scholarly journals Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach

2015 ◽  
Vol 4 (2) ◽  
pp. 87-95 ◽  
Author(s):  
Newton Djin Mori ◽  
Frederico José Ribeiro Teixeira Jr ◽  
Sérgio Dias do Couto Netto ◽  
Francisco Salles Collet e Silva ◽  
Belchor Fontes ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Saline Solution ◽  
Bone Fractures ◽  
Damage Control ◽  
Treatment Protocol ◽  
Perineal Wound ◽  
Trauma Patients ◽  
Visceral Injury ◽  
Control Approach ◽  
Perineal Injuries

ABSTRACT Purpose In a previous work, we presented a protocol for the management of patients with complex pelviperineal injuries (CPI) resulting from blunt trauma. This treatment protocol included: early hemorrhage control, surgical debridement of devitalized tissue, selective loop transverse colostomy according to the location of the perineal wound, distal colonic irrigation with saline solution, pulsatile saline solution irrigation of the perineal wound, maintenance of the perineal wound open, management of bone fractures and visceral injuries, surgical revisions at intervals of 24 to 48 hours, presumptive antibiotic therapy, early nutritional support, and definitive repair of wound defect and visceral injuries after infection control and metabolic recovery. In order to determine whether the evolution of the authors's protocol for the assessment and management of patients with CPI is associated with improved patient outcome we conduct this review. Materials and methods The medical records of 42 patients with CPI resulting from blunt trauma admitted in the level I trauma center at the HC-USPSM, were reviewed. Demographic data, mechanism of trauma, revised trauma score (RTS) and injury severity score (ISS), classification of perineal injuries, associated systemic trauma, infection complications and mortality rates (overall, early and late) were collected. Results The early mortality was 19% and the late mortality was 17%. The overall mortality was 36%. Patients who died had higher average ISS (average ISS = 45) comparing to patients who survived (average ISS = 25) with significant statistical difference (p < 0.05). Damage control principles applied to CPI was the standard of care and a selective approach to perform fecal stream diversion were used. Conclusion The results of this study showed that the use of this protocol was effective and reinforced the importance of the priority in early control of hemorrhage, early fecal diversion in selected cases, multiple surgical perineal revisions, and avoidance of complex visceral injury repair at the first surgical intervention. How to cite this article Teixeira Jr FJR, do Couto Netto SD, Collete e Silva FS, Mori ND, Fontes B, Poggetti RS, Birolini D, Bernini CO, Utiyama EM. Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach. Panam J Trauma Crit Care Emerg Surg 2015;4(2):87-95.

scholarly journals Damage control surgery: it's evolution over the last 20 years

2012 ◽  
Vol 39 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Brett H Waibel ◽  
Michael MF Rotondo
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Primary Treatment ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Visceral Injury ◽  
Core Concepts ◽  
Life Threatening ◽  
Surgical Conditions ◽  
Original Application

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics. A host of new resuscitation strategies and technologies have been developed over the past two decades, from permissive hypotension and damage control resuscitation to advanced ventilators and hemostatic agents, which have allowed for a more focused resuscitation, allowing some of the morbidity of this model to be reduced. The combination of the simple, malleable paradigm along with better understanding of resuscitation has proven to be a potent blend. As such, what was once an almost lethal injury (combined vascular and visceral injury) has become a survivable one.

scholarly journals Damage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm

2021 ◽  
Vol 52 (2) ◽  
pp. e4164800
Author(s):  
Michael W Parra ◽  
Carlos Alberto Ordoñez ◽  
David Mejia ◽  
Yaset Caicedo ◽  
Javier Mauricio Lobato ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Damage Control ◽  
Aortic Pressure ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Algorithmic Approach ◽  
Control Approach ◽  
Neurogenic Shock ◽  
Cord Injury ◽  
Prolonged Hypotension

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is commonly used as an adjunct to resuscitation and bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It has also been performed for patients with neurogenic shock to support the central aortic pressure necessary for cerebral, coronary and spinal cord perfusion. Although volume replacement and vasopressors are the cornerstones of the management of neurogenic shock, we believe that a REBOA can be used as an adjunct in carefully selected cases to prevent prolonged hypotension and the risk of further anoxic spinal cord injury. This manuscript aims to propose a new damage control algorithmic approach to refractory neurogenic shock that includes the use of a REBOA in Zone 3. There are still unanswered questions on spinal cord perfusion and functional outcomes using a REBOA in Zone 3 in trauma patients with refractory neurogenic shock. However, we believe that its use in these case scenarios can be beneficial to the overall outcome of these patients.

scholarly journals Epidemiological evaluation of hepatic trauma victims undergoing surgery

2016 ◽  
Vol 43 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Mitre Kalil ◽  
Isaac Massaud Amim Amaral
Keyword(s):  
Blunt Trauma ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Metropolitan Region ◽  
Trauma Patients ◽  
Hepatic Trauma ◽  
Female Ratio ◽  
Packed Red Blood Cells

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

scholarly journals Features of treatment of victims of the terrorist attack in St. Petersburg metro (03.4.2017) with severe explosive injuries

2019 ◽  
pp. 47-58
Author(s):  
A. N. Tulupov ◽  
I. V. Kazhanov ◽  
V. A. Manukovskiy ◽  
A. V. Nikitin
Keyword(s):  
Soft Tissues ◽  
Bone Fractures ◽  
Terrorist Attack ◽  
Damage Control ◽  
The Body ◽  
Trauma Centers ◽  
Severe Injuries ◽  
Golden Hour ◽  
Control Approach ◽  
Level I

Relevance.The realities of modern life do not exclude the risks of terrorist attacks. During explosion, heterogeneous factors simultaneously affect the body, thus involving organs and systems in various combinations in the pathological process.Intention.To analyze results of the treatment of victims with severe explosive wounds resulted from the terrorist attack of April 3, 2017 in the train car of the St. Petersburg metro.Methodology.As a result of the terrorist attack, 10 passengers and the terrorist himself died on the spot, 102 people were recognized as victims. On April 4, 2017, 57 wounded were admitted to the city hospitals, of which four did not survive. Twenty five wounded in the terrorist attack in the St. Petersburg metro car were admitted to the St. Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze within the “golden hour”. In 15 of them, injuries were combined with surface thermal burns.Results and Discussion.Five cases with the most severe injuries are described. It was established that multifactorial, combined and multiple of injuries were typical for this pathology. Most victims had severe cranial-brain trauma, shrapnel wounds of soft tissues and gunshot bone fractures. Specialized medical care at the Level I Trauma Centers was characterized by simultaneous admission of several seriously injured, the need to organize several surgical teams, Damage control approach, multidisciplinary and a long-term, multi-stage and very expensive treatment with the participation of surgeons and doctors of various specialties.Conclusion.To achieve the best results, victims with severe explosive injuries should be sent as soon as possible to the Level I Trauma Centers, where up-to-date treatment and diagnostic technologies (spiral-computed tomography, magnetic resonance imaging, angiography, selective arterial embolization, computerized 3D modeling, etc.) and comprehensive rehabilitation measures are available.

scholarly journals Damage control surgery (DCS) in the management of maxillofacial bomb blast patients during the Yemen civil conflict. Neighboring Level 1 trauma hospital experience

2021 ◽  
Vol 6 ◽  
pp. 247275122110383
Author(s):  
John Spencer Daniels ◽  
Ibrahim Albakry ◽  
Ramat Oyebunmi Braimah ◽  
Mohammed Ismail Samara ◽  
Rabea Arafa Albalasi ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Damage Control ◽  
Maxillofacial Surgery ◽  
Treatment Protocol ◽  
Damage Control Surgery ◽  
Civil Conflict ◽  
Oral And Maxillofacial Surgery ◽  
Blast Injuries ◽  
Treatment Protocols ◽  
Definitive Surgery

Study design: Application of Damage Control Surgery (DCS) in Oral and maxillofacial surgery is still evolving, therefore, the current study hopes to share our experience in the management of bomb blast patients. Objectives: The objectives of the current study is to share our experience in the management of maxillofacial bomb blast injuries emphasizing on DCS. Methods: This was a retrospective study of combatant Yemeni war patients who were transported across the border from Yemen and treated in Najran, Kingdom of Saudi Arabia from December 2015 to December 2019. Information such as etiology of injury, age, zone of injury and mechanisms of bomb blast associated injuries, treatment protocol and complications. The treatment protocols adopted include; DCS in which exploration to control soft tissue bleeding was done and when bone bleeding could not be controlled, immediate reduction and osteosynthesis of bone fractures was carried out. Early Definitive Surgery (EDS) was done in patients that were hemodynamically stable with open reduction and internal fixation (ORIF) of all facial bone fractures. Closed reduction and fixation were done with the use of arch bars while in conservative approach, patients were placed only on soft diet. Data was stored and analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp). Results: A total of 235 (57.6%) patients sustained bomb blast injuries from the 408 war casualties. Other patients (42.4%) sustained other types of injuries. All the patients were males. Their ages ranged from 21 to 53 years with mean (SD) at 27.3 (5.6) years. DCS was carried out in a large proportion of the patients totaling 78 (33.2%) patients, while EDS was carried out in 58 (24.7%) hemodynamically stable patients. ORIF was the main treatment modality for the fractures in 136 (57.9%) of the patients. Conclusion: The result of the study showed a large proportion of the patients were managed with DCS. DCS should be seen as a strategy in stabilizing the patients before definitive surgery is performed.

Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

2020 ◽  
Author(s):  
Joshua Ewy ◽  
Martin Piazza ◽  
Brian Thorp ◽  
Michael Phillips ◽  
Carolyn Quinsey
Keyword(s):  
At Risk ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Pediatric Trauma ◽  
Ct Scans ◽  
Trauma Patients ◽  
Cranial Ct

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

Sign in / Sign up

Export Citation Format

Share Document