Damage Control in Trauma by Brohi

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Damage control strategies. Karim Brohi outlines the critical concepts for the managment of the actively bleeding patient.

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  • Newham staff trained with Royal London staff. Rapidly identify cardiac injury. Call for transfer.
  • Damage Control in Trauma by Brohi

    1. 1. DAMAGE CONTROL RESUSCITATION Centre for Trauma Sciences Queen Mary University of London www.c4ts.qmul.ac.uk Royal London Major Trauma Centre Barts Health NHS Trust KARIM BROHI, FRCS FRCA Professor of Trauma Sciences, QMUL
    2. 2. National Trauma Haemorrhage Mortality Rates
    3. 3. 43%
    4. 4. 0 10 20 30 40 50 60 70 ISS > 15 ISS > 24Injury Severity Score Mortality(%) RLH MSH CH * * Comparative Mortality
    5. 5. Damage Control Resuscitation
    6. 6. Damage Control Resuscitation MAINTAIN HAEMOSTATIC COMPETENCE
    7. 7. Damage Control Resuscitation 1. Early haemorrhage control (DCS) 2. Permissive hypotension 3. Limit fluid infusions (dilution) 4. Target coagulopathy
    8. 8. Damage Control Resuscitation 1. Early haemorrhage control (DCS) 2. Permissive hypotension 3. Limit fluid infusions (dilution) 4. Target coagulopathy
    9. 9. Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
    10. 10. Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs. Haemorrhage Control
    11. 11. Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs. Haemorrhage Control Manage Sepsis Protect from further injury
    12. 12. Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs. Restoration of Physiology (ICU)
    13. 13. What is it really?
    14. 14. FAILURE:
    15. 15. FAILURE: to maintain homeostasis
    16. 16. FAILURE: to protect cells, tissues & organs
    17. 17. FAILURE: to preserve endothelial integrity
    18. 18. What’s bad about DCS?
    19. 19. Damage Control Resuscitation 1. Early haemorrhage control (DCS) 2. Permissive hypotension 3. Limit fluid infusions (dilution) 4. Target coagulopathy
    20. 20. Damage Control Resuscitation 1. Early haemorrhage control (DCS) 2. Permissive hypotension 3. Limit fluid infusions (dilution) 4. Target coagulopathy
    21. 21. Trauma Hemorrhage Shock ATC TRAUMA-INDUCED COAGULOPATHY (TIC)
    22. 22. Trauma Hemorrhage Genetics Shock Fibrinolysis Inflammation Hypothermia Acidemia Loss, Dilution ATC TRAUMA-INDUCED COAGULOPATHY (TIC)
    23. 23. 750 ml crystalloid 1U PRBC
    24. 24. 750 ml crystalloid 4U PRBC 2 FFP
    25. 25. 4500 ml crystalloid 500 colloid 8U PRBC 7U FFP 1 PLT, 2 CRYO
    26. 26. 7500 ml crystalloid 1000 colloid 12U PRBC 8U FFP 1 PLT, 2 CRYO
    27. 27. 0.3 0.4 0.5 0.6 0.7 0.8 0.9 30 40 50 60 70 80 Center Mean FFP:RBC PercentSurviving AB BC FF GH HI IJ LM MM OP PP QQ ST VX WW WX XY p = 0.05 R 2 = 0.19 34 ISS 44 27 ISS 34 22 ISS 27
    28. 28. * *
    29. 29. 0 10 20 30 40 50 60 70 ISS > 15 ISS > 24Injury Severity Score Mortality(%) RLH MSH CH * * Comparative Mortality
    30. 30. Damage Control Resuscitation 1. Early haemorrhage control (DCS) 2. Permissive hypotension 3. Limit fluid infusions (dilution) 4. Target coagulopathy

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