Coagulopathy, hypothermia and acidosis in trauma patients: the rationale for damage control surgery.
ABSTRACT Severe trauma to the torso or extremities often results in significant hemorrhage, which contributes to morbidity and mortality. The pathophysiological mechanisms contributing to this traumatic blood loss are complex. We review its major components: coagulopathy, acidosis and hypothermia, which have led to the concept of damage control surgery.
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ABSTRACT: The Forward Army Surgical Team (FST) was designed to provide surgical capability far forward on the battlefield to stabilize and resuscitate those soldiers with life and limb threatening injuries. Operation Iraqi Freedom represents the largest military operation in which the FST concept of health care delivery has been employed. The purpose of our review is to describe the experience of the 555FST during the assault phase of Operation Iraqi Freedom. During the 23 days beginning 21 March 2003, data on all patients seen by the 555 FST were recorded. These data included combatant status, injuries according to anatomic location, and operative procedures performed. During the twenty-three day period, the 555 FST evaluated 154 patients. There were 52 EPWs, 79 U.S. soldiers, and 23 Iraqi civilians treated. Injuries to the lower extremity and chest (48% and 25%) were the most common in the EPW group. Upper extremity and lower extremity injuries were the most common in the civilian (57% and 39%) and U.S. soldier groups (32% and 30%). The number of injured regions per patient were 1.14 for U.S. soldiers, 1.33 for EPWs, and 1.52 for Iraqi civilians (p < 0.003). EPWs had proportionately more thoracic and abdominal injuries than the other groups (p < 0.05). Majority of the life threatening injuries evaluated involved EPWs. A combination of body armor and armored vehicles used by U.S. soldiers limited the number of torso injuries presenting to the FST. Early resuscitation and stabilization of U.S. soldiers, EPWs, and civilians can be successfully accomplished at the front lines by FSTs. Further modification of the FST's equipment will be needed to improve its ability in providing far forward surgical care.The Journal of trauma 08/2004; 57(2):201-7. DOI:10.1097/01.TA.0000133638.30269.38 · 2.96 Impact Factor
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ABSTRACT: SIMEONOVA, G. P., D. N. DINEV, I. I. TODOROVA: Influence of hypothermia and acidosis upon some indices of blood coagulation in three schemes of anaesthesia in dogs. Vet. arhiv 75, 233-242, 2005. ABSTRACT The aim of the present study was to investigate the influence of hypothermia and acidosis on blood coagulation in different anaesthesia protocols. Our experiment was performed with 28 dogs, divided into four groups: three experimental submitted to inhalation, balanced, and epidural anaesthesia and one control. In all animals blood pH, core body temperature and some principal parameters of blood coagulation (platelet count, activated partial prothrombine time-APPT, prothrombine time-PT and plasma fibrinogen concentrations) were investigated. The dynamics included five periods; prior to anaesthesia (0 th minute), at the time of pre-medication (30 th minute), during deep anaesthesia (120 th minute), after recovery (about 140 th minute), and on the next day (24 th hour). The results indicated that the most significant were changes in balanced anaesthesia. APPT was shortened after recovery from balanced anaesthesia (14.1 ± 0.9 seconds, P<0.05) and on the next day (14.5 ± 0.7, P<0.05) compared to the initial value (16.1 ± 0.5). The most pronounced acidosis in this group was recorded during deep anaesthesia (7.126 ± 0.041, P<0.001) and after recovery (7.241 ± 0.028, P<0.05) by comparison with the baseline (7.312 ± 0.008). Parameters of blood coagulation in inhalation anaesthesia group were unchanged. Statistically significant alterations in blood pH were observed only during the deep anaesthesia stage (7.199 ± 0.049, P<0.01) compared to the beginning (7.316 ± 0.006). Epidural anaesthesia did not result in blood pH and coagulation changes. In this group an increase in fibrinogen concentrations at 24 th hour (3.7 ± 0.2, P<0.05) were found, compared to the baseline (3.1 ± 0.2), which was probably due to the intervention. In the three groups the core body temperature was decreased at the 120 th minute and 140 th minute. In conclusion, balanced anaesthesia activated blood coagulation at the 140 th minute and 24 th hour, which was manifested by a shortening in APPT at these periods. Hypothermia and acidosis accompanying balanced and inhalation anaesthesia groups, as well as hypothermia in epidural anaesthesia had no influence upon blood coagulation parameters.