Damage Control Surgery Flashcards
What are the principles of DCS
to optimise physiology before putting the body under surgical strain
surgery to ICU then back to surgery
Which patients should be considered for DCS?
multiple injuries deranged physiology (sBP <90) hollow viscous + vascular injury vascularised organ injury coagulopathic, hypothermic (<34) or acidotic (<7.2)
What does BASTE stand for and what is its purpose
To check in every 10 minutes or so during DCS to see if the patient is spiralling, dying and if resources could be better used on other patients (in mass casualty scenarios) Blood products Acid base balance Surgical progress Temperature Electrolytes
What generally happens in the first stage of DCS
Explore extent of injuries
control haemorrhage - balloon catheter tamponade, shunts, ligation, amputation
minimise contamination - clamping, resecting, use of staples
packs can be left in
When is a patient ready for the third stage of DCS (second surgery after ICU)
normal physiology, temp, coagulation
moderate O2 requirements
What are the two types of wound packing
resuscitative - control and minimise bleeding
therapeutic - pressure stops the bleeding and tissue viability is maintained
What are the advantages and disadvantages of closing after DCS
Closing will maintain a tamponade effect
risk of abdominal compartment syndrome
splints the diaphragm making ventilation hard
compress the kidneys which don’t function as well
What can cause abdominal compartment syndrome
packs
oedematous bowel
bleeding/rebleeding either intraabdominal or retroperitoneal
What are some complications of DCS
abdominal compartment syndrome abscess sepsis abdominal wall defects MOF
Why do patients get cold in trauma?
Environmental exposure
exsanguination
open body cavities
cold fluid administration
Why would a patient on inotropes not be considered ready for 3rd stage DCS
Because profound vasoconstriction in organs such as the bowel vasculature would mean that any new anastamoses formed would just die due to lack of blood supply
In orthopaedic DCS, what is the advantage of leaving the patient with an external fixator
reduces risk of fat embolism occurring if you’re not messing around inside
Describe a lung/hilar twist
The pulmonary ligament is divided
anterior rotation of the lower lobe over the upper lobe
vessles at the hilum are twisted and therefore occluded
Where is a chest drain inserted
midaxillary line, 5th IC space, above the rib
What are the indications for a thoracotomy
penetrating chest/epigastrium injury with cardiac arrest:
release clotted blood built up in pericardial space
repair any holes cause haemorrhage
perform cardiac massage
aortic clamp
