De Waele JJ, Vermassen FE. Coagulopathy, hypothermia and acidosis in trauma patients: the rationale for damage control surgery

Department of Surgery, Universitair Ziekenhuis Ghent, Gand, Flanders, Belgium
Acta chirurgica Belgica (Impact Factor: 0.41). 11/2002; 102(5):313-6.
Source: PubMed


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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    • "Hirschberg et al mentioned high observed rates of multiple organ failure in patients surviving the initial 24 hours after their injuries [23]. These processes seem to be initiated by cascading events resulting from blood loss and inflammatory release leading to a 'vicious circle' of shock, hypothermia, acidosis and coagulopathy resulting in end organ failure [24]. Delayed referral from the contaminated and austere surroundings of a mass disaster means that the patient has already sustained a 'second hit' in terms of the delay. "
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    ABSTRACT: Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality. We studied the damage control modality in the management of polytrauma cases with orthopaedic injuries who had been referred to our hospital after more than 24 hours of sustaining their injuries in an earthquake. This study was conducted on 51 cases after reviewing their records and complete management one year after the trauma. At one year, out of the 62 fractures, 3 were still under treatment, while the others had united. As per the radiological and functional scoring there were 20 excellent, 29 good, 5 fair and 5 poor results. In spite of the delayed referral there was no mortality. In situations of delayed referral in areas where composite trauma centers do not exist the damage control modality provides an acceptable method of treatment in the management of polytrauma cases.
    Full-text · Article · Feb 2008 · Journal of Trauma Management & Outcomes
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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.
    No preview · Article · Aug 2004 · The Journal of trauma
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