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Damage Control RESUS

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Damage control resuscitation technique explained in easy way.

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Damage Control RESUS

  1. 1. DCR: DAMAGE CONTROL RESUSCITATION BY Dr. Valerio Pisano Brasca MD.
  2. 2. TECHNIQUE EFFECTIVE IN MANAGEMENT OF BLEEDING TRAUMA
  3. 3. LETHAL TRIAD OR LETHAL CIRCLE - COAGULOPATHY OF TRAUMA -ACIDOSIS -HYPOTHERMIA
  4. 4. DAMAGE CONTROL RESUSCITATION 1) HAEMOSTATIC RESUSCITATION 2)PERMISSIVE HYPOTENSION 3)DAMAGE CONTROL SURGERY
  5. 5. HAEMOSTATIC RESUSCITATION “FIND THE BLEEDING, STOP THE BLEEDING” - DIRECT PRESSURE AND ELEVATION -HAEMOSTATIC DRESSING -TOURNIQUETS -REDUCE AND SPLINT LONG BONES AND PELVIC FRACTURES - SEARCH HELP OF SURGEON ASAP FOR CLOSED BLEEDING WOUNDS
  6. 6. BLOOD PRODUCTS ASAP IN A RATIO OF 1:1:1 (1 U PCRB:1 U PLASMA: 1 U PLATELETS) ACHIEVE THIS RATIO WITHIN 6 HOURS
  7. 7. TRANEXAMIC ACID 1g IV OVER 10 MINS, 1g IV OVER 8 HOURS FIBRINOGEN 1U EVERY 10 KG OF WEIGHT
  8. 8. permissive hypotension “…. Injectionof a fluid that increase blood pressure has dangers in itself…. If the pressure is raised before the surgeon is ready to check any bleeding that might place, blood that is sorely needed maybe lost.” Cit. Walter Cannon, 1918
  9. 9. PERMISSIVE HYPOTENSION - Allow SBP to fall low enough to avoid exanguination but keep high enough to maintain perfusion. - Goal is to avoid disruption of unstable clot by higher pressure and worsening bleeding. -avoid cyclic over-resuscitation that can lead to rebleeding. - Low BP is not the target; is a compromise pending emergency surgical intervention; - The target IS Haemorragy control (Haemostasis and Surgery)
  10. 10. PERMISSIVE HYPOTENSION SBP GOALS IN PERMISSIVE HYPOTENSION APPROACH: - PENETRATING INJURIES AND CLOSED BLEEDING TRAUMA INJURIES: 80-90 mmHg - IF ASSOCIATED TBI:100 mmHg -IF ISOLATED TBI: 110 mmHg
  11. 11. PERMISSIVE HYPOTENSION PALPABLE RADIAL PULSE: SBP OVER 80 mmHg PALPABLE FEMORAL PULSE: SBP 70-80 mmHg PALPABLE CAROTID PULSE:SBP 60-70 mmHg
  12. 12. DAMAGE CONTROL SURGERY DAMAGE CONTROL SURGERY REFERS TO LIMITED SURGICAL INTERVENTIONS THAT SERVE TO CONTROL HAEMORRAGE AND MINIMIZE CONTAMINATION UNTIL PATIENT HAS SUFFICIENT PHYSIOLOGICAL RESERVE TO UNDERGO DEFINITIVE INTERVENTIONS. THIS STRATEGY AIMS TO BRING THE “LETHAL TRIAD” UNDER CONTROL, SO THAT THE PATIENT WILL BE ABLE TO TOLERATE FURTHER SURGERY ONCE HE OR SHE IMPROVES.
  13. 13. BULLET POINTS AIM OF DCS: KEEP UNDER CONTROL LETHAL TRIAD UNTIL DEFINITIVE TREATMENT. PERMISSIVE HYPOTENSION: RISE SBP WITH FLUID AND/OR BLOOD PRODUCTS TO A MINIMUM STANDARD TO AVOID PERPETRATION OF HAEMORRAGE BUT ALSO GUARANTEE PERFUSION OF VITAL ORGANS. HAEMOSTATIC RESUSCITATION: - FIND THE BLEEDING, STOP THE BLEEDING. - RESUSCITATE WITH BLOOD PRODUCTS ASAP TO AVOID DETRIMENTAL EFFECTS OF USE OF LARGE AMOUNT OF CRISTALLOIDS. - USE BLOOD PRODUCTS RATIO OF 1PBRC:1FFP:1PLT (TO BE ACHIEVED BY 6 HOURS). DAMAGE CONTROL SURGERY: LIMITED SURGICAL INTERVENTIONS THAT SERVE TO CONTROL HAEMORRAGE AND MINIMIZE CONTAMINATION UNTIL PATIENT HAS SUFFICIENT PHYSIOLOGICAL RESERVE TO UNDERGO DEFINITIVE INTERVENTIONS.
  14. 14. FIN

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