damage control in trauma by brohi
DESCRIPTION
Damage control strategies. Karim Brohi outlines the critical concepts for the managment of the actively bleeding patient.TRANSCRIPT
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DAMAGE CONTROL RESUSCITATION
Centre for Trauma SciencesQueen Mary University of Londonwww.c4ts.qmul.ac.uk
Royal London Major Trauma CentreBarts Health NHS Trust
KARIM BROHI, FRCS FRCAProfessor of Trauma Sciences, QMUL
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National Trauma Haemorrhage Mortality Rates
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43%
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0
10
20
30
40
50
60
70
ISS > 15 ISS > 24Injury Severity Score
Mo
rta
lity
(%
)
RLHMSHCH
*
*
Comparative Mortality
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Damage Control Resuscitation
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Damage Control Resuscitation
MAINTAIN HAEMOSTATICCOMPETENCE
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Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
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Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
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Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
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Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
Haemorrhage Control
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Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
Haemorrhage ControlManage Sepsis
Protect from further injury
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Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
Restoration of Physiology(ICU)
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What is it really?
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FAILURE:
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FAILURE: to maintain homeostasis
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FAILURE: to protect cells, tissues & organs
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FAILURE: to preserve endothelial integrity
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What’s bad about DCS?
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Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
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Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
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Trauma
Hemorrhage
Shock
ATC
TRAUMA-INDUCED COAGULOPATHY (TIC)
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Trauma
Hemorrhage
Genetics
Shock
Fibrinolysis Inflammation Hypothermia Acidemia
Loss, Dilution
ATC
TRAUMA-INDUCED COAGULOPATHY (TIC)
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750 ml crystalloid
1U PRBC
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750 ml crystalloid
4U PRBC2 FFP
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4500 ml crystalloid500 colloid8U PRBC7U FFP1 PLT, 2 CRYO
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7500 ml crystalloid1000 colloid12U PRBC8U FFP1 PLT, 2 CRYO
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0.3 0.4 0.5 0.6 0.7 0.8 0.9
30
40
50
60
70
80
Center Mean FFP:RBC
Pe
rce
nt S
urv
ivin
g
AB
BC
FF
GH
HI
IJ
LM
MM
OP
PP
ST
VX
WWWX
XY
p = 0.05R2 = 0.19
34 ISS 4427 ISS 3422 ISS 27
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*
*
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0
10
20
30
40
50
60
70
ISS > 15 ISS > 24Injury Severity Score
Mo
rta
lity
(%
)
RLHMSHCH
*
*
Comparative Mortality
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Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
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