Damage control surgery: Difference between revisions
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'''Damage control surgery''' is a relatively recent approach to the surgical component of [[trauma medicine]], which focuses on doing "just enough" surgery to stabilize the patient before the [[lethal triad]] of [[trauma induced coagulopathy]], [[hypothermia]], and [[metabolic acidosis]]. The components of the lethal triad are metabolic rather than [[trauma (physical)]] that require definitive repair. It has been defined as "the rapid initial control of hemorrhage and contamination, temporary closure, resuscitation to normal physiology in the [[intensive care unit|ICU]], and subsequent re-exploration and definitive repair."<ref>{{citation | '''Damage control surgery''' is a relatively recent approach to the surgical component of [[trauma medicine]], which focuses on doing "just enough" surgery to stabilize the patient before the [[lethal triad]] of [[trauma induced coagulopathy]], [[hypothermia]], and [[metabolic acidosis]]. The components of the lethal triad are metabolic rather than [[trauma (physical)]] that require definitive repair. It has been defined as "the rapid initial control of hemorrhage and contamination, temporary closure, resuscitation to normal physiology in the [[intensive care unit|ICU]], and subsequent re-exploration and definitive repair."<ref>{{citation | ||
| title = Emergency war surgery' | | title = Emergency war surgery' | ||
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<center>"The modern operation is safe for the patient. The modern surgeon must make the patient safe for the modern operation" - ''Lord Moynihan''</center> | <center>"The modern operation is safe for the patient. The modern surgeon must make the patient safe for the modern operation" - ''Lord Moynihan''</center> | ||
Its basic | Its basic premise is that patients with multisystem trauma can only be submitted to enough surgery, at one time, for "control of hemorrhage, prevention of contamination and protection from further injury," without making the metabolic disorders worse. Trauma surgeons now routinely split what had been one lengthy procedure in many, then turning to [[critical care|surgical critical care]] to prepare for the next procedure. Damage control surgery first was widely used when 9mm gunshot wounds became common in civilian practice, inflicting damage that had previously been associated with battlefield weapons. The surgical approach then moved to Iraq and Afghanistan, and a new generation then came back for civilian use.<ref>{{citation | ||
| journal = CMAJ | | journal = CMAJ | ||
| url = http://www.cmaj.ca/cgi/content/full/175/7/727 | | url = http://www.cmaj.ca/cgi/content/full/175/7/727 | ||
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| author = Janet Brooks | | author = Janet Brooks | ||
| date = 26 September 2006 | volume= 175 | issue = 7 | doi=10.1503/cmaj.061095.}}</ref> | | date = 26 September 2006 | volume= 175 | issue = 7 | doi=10.1503/cmaj.061095.}}</ref> | ||
==Organizing for DCS== | |||
==Supporting normal coagulation== | |||
<ref>{{citation | |||
| url = http://www.google.com/url?sa=t&source=web&cd=25&ved=0CCkQFjAEOBQ&url=http%3A%2F%2Fwww.transfusion.com.au%2Fadmin%2Ffile%2Fcontent13%2Fc6%2F6%2520May%25206%2520-%2520Sandy%2520Zalstein.pdf&ei=SgssTNroPML58AaD5KmjDg&usg=AFQjCNHnWJ6t0qftanDXgPi8ogfYrAqNWA | |||
| Massive Transfusion Protocols that support Damage Control Surgery: A new dimension in critical care haematology | |||
| journal = ARCBS Transfusion Update 2008 | |||
| date = 6 May 2008 | author = Sandy Zalstein}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 22:34, 30 June 2010
Damage control surgery is a relatively recent approach to the surgical component of trauma medicine, which focuses on doing "just enough" surgery to stabilize the patient before the lethal triad of trauma induced coagulopathy, hypothermia, and metabolic acidosis. The components of the lethal triad are metabolic rather than trauma (physical) that require definitive repair. It has been defined as "the rapid initial control of hemorrhage and contamination, temporary closure, resuscitation to normal physiology in the ICU, and subsequent re-exploration and definitive repair."[1] As of 2010, while DCS is increasingly the practice among trauma surgeons, a Cochrane Review did not find enough evidence that it was definitively superior to conventional abdominal surgery, but also observed they found no randomized controlled trials for definitive comparison. [2]
Its basic premise is that patients with multisystem trauma can only be submitted to enough surgery, at one time, for "control of hemorrhage, prevention of contamination and protection from further injury," without making the metabolic disorders worse. Trauma surgeons now routinely split what had been one lengthy procedure in many, then turning to surgical critical care to prepare for the next procedure. Damage control surgery first was widely used when 9mm gunshot wounds became common in civilian practice, inflicting damage that had previously been associated with battlefield weapons. The surgical approach then moved to Iraq and Afghanistan, and a new generation then came back for civilian use.[3]
Organizing for DCS
Supporting normal coagulation
References
- ↑ Dave Ed. Lounsbury, ed. (2004), Chapter 12, Damage Control Surgery, Emergency war surgery' (3rd U.S. revision ed.), U.S. Department of Defense, p. 12-1
- ↑ Cirocchi R, Abraha I, Montedori A, Farinella E, Bonacini I, Tagliabue L, Sciannameo F. D (2010), "Damage control surgery for abdominal trauma", Cochrane Database of Systematic Reviews, DOI:10.1002/14651858.CD007438.pub2
- ↑ Janet Brooks (26 September 2006), ""Damage control" surgery techniques used on soldiers", CMAJ 175 (7), DOI:10.1503/cmaj.061095.
- ↑ Sandy Zalstein (6 May 2008), ARCBS Transfusion Update 2008