Duchesne jc et al article on clickup 20 dr du plessis. The concept of damagecontrol resuscitation has been developed with the aim of providing optimal fluid resuscitation and transfusion to patients with hemorrhagic shock secondary to severe trauma 810. Addresses the resuscitation of patients with lifethreatening hemorrhage in prehospital settings. Haemostatic resuscitation massive transfusion protocol 3.
Damage control resuscitation for patients with major. Clinical practice guidelines cpgs joint trauma system. Trauma resuscitation hemorrhage the most common cause of preventable death in trauma optimal fluid resuscitation regimen debate is on more recently damage control resuscitation dcr has received more attention permissive hypotension aka controlled resuscitation is part of a broader strategy dcr. Ppt damage control resuscitation powerpoint presentation. Early and increased use of red blood cells, plasma and platelets in a 1. Damage control surgery is a surgical intervention intended to stop hemorrhage and limit gastrointestinal contamination of the abdominal compartment in severely injured and bleeding patients. In the beginning, damage control surgery was described by the three main steps. Damage control resuscitation powerpoint ppt presentation. Thor position paper on remote damage control resuscitation. Wed like to understand how you use our websites in order to improve them. Damage control resuscitation and surgery in a forward. The marriage of surgical simulation and telementoring for damagecontrol.
The aim is to keep the patient alive whilst avoiding interventions and situations that risk worsening their situation by driving the lethal triad of hypothermia, coagulopathy and acidosis or excessively stimulating the immuneinflammatory system. Richmond center of excellence offers prepared powerpoint presentations that may be downloaded and used by clinicians, advocates, community organizations, and educators anyone interested in speaking on tobacco and secondhand smoke. Small enteric injuries are closed with staples large ones are stapled on both sides with the gia stapling device and the damaged segment removed. While typically trauma surgeons are heavily involved in treating such patients, the concept has evolved to other subspecialty services. A practice management guideline from the eastern association for the surgery of trauma. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. A systematic approach to major exsanguinating trauma incorporating several strategies to decrease mortality and morbidity. Damage control resuscitation of the exsanguinating trauma. Although damage control surgery and resuscitation was initially described following abdominal injury, the basic principle has been extended to all aspects of trauma care. Damage control resuscitation dcr is a systematic approach to major exsanguinating trauma incorporating strategies of permissive hypotension, haemostatic resuscitation and damage control surgery. Damage control resuscitation dcr refers to a structured process initiated at point of injury and continued through operative intervention. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients.
Steps is damage control surgery bleeding raw surfaces, like that of the liver, are packed with laparotomy pads. Damage control surgery and damage control resuscitation. The introduction of damage control surgery to control hemorrhage and contamination, minimize operative time, and allow for ongoing resuscitation to occur in the intensive care unit changed the way trauma surgeons managed those in profound shock 15 x 15 rotondo, m. The term damage control originated in the united kingdom uk royal navy as early as the 17th century and relates to doing whatever is required to bring a damaged ship home to port. Damage control resuscitation dcr has evolved from surgical techniques to a full continuum of care including all stages of patient management. Damage control questions what is damage control surgery.
Focuses on both civilian and military applications of dcr. Surgery to control bleeding, massive transfusion, and hemostatic resuscitation are. Professor and vice chair director, center for translational injury research university of texas health sciences center houston. Ppt endpoints of resuscitation in trauma powerpoint. Trauma hemostasis and oxygenation research network thor. Damage control surgery dcs is a strategy originally described in the context of exsanguinating abdominal trauma, where the completeness of operative repair is sacrificed in order to limit physiologic deterioration. The successful resuscitation of the massively bleeding and unstable trauma patient will depend on effective trauma team leadership, identification of early traumarelated coagulopathy, sound decisionmaking in the emergency and operating rooms, and prompt implementation of a dcr and a damage control operative approach. The leading cause of death among trauma patients remains uncontrolled hemorrhage and accounts for approximately 3040% of traumarelated deaths.
Today, well concentrate on the lethal triad and bp goals. Damage control resuscitation integrates permissive hypotension, haemostatic resuscitation, and damage control surgery coagulopathy is common in patients with haemorrhagic shock in trauma patients predicted to require massive transfusion, administration of fresh frozen plasma, packed red blood cells, and platelets in a 1. Damage control resuscitation dcr is a strategy that seeks to prevent or mitigate hypothermia, acidosis, and coagulopathy through combined treatment paradigms. Dubose, in richs vascular trauma third edition, 2016. Clinical practice guidelines cpgs clinical practice guidelines cpgs are the backbone of the systemwide jts performance improvement program. Bleeding causes acidosis, hypothermia, and coagulopathy. Recently, remote damagecontrol resuscitation rdcr has been conceived as a. Health data abstracted from patient records and after action reports is analyzed and distilled into globally relevant cpgs to remove medical practice variations and prevent needless deaths. It currently includes early blood product transfusion, immediate arrest andor temporization of. Damage control surgery dcs is a technique of surgery used to care for critically ill patients. Generally, an ebook can be downloaded in five minutes or less. Thor is a multidisciplinary group of clinical, translational and basic investigators with a common interest in improving outcomes and safety in patients.
There are clear parameters to decide when to perform the definitive surgery. The algorithms used are summarized under the concept of damage control resuscitation dcr, initiated by john holcomb in 2007. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room. Ppt the concept of damage control surgery powerpoint. Damage control resuscitation dcr represents the natural evolution of the initial concept of damage control surgery. Translating tactical combat casualty care lessons learned. Harlan stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. Identification and treatment of lifethreatening hemorrhage. Addition of a prehospital initial evaluation stage ground zero and separation of definitive. It has been stated that surgery does not follow resuscitation, it. Trauma resuscitation of the critically ill hemorrhagic. Damage control orthopedics is treatment option in borderline and in extremis patients. Thought wed talk about some trauma stuff, specifically the resuscitation of the critically ill hemorrhagic shock patient.
Download ppt damage control resuscitation gregory w. The key tenets of dcr include early mechanical hemorrhage control, permissive hypotension, limited crystalloid resuscitation, hypothermia prevention, acidosis prevention, and early utilization of balanced. What if the patient is not responding to resuscitation efforts. Damage control resuscitation dcr, the strategic approach to the trauma patient who presents in extremis, consists of balanced resuscitation, hemostatic resuscitation, and prevention of acidosis. A free powerpoint ppt presentation displayed as a flash slide show on id. The concept of damage control surgery powerpoint ppt presentation. Training for damage control resuscitation using a rapid. Definitive control of bleeding is the principal objective in any comprehensive resuscitation scheme for hemorrhagic shock, and therefore dcr must not eclipse emergent endoscopic, surgical or angiographic intervention. In this article, we describe damage control resuscitation dcr as a. Damage control resuscitation comprises early hemorrhage control, hypotensive resuscitation permissive hypotension, hemostatic resuscitation.
He is found to have grade iv liver and splenic lacerations as well as an open book pelvic fracture, bilateral open tibia fractures, a closed left forearm fracture, and a left femoral shaft fracture. The trauma hemostasis and oxygenation research thor network held its third annual remote damage control resuscitation rdcr symposium in june of 20 at solstrand hotel, near bergen norway. Damage control surgery dcs is a wellestablished concept and consists of an initial timelimited operation to save life th e or icaly sn 1 u, p d f m resuscitation on the intensive care unit, then further definitive surgery. Aural blast injuryacoustic trauma and hearing loss. Damage control resuscitation dcr11 is now the gold standard of care for treating casualties involved in complex trauma, which involves permissive hypotension, damage control surgery and. There is much to discuss, so this will be a multiepisode affair.
View and download powerpoint presentations on damage control surgery ppt. Permissive hypotension is included in the overarching concept of damagecontrol resuscitation. Since the initial introduction of damage control surgery dcs in 1983, its application has broadened to include resuscitation and icu management 4, 5. Coagulopathy observed in trauma patients was thought to be a resuscitationassociated phenomenon. Damage control resuscitation dcr1 is now the gold standard of care for treating casualties involved in complex trauma, which involves permissive hypotension, damage control surgery and haemostatic resuscitation, where blood and blood products are administered and filler fluids such as crystalloid are avoided.
Damage control laparotomy was first described by dr. The concept of damage control resuscitation dcr was proposed in the mid 2000s as an alternative resuscitation approach to hemorrhagic shock. Damage control resuscitation in patients with severe traumatic hemorrhage. Emerging concepts including damage control resuscitation, thromboelastography directed infusions of blood components, and resuscitative endovascular balloon occlusion of the aorta reboasee chapter 34 will be discussed, as. Jts performance improvement division provides trauma care training literature which highlights primary instructions presented in jts clinical practice guidelines. A treatment strategy that targets conditions that exacerbate haemorrhage in trauma patients 1. Cdr mc usn naval hospital camp pendleton acknowledgment thanks to col jay johannigman, mc, usaf, for his. Andy fisher and his damage control resuscitation for prolonged field care cpg. This is a guideline truly written for the medic working despite lack of help or resources in an austere environment continue reading podcast episode 47. Find powerpoint presentations and slides using the power of, find free presentations research about damage control resuscitation ppt. Damage control surgery an overview sciencedirect topics. View large image view hires image download powerpoint slide. Twenty years ago, damage control surgery dcs was implemented to challenge the coagulopathy of trauma.
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