Damage control surgery
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2002, Vol 19, Issue 3
Abstract
During the past 20 years, it gradually became apparent that the results of prolonged and extensive surgical procedures in the critically injured patient were often poor, even in experienced hands. The triad of hypothermia, coagulopathy and metabolic acidosis effectively marks the limit of the patient’s ability to cope with the physiological consequences of injury. Crossing this limit will frustrate even the most technically successful repair. These observations led to the development of a new surgical strategy that sacrifices the completeness of the immediate repair, in an effort to adequately address the combined physiological impact of trauma and surgery. This approach is unfolded in three phases. During the initial operation, the surgeon does only the absolute minimum necessary to control exsanguination rapidly and to prevent spillage of intestinal content and urine into the peritoneal cavity. Packing is the traditional method for the management of major liver injuries. Examples of simple techniques applied to buy time, besides packing, include temporary closure or exteriorization of the lumen of the injured bowel without resection, tying off or rapid exteriorization of an injured ureter, and balloon tamponade of bleeding cavities or inaccessible vessels. Some patients continue to bleed after surgery, necessitating a decision about the feasibility of re exploration, while in others, increased intra abdominal pressure impairs ventilation and renal function, requiring immediate decompression. The second phase consists of secondary resuscitation in the intensive care unit, under complete ventilatory support, characterized by maximization of hemodynamics, correction of coagulopathy and rewarming. During the third phase, the intraabdominal packing is removed and definitive repair of abdominal injuries is performed. The “damage control” concept has been shown to decrease overall mortality and morbidity and its success is like ly to modify significantly the management of the critically injured patient.
Authors and Affiliations
G. KOURAKLIS, C. VAGIANOS
Keywords
Related Articles
- EP ID EP133965
- DOI -
- Views 84
- Downloads 0
SLE – vasculitis – cold hemagglutinin disease (CHAD)
Laboratory tests were as follows: Hct=21.3%, Hb=6.1 g/dL, WBC=2,800/μL (neutrophils 38%, lymphocytes 50%, monocytes 12%), reticulocytes=6.1% and platelets=144.000/μL. Peripheral blood smears is shown in figures 2 an...
Intraosseus skull hematoma
No abstract available
Διοίκηση συστήματος υπηρεσιών υγείας στο δημόσιο τομέα με βάση τις προσδοκίες των χρηστών
Η ποιότητα αποτελεί μια πολυδιάστατη έννοια με πολλαπλές συνέπειες για τον τρόπο λειτουργίας και διοίκησης των υπηρεσιών υγείας. Η σύγχρονη αντίληψη για τη διοίκηση της ποιότητας στην υγεία διευρύνεται πέρα από τις εσωτε...
Right ovary-containing hernia
No abstract available
Buccal metastases and lung cancer - a case report
The case is presented of a 68-year-old man with a lung adenocarcinoma, with buccal and cutaneous metastases, which subsided after a chemotherapy regime combining a platinum derivative and paclitaxel. Follow-up of 12 mont...