Damage control-Storm.pptx
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Damage control surgery involves performing an abbreviated initial surgery to control hemorrhage, prevent contamination, and avoid further injury in critically injured patients. It is a multi-step process beginning with rapid transport and resuscitation at the scene (damage control resuscitation with permissive hypotension), followed by an abbreviated laparotomy in the operating room to arrest bleeding and control contamination without definitive repairs. The patient is then taken to the ICU to be stabilized, and a reoperation is performed 24-48 hours later to remove packs, perform definitive repairs, and close the abdomen. The goal is to stabilize the patient's physiology before performing more extensive surgery.
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1) Acute gastrointestinal bleeding can originate from the upper GI tract and has many potential causes, including peptic ulcers, esophageal and gastric varices, erosive mucosal disease, and tumors.
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3) Specific treatments depend on the underlying cause, with peptic ulcers commonly treated with proton pump inhibitors, endoscopic therapy, and surgery if bleeding persists, while variceal bleeding is managed with vasoactive drugs, balloon tamponade, endoscopic band ligation or sclerotherapy, and TIPS procedure.
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- Screening criteria like QSOFA and SOFA scores to help identify sepsis early.
- Diagnosis through appropriate cultures and lactate levels.
- "Bundle" of treatments to administer antibiotics, fluids, and vasopressors within specific timeframes.
- Antimicrobial therapy including broad-spectrum antibiotics within 1 hour, duration of 7-10 days, and use of procalcitonin to determine stop.
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- 2. What means damage control “Capacity to absorb damage maintaining mission integrity” First phase (Abbreviated laparotomy) in critically injured patient in an attempt to • Control Hemorrhage • Prevent contamination • Avoid further injury
- 3. Indications of damage control • Hypothermia that persist (<35◦C) • Coagulopathy • Metabolic acidosis (pH <7.2, base deficit >15)
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- 7. Principles • Arrest hemorrhage Packing, suturing, ligation vs. repair, shunts • Control contamination Ligation, Suturing, stapling, drainage • Avoid further damage
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