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Once stabilized, the patient undergoes reexploration and definitive repair of injuries. Damage control resuscitation integrates permissive hypotension, haemostatic resuscitation, and damage control surgery . The optimal strategy for managing hemorrhaging trauma patients is now termed damage control resuscitation (DCR) (Table 1). Define the situations in which “damage control” should be helpful in stabilizing patients. The underlying goal is to abbreviate the initial laparotomy in those patients who would develop hypothermia, acidosis, and an acquired coagulopathy and the associated complications they bring using a more traditional approach. Ann Surg 2016;263(5):1018–1027. Besides the ordinary Airway-Breathing-Circulation (ABC) approach, a correctly placed pelvic C-clamp is an obligatory part of the initial resuscitation of the majority of patients with pelvic fractures and bleeding complications [ 7 ]. Methods: we carried out a prospective study between January 2016 and February 2017, with 46 trauma victims who were submitted to damage control surgery. Damage control surgery has been performed for a wide range of indications, but most frequently for uncontrolled bleeding during elective surgery, haemorrhage from complicated gastroduodenal ulcer disease, generalized peritonitis, acute mesenteric ischaemia and other sources of intra‐abdominal sepsis. The damage control surgery (DCS) in based on a 3-step paradigm: a first intentionally incomplete surgery focused on the control of haemorrhage, a stay in an intensive care unit to correct physiological disorders (acidosis, hypothermia and coagulopathy) and a second surgery for the definitive treatment of lesions. Damage-control surgery, or temporary abdominal closure, is the rapid initial surgical control of contamination and hemorrhage followed by a temporary closure to resuscitate the patient to a normal physiology. Damage control surgery has increased as a popular application in patients with a deteriorated general condition due to a severe trauma incident. The purpose of … Correction of acid base balance 3. The need to establish consensus indications was made clear by a recent meta-analysis reporting over one thousand indications for damage control surgery found throughout the literature [6]. Delayed medical correction of these metabolic derangements leads to an irreversible … I was able to find this list of indications in Godat's 2013 position paper. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Secondary survey of the abdomen: missed injuries at the time of damage control surgery are not uncommon. 2. Crit Care Clin 2004;20(1):101–118. Unlike in trauma patients with massive bleeding, the main aims of the OA … History and Evolution of Damage Control The foundation of damage control surgery (DCS) focuses on exsanguinating truncal trauma. Damage Control Surgery Brett H. Waibel Michael F. Rotondo I. 19. Maintaining the abdomen domain requires a temporary abdominal closure (TAC). 43.5.1 Stage 1: Indications for Damage Control (Patient Selection) Although the evidence is clear that damage control decreases mortality, it can be associated with an increase in morbidity, length of ICU stay, number of surgical procedures and cost; hence overzealous use should be avoided. D R B A S H I R Y U N U S S U R G E R Y R E S I D E N T DAMAGE CONTROL SURGERY 2. One of the most challenging aspects of DC strategy remains identifying which patients should be “damage controlled.” The lethal . The concept of abdominal damage control surgery has two basic components; controlling bleeding and contamination in the abdominal cavity, and leaving the abdomen open, to decompress or facilitate return at planned re-laparotomy. PRACTICE GUIDELINES: DAMAGE CONTROL. Not only do principles of damage control apply to the abdomen, but for many others body regions.10, 11, 12 This study reviewed the physiology of the components of the ‘lethal triad’, the damage control principles and indications, the time of reoperation, as well as the pathophysiology of ACS in trauma patients. There are indications for damage control surgery, for example absolute indications and relative indications; however, it is better not to wait for indications. Damage control surgery indications and current evidence data-base. Damage control surgery 1. Penninga et al. Crossref, Medline, Google Scholar; 10. Indications for damage control surgery. Indications for Damage Control Surgery. Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study. The DCS has become a standard approach in trauma care only on the basis of clinical experiences and observations. OBJECTIVES: To characterize and evaluate indications for use of damage control (DC) surgery in civilian trauma patients. A small study on penetrating abdominal injuries showed a survival benefit over historical controls(90% v 58%; … Restoration of gastrointestinal and vascular continuity if necessary. Coagulopathy is common in patients with haemorrhagic shock. Schreiber MA. Keywords: damage control, diverticular disease, diverticulitis, open abdomen, surgery. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. INDICATIONS FOR DEFINITIVE SURGERY 1. 4. OBJECTIVE: Define the technique and expectations of “damage control” used in the operating room to temporarily control life-threatening injuries. Patients usually present with shock physiology and metabolic derangements including acidosis, hypothermia, and coagulopathy. It consists of three steps: abbreviated surgery to control … Damage control was based on the recognition of the lethal triad of hypothermia, acidosis, and a coagulopathy resulting from massive blood loss, large-volume resuscitation and ischemia-reperfusion. METHODS: we carried out a prospective study between January 2016 and February 2017, with 46 trauma victims who were submitted to damage control surgery. They include the broad and complex area, from damage control to liver resection. Coagulopathy observed in trauma patients was thought to be a resuscitation-associated phenomenon. Crossref, Medline, Google Scholar; 11. Absolute indications include the following: Acidosis, where the pH is less than 7.2. DCR involves haemostatic resuscitation, permissive hypotension (where appropriate) and damage control surgery The underpinning for damage control is that a traditional operative approach risks physiologic exhaustion, and an abbreviated initial operation controlling only hemorrhage and contamination and … Damage control surgery is considered by many surgeons as one of the most significant advances in the last 2 decades in the care of trauma or other surgical patients with severe hemorrhage, which cannot easily be controlled by other techniques. Normalization of coagulation profile. Objective: to analyze the surgeons' subjective indications for damage control surgery, correlating with objective data about the patients' physiological state at the time the surgery was chosen. [1–25] Damage control resuscitation seeks to minimize blood loss until definitive hemostasis is achieved. described the damage control concept and discussed, in a literature review, indications for damage control surgery. As mentioned earlier, DCS can play a vital role in the setting of the “lethal triad” and thus metabolic acidosis (pH <7.2), hypothermia (<34°C), and coagulopathy (prolonged activated partial thromboplastin time and prothrombin time > two times normal) constitute absolute indications for DCS. Aspects of DC strategy remains identifying which patients should be taken early DC surgery., where the pH is less than 7.2 patients when utilized in appropriate scenarios a review. A deteriorated general condition due to a severe trauma incident results: the main indications for damage control in... 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