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Rationale
- Severe trauma is associated with severe bleeding, coagulopathy, acidosis
and hypothermia
- Both acidosis and hypothermia exacerbate coagulopathy resulting in
increased bleeding
- Hypovolaemia will exacerbate acidosis
- Blood transfusion will exacerbate hypothermia and coagulopathy
- Laparotomy is associated with considerable heat loss and both acidosis
and hypothermia are difficult to correct intra-operatively
- Prolonged attempts at definitive repair of injuries may, therefore,
result in a patient entering a downward spiral of progressive bleeding
- Aim of damage control surgery is to:
- stop bleeding
- provide simple closure of hollow viscera perforation
Components
- stop bleeding, close perforations
- continue resuscitation with an emphasis on correction of coagulopathy,
acidosis and hypothermia
- planned re-operation for definitive repair
Indications
Recommended for severely injured patient with:
- severe haemorrhagic shock
- signs of on-going bleeding
- coagulopathy
- hypothermia
- acidosis
- inaccessible major anatomic injury
- need for time-consuming procedures
- concomitant major injury
ICU management
- continue resuscitation with an emphasis on correction of coagulopathy,
acidosis and hypothermia
- monitor for development of complications. High risk of abdominal
compartment syndrome
Emergency re-operation
Indications:
- massive on-going bleeding (eg >2 units per hour for 3 hours,
particularly in a warm non-coagulopathic patient)
- evidence of bowel leak or ischaemic organ
- abdominal compartment syndrome (risks of profuse bleeding from loss of
tamponade effect must be weighed against risks of continued intra-abdominal
hypertension)
Futher reading
Spahn DR et al.
Management of bleeding following major trauma: a European guideline. Crit Care,
2007; 11:R17
Sagraves
SG et al. Damage control surgery - the Intensivist's role. J Intensive Care Med,
2006; 21:5-16
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