scholarly journals Demystifying damage control in musculoskeletal trauma

2016 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
P Bates ◽  
P Parker ◽  
I McFadyen ◽  
I Pallister
Keyword(s):  
Large Scale ◽  
Major Trauma ◽  
Damage Control ◽  
Trauma Surgery ◽  
Major Surgery ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Appropriate Care ◽  
Fracture Management ◽  
Early Appropriate Care

Trauma care has evolved rapidly over the past decade. The benefits of operative fracture management in major trauma patients are well recognised. Concerns over early total care arose when applied broadly. The burden of additional surgical trauma could constitute a second hit, fuelling the inflammatory response and precipitating a decline into acute respiratory distress syndrome, sepsis and multiple organ dysfunction syndrome. Temporary external fixation aimed to deliver the benefits of fracture stabilisation without the risk of major surgery. This damage control orthopaedics approach was advocated for those in extremis and a poorly defined borderline group. An increasing understanding of the physiological response to major trauma means there is now a need to refine our treatment options. A number of large scale retrospective reviews indicate that early definitive fracture fixation is beneficial in the majority of major trauma patients. It is recommended that patients are selected appropriately on the basis of their response to resuscitation. The hope is that this approach (dubbed ‘safe definitive fracture surgery’ or ‘early appropriate care’) will herald an era when care is individualised for each patient and their circumstances. The novel Damage Control in Orthopaedic Trauma Surgery course at The Royal College of Surgeons of England aims to equip senior surgeons with the insights and mindset necessary to contribute to this key decision making process as well as also the technical skills to provide damage control interventions when needed, relying on the improved techniques of damage control resuscitation and advances in the understanding of early appropriate care.

scholarly journals (A39) Civil-Military Collaboration in Trauma Training

2011 ◽  
Vol 26 (S1) ◽  
pp. s11-s12
Author(s):  
L. Lundberg ◽  
P. Ortenwall
Keyword(s):  
Major Trauma ◽  
Trauma Surgery ◽  
Armed Forces ◽  
Medical Personnel ◽  
Health Staff ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Military Health ◽  
Medical Organisation ◽  
The Military

In the present Swedish military medical organisation all medical personnel, including surgeons, have to be recruited from civilian hospitals. Even if there are many civilian surgeons well qualified to perform trauma surgery, the injury patterns seen in e.g. Afghanistan are quite different compared to what is generally seen in trauma patients arriving to the ED at a civilian hospital. In order to upgrade the major trauma skills of the civilian surgeons recruited to and trained for participating in international missions, the (extended) military version of the Definitive Surgical Trauma Care (DSTC) Course has been implemented. DSTC is given with the intention not to duplicate ATLS, nor to provide an in depth course in surgery, but rather to teach those techniques particularly applicable to the patient who requires surgery and intensive care for major trauma, in a setting where such care is not commonly practised or even necessarily available. The course, made up by a mix of lectures, case discussions and skill stations has been given at the Swedish Armed Forces Centre for Defence Medicine in Gothenburg since 2007. It has gradually evolved to incorporate also anaesthesiologists and nursing staff into an integrated team. The faculty during these courses has been made up by a mix of international and Swedish instructors. Course candidates have primarily been military health staff, but vacant slots have been offered clinicians working in civilian hospitals in the western part of Sweden. During the last course in September 2010 17/20 (85%) of the physicians and 13/17 (76%) of the nurses rated the course as very beneficial or indispensible. The Swedish Armed Forces Centre for Defence Medicine will continue to run the military version of the DSTC course. Due to a certain over-capacity, course participation can be offered the civilian health care system.

The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees

2018 ◽  
Vol 164 (5) ◽  
pp. 360-361 ◽  
Author(s):  
Douglas Hammond ◽  
J Breeze ◽  
D Evriviades
Keyword(s):  
Surgical Training ◽  
Major Trauma ◽  
Complex Trauma ◽  
Trauma Surgery ◽  
Queen Elizabeth Hospital ◽  
Trauma Patients ◽  
Multidisciplinary Management ◽  
Leadership Experience ◽  
The Uk ◽  
The Military

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees.

Retained Foreign Bodies after Emergent Trauma Surgery: Incidence after 2526 Cavitary Explorations

2007 ◽  
Vol 73 (10) ◽  
pp. 1031-1034 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Kenji Inaba ◽  
Ali Salim ◽  
Carlos Brown ◽  
Peter Rhee ◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Damage Control ◽  
Trauma Surgery ◽  
Radiographic Evaluation ◽  
Trauma Patients ◽  
X Rays ◽  
Chest X Ray ◽  
Cavity Closure ◽  
Level 1 Trauma Center

Trauma patients are thought to be at high risk for iatrogenic retained foreign bodies (RFBs). The objective of this study was to evaluate this incidence. All cases of RFB after cavitary trauma surgery were identified by review of Morbidity and Mortality reports at a Level 1 trauma center from January 1998 to December 2005 and confirmed by the Octagon Risk Management System. Over 8 years, 10,053 trauma operations were performed (2075 laparotomies, 377 thoracotomies, and 74 sternotomies). Three cases (0.1%) of RFB (all sponges) occurred during one single-stage and two damage control laparotomies. The counts were correct before definitive closure in two of three cases. No postoperative x-rays were obtained in any of the cases. RFB diagnosis occurred between days 3 and 9, one on a routine chest x-ray and the other two on abdominal computed tomography scans during a septic workup. Four-month to 8-year follow up documented one pleural effusion and one abscess resulting from the RFB. Iatrogenic RFBs after emergent cavitary trauma surgery occur at a rate of 0.12 per cent and are associated with significant morbidity. In addition to standard preventive strategies, in emergent cases with risk factors such as requiring damage control, before final cavity closure, even with a correct sponge count, radiographic evaluation is warranted.

Coagulation management in major trauma

2006 ◽  
Vol 26 (S 02) ◽  
pp. S50-S55 ◽  
Author(s):  
H. Schoechl
Keyword(s):  
Blood Loss ◽  
Major Trauma ◽  
Damage Control ◽  
Coagulation Factor ◽  
Damage Control Surgery ◽  
Coagulation Factors ◽  
Conclusive Evidence ◽  
Trauma Patients ◽  
Coagulation Management ◽  
Haemostatic Agents

SummaryBleeding is a common problem in major trauma. Coagulopathy could be detected in approximately 25% of all trauma patients on arrival in the emergency room. The reasons for that are blood loss, dilution of the remaining coagulation factors by fluids not containing coagulation factors, consumption of coagulation factors and hyperfibrinolysis. Hypothermia and acidosis are also well described contributors of coagulopathy.Diagnosis of coagulation abnormalities should be based on clinical judgement. Standard coagulation tests are universally available, but there is some evidence, that those tests are not predictive for transfusion requirement. Thrombelastography/ metry is a promising technology which not only shows the initiation of the coagulation process but also the dynamic of clot formation and the clot firmness. It is the golden standard for the diagnosis of hyperfibrinolysis. To restore adequate haemostasis an aggressive treatment of hypothermia and acidosis is essential. The concept of damage control surgery and permissive hypotension in server bleeding patients could reduce the whole amount of blood loss.For coagulation factor replacement therapy fresh frozen plasma, PCC, fibrinogen concentrates and cryoprecipitate could be used. Haematocrit should be maintained in the range of 30% and platelet count should not drop below 50 000/μl. In some circumstances haemostatic agents such as DDAVP, antifibrinolytics and rFVIIa could be helpful, even there is no conclusive evidence for the use of these drugs in severe trauma patients.

Options and hazards of the early appropriate care protocol for trauma patients with major fractures: Towards safe definitive surgery

Injury ◽  
2016 ◽  
Vol 47 (4) ◽  
pp. 787-791 ◽  
Author(s):  
H.C. Pape ◽  
H. Andruszkow ◽  
R. Pfeifer ◽  
F. Hildebrand ◽  
B.M. Barkatali
Keyword(s):  
Trauma Patients ◽  
Appropriate Care ◽  
Care Protocol ◽  
Definitive Surgery ◽  
Early Appropriate Care

In hypothermic major trauma patients the appropriate hospital for damage control and rewarming may be life saving

Injury ◽  
2013 ◽  
Vol 44 (11) ◽  
pp. 1665 ◽  
Author(s):  
Peter Paal ◽  
Douglas J.A. Brown ◽  
Hermann Brugger ◽  
Jeff Boyd
Keyword(s):  
Major Trauma ◽  
Damage Control ◽  
Trauma Patients ◽  
Life Saving

scholarly journals Pediatric Orthopedic Trauma Care During the COVID-19 Pandemic: A Survey of the Pediatric Orthopedic Society of North America

2021 ◽  
pp. 155633162110560
Author(s):  
Mitchell A. Johnson ◽  
Theodore J. Ganley ◽  
Lindsay Crawford ◽  
Ishaan Swarup
Keyword(s):  
North America ◽  
Trauma Care ◽  
Care Delivery ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Fracture Management ◽  
Pediatric Orthopedic ◽  
The Impact

Background: The COVID-19 pandemic has dramatically altered the practice of pediatric orthopedic trauma surgery in both outpatient and inpatient settings. While significant declines in patient volume have been noted, the impact on surgeon decision-making is unclear. Purpose: We sought to investigate changes in pediatric orthopedic trauma care delivery as a result of COVID-19 and determine their implications for future orthopedic practice. Methods: An electronic survey was distributed to all members (N = 1515) of the Pediatric Orthopedic Society of North America (POSNA) in March to April 2021; only members who provided care for pediatric orthopedic trauma patients were asked to complete it. The survey included questions on hospital trauma call, inpatient care, outpatient clinic practice, and 3 unique fracture case scenarios. Results: A total of 147 pediatric orthopedic surgeons completed the survey, for a 9.7% response rate, with 134 (91%) taking trauma call at a hospital as part of their practice. Respondents reported significant differences across institutions regarding COVID-19 testing, hospital rounding, and employee COVID-19 screening. Changes in outpatient fracture management were observed, including a decreased number of follow-up visits for nondisplaced clavicle fractures, distal radius buckle fractures, and toddler’s fractures. Of respondents who changed their fracture follow-up schedules due to COVID-19, over 75% indicated that they would continue these outpatient treatment schedules after the pandemic. Conclusions: This survey found changes in pediatric orthopedic trauma care as a result of the COVID-19 pandemic. The use of telemedicine and abbreviated follow-up practices for common fracture types are likely to persist following the resolution of the COVID-19 pandemic.

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