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28 - Damage Control in Severe Trauma

Published online by Cambridge University Press:  18 January 2010

By
Michael J. A. Parr  and
Ulrike Buehner
Edited by
Charles E. Smith
Michael J. A. Parr
Affiliation:
Department of Intensive Care, Liverpool Hospital, University of New South Wales, Sydney, Australia
Ulrike Buehner
Affiliation:
Anesthetic Department, St James's University Hospital, Leeds, United Kingdom
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Understand concept of damage control surgery (DCS).

  2. Understand that reversal of lethal triad requires aggressive intervention for improved outcome.

  3. Understand staged physiological restoration (four stages).

SUMMARY

The management of the multiply injured patient has been revolutionized during the past century. Advances in prehospital care, resuscitation, interventional radiology, and intensive care medicine have all contributed to better trauma outcomes. The damage control process of abbreviated laparotomy with rapid control of hemorrhage and contamination has proved to be effective to combat the physiologic failure associated with severe blunt and penetrating injury.

This chapter reviews some of the key issues of damage control surgery, highlighting the importance of a multidisciplinary team approach to optimize trauma patient management.

INTRODUCTION

Damage control surgery (DCS) is abbreviated surgery performed on selected critically injured patients. Definitive operative management is accomplished in a stepwise fashion based on the patient's physiologic tolerance; the objective is to gain time to stabilize the severely traumatized patient and to optimize their physiologic state before definitive repair. Rather than restoring anatomic integrity, the rationale for DCS is to minimize the metabolic insults of coagulopathy, hypothermia, and acidosis. Each of these three factors tends to exacerbate the others and interact to produce a downward metabolic spiral: the bloody vicious cycle [36]. The concept of DCS originally emerged from collective experience with major abdominal injuries. Over the past decade, however, other surgical subspecialties have adopted the DCS concept success-fully.

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Trauma Anesthesia , pp. 431 - 444
Publisher: Cambridge University Press
Print publication year: 2008

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  • Damage Control in Severe Trauma
    • By Michael J. A. Parr, Department of Intensive Care, Liverpool Hospital, University of New South Wales, Sydney, Australia, Ulrike Buehner, Anesthetic Department, St James's University Hospital, Leeds, United Kingdom
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.031
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  • Damage Control in Severe Trauma
    • By Michael J. A. Parr, Department of Intensive Care, Liverpool Hospital, University of New South Wales, Sydney, Australia, Ulrike Buehner, Anesthetic Department, St James's University Hospital, Leeds, United Kingdom
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.031
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  • Damage Control in Severe Trauma
    • By Michael J. A. Parr, Department of Intensive Care, Liverpool Hospital, University of New South Wales, Sydney, Australia, Ulrike Buehner, Anesthetic Department, St James's University Hospital, Leeds, United Kingdom
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.031
Available formats
×