (<30d). Secondary criteria were systolic blood pressure (SBP) and red blood cells (RBC) units administered.Results20 patients with a pelvic fracture had a PPP. Mean age was 49,65 +/-23,97 years and median ISS was 49 (31; 67). The decrease of blood transfusion and increase of SBP between pre- and postoperative values were statistically significant. Eight patients (40%) had postoperative arterial pelvic blush and 7 patients were embolised. The early mortality by refractory hemorrhagic shock was 25% (5/20). Overall mortality at 30 days was 50% (10/20).ConclusionPPP is a quick, easy, efficient and safe procedure. It can control venous, bony and sometimes arterial bleeding. PPP is part of damage control surgery and we propose it in first line. Angio-embolization remains complementary. Besides, PPP is the only means available in precarious conditions of practice, notably in military forward units.

scholarly journals The 10 commandments of exsanguinating pelvic fracture management

2019 ◽  
Vol 26 (6) ◽  
pp. 357-370
Author(s):  
Chak Wah Kam ◽  
Ping Keung Joe Law ◽  
Hon Wai Jacky Lau ◽  
Rashidi Ahmad ◽  
Chiu Lun Joseph Tse ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Key Management ◽  
Damage Control ◽  
Balloon Occlusion ◽  
Pelvic Packing ◽  
Pelvic Fixation ◽  
Pelvic Binder ◽  
Lethal Triad ◽  
Fracture Management ◽  
Definitive Therapy

Background: Unstable pelvic fractures are highly lethal injuries. Objective: The review aims to summarize the landmark management changes in the past two decades. Methods: Structured review based on pertinent published literatures on severe pelvic fracture was performed. Results: Ten key management points were identified. Conclusion: These 10 recommendations help diminish and prevent the mortality. (1) Before the ABCDE management, preparedness, protection, and decision are essential to optimize patient outcome and to conserve resources. (2) Do not rock the pelvis to check stability, avoid logrolling but prophylactic pelvic binder can be life-saving. (3) Computed tomography scanner can be the tunnel to death for hemodynamically unstable patients. (4) Correct application of pelvic binder at the greater trochanter level to achieve the most effective compression. (5) Choose the suitable binder (BEST does not exist, always look for BETTER) to facilitate body examination and therapeutic intervention. (6) Massive transfusion protocol is only a temporizing measure to sustain the circulation for life maintenance. (7) Damage control operation aims to promptly stop the bleeding to restore the physiology by combating the trauma lethal triad to be followed by definitive anatomical repair. (8) Protocol-driven teamwork management expedites the completion of the multi-phase therapy including external pelvic fixation, pre-peritoneal pelvic packing, and angio-embolization, preceded by laparotomy when indicated. (9) Resuscitation endovascular balloon occlusion of aorta can reduce the pelvic bleeding while awaiting hospital transfer or operation theater access. (10) Operation is the definitive therapy for trauma but prevention is the best treatment, comprising primary, secondary, and tertiary levels.

scholarly journals Damage control surgery for splenic trauma: "preserve an organ - preserve a life"

2021 ◽  
Vol 52 (2) ◽  
pp. e4084794
Author(s):  
Carlos Serna ◽  
José Julian Serna ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Linda M Gallego ◽  
...  
Keyword(s):  
Damage Control ◽  
Abdominal Cavity ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Splenic Trauma ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Arterial Bleeding ◽  
Non Operative Management ◽  
Injured Patients

The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.

Critical Care Considerations for Damage Control in a Trauma Patient

2021 ◽  
Vol 32 (1) ◽  
pp. 64-75
Author(s):  
Shannon Gaasch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cause Of Death ◽  
Damage Control ◽  
Operative Procedure ◽  
Fixed Ratio ◽  
Damage Control Surgery ◽  
Fluid Restriction ◽  
Damage Control Resuscitation ◽  
Lethal Triad

Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.

scholarly journals Effectiveness and postoperative wound infection of preperitoneal pelvic packing in patients with hemodynamic instability caused by pelvic fracture

PLoS ONE ◽  
2018 ◽  
Vol 13 (11) ◽  
pp. e0206991 ◽  
Author(s):  
Hongjin Shim ◽  
Ji Young Jang ◽  
Ji Wan Kim ◽  
Hoon Ryu ◽  
Pil Young Jung ◽  
...  
Keyword(s):  
Wound Infection ◽  
Pelvic Fracture ◽  
Hemodynamic Instability ◽  
Postoperative Wound Infection ◽  
Pelvic Packing ◽  
Postoperative Wound ◽  
Preperitoneal Pelvic Packing

scholarly journals Resusitasi Pengendalian Kerusakan Di Unit Perawatan Intensif

2021 ◽  
Vol 36 (2) ◽  
pp. 71-75
Author(s):  
Dhanu Pitra Arianto ◽  
Nurita Dian Kestriani
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Massive Bleeding ◽  
Trauma Patients ◽  
Damage Control Resuscitation ◽  
Early Management ◽  
Severe Haemorrhage ◽  
Lethal Triad ◽  
Clotting Cascade ◽  
Injured Patients

Abstrak Resusitasi dengan pengendalian kerusakanmenggambarkan suatu pendekatan ke perawatan awal pada pasien dengan cedera berat. Tujuan pendekatan ini untuk menjaga pasien tetap stabil dengan menghindari intervensi dan kondisi yang berisiko kepada keadaan perburukan dengan mengendalikan trias kematian, yaitu hipotermia, koagulopati, dan asidosis. Merupakan hal yang penting bahwa konsep dan kepraktisan pendekatan ini dipahami oleh semua yang terlibat dalam manajemen awal pasien trauma. Pendekatan ini dimulai dengan pemberian produk darah sejak awal, penghentian perdarahan dan pengembalian volume darah yang bertujuan untuk mengembalikan stabilitas fisiologis dengan cepat. Resusitasi dengan pengendalian kerusakan memilikibeberapa tambahan pendekatan dari bidang farmakologis dan laboratorium untuk meningkatkan perawatan pasien yang mengalami perdarahan. Pendekatan ini termasuk trombelastografi sebagai ukuran rinci kaskade pembekuan, asam traneksamat sebagai antifibrinolitik.   Kata kunci : hipotermia, koagulopati, asidosis, perdarahan masif     Damage Control Resuscitation in Intensive Care Unit   Abstract Damage control resuscitation (DCR) describes an approach to the early care of very seriously injured patients. The aim is to keep the patient alive whilst avoiding interventions and situations that risk worsening their situation by driving the lethal triad of hypothermia, coagulopathy and acidosis.It is critical that the concepts and practicalities of this approach are understood by all those involved in the early management of trauma patients. Damage control resuscitation forms part of an overall approach to patient care rather than a specific intervention and has evolved from damage control surgery. It is characterised by early blood product administration, haemorrhage arrest and restoration of blood volume aiming to rapidly restore physiologic stability. The infusion of large volumes of crystalloid is no longer appropriate, instead the aim is to replace lost blood and avoid dilution and coagulopathy. In specific situations, permissive hypotension may also be of benefit, particularly in patients with severe haemorrhage from an arterial source. Damage control resuscitation has been augmented by both pharmacologic and laboratory adjuncts to improve the care of the hemorrhaging patient. These include thrombelastography as a detailed measure of the clotting cascade, tranexamic acid as an antifibrinolytic.   Keywords: hypothermia, coagulopathy, acidosis, massive bleeding

scholarly journals Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia

2017 ◽  
Vol 6 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Carlos A Ordóñez ◽  
Albaro J Nieto ◽  
Javier A Carvajal ◽  
Juan M Burgos ◽  
Adriana Messa ◽  
...  
Keyword(s):  
Damage Control ◽  
Case Series ◽  
Damage Control Surgery ◽  
Descriptive Study ◽  
Clinical Severity ◽  
Damage Control Resuscitation ◽  
Obstetric Hemorrhage ◽  
Rapid Control ◽  
Expected Mortality ◽  
Overall Mortality

ABSTRACT Objective The aim of this case series is to describe the experience of implementing damage control resuscitation (DCR) in patients with major obstetric hemorrhage (MOH) between January 2005 and December 2015 in the Fundación Valle del Lili, Cali, Colombia. Materials and methods This is a prospective descriptive study of a case series from 108 patients with MOH who were subjected to DCR. All patients were operated on using a standardized surgical technique in accordance with the institutional protocol. Results The median age was 28 years, with a gestational age of 38 weeks. The principal associated diagnosis was severe preeclampsia (in 39% of cases). A total of 96 patients presented massive postpartum hemorrhage, and 75% of these cases presented after a cesarean section. In all patients, normal control of bleeding was achieved, 60% during the first surgical period. The Acute Physiology and Chronic Health Evaluation score was 14, with an overall mortality of 6.48%, far below the expected mortality according to the clinical severity of these patients. Conclusion This study includes the biggest series of pregnant women with MOH, in a critical condition, in whom DCR was used, during which rapid control of bleeding was achieved, associated with a significantly lower mortality than expected. How to cite this article Escobar MF, Carvajal JA, Burgos JM, Messa A, Ordoñez CA, García AF, Granados M, Forero AM, Casallas JD, Thomas LS, Nieto AJ. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017;6(1):1-7.

scholarly journals Damage control surgery – experiences from a level I trauma center

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Bernhard Gasser ◽  
Thomas M. Tiefenboeck ◽  
Sandra Boesmueller ◽  
Danijel Kivaranovic ◽  
Adam Bukaty ◽  
...  
Keyword(s):  
Trauma Center ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Level I

Damage Control Surgery; A 3-Year Experience at an American College of Surgeons Verified Level 1 Trauma Center

2019 ◽  
Vol 229 (4) ◽  
pp. e223
Author(s):  
Ramy Abdel-Naby ◽  
Deoranie N. Abdel-Naby ◽  
Akella Chendrasekhar
Keyword(s):  
Trauma Center ◽  
Damage Control ◽  
Damage Control Surgery ◽  
American College Of Surgeons ◽  
Level 1 ◽  
Level 1 Trauma Center
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