COMPLICATIONS OF TORSO TRAUMA 2013 1

COMPLICATIONS AORTIC RUPTURE (DELAYED) ABDOMINAL COMPARTMENT SYNDROME (after aggressive resus) WOUND DISRUPTION DAMAGE CONTROL FISTULAE 2

AORTIC RUPTURE Blunt trauma - deceleration (AP, vertical) Shock Chest X Ray – Widened mediastinum CXR – 100 cm 3

AORTIC RUPTURE TREATMENT Control blood pressure – B blockade Hypotensive resuscitation Transfer to trauma center Open repair or stent Mortality and morbidity high 4

Rupture thoracic aorta Descending aorta Mortality (prehospital) 85% Hospital 50% (48hrs) Operative 15% Paraplegia 8-30% 5

ABDOMINAL COMPARTMENT SYNDROME 6

ABDOMINAL COMPARTMENT SYNDROME INCREASE IN INTRA-ABDOMINAL PRESSURE ORGAN DYSFUNCTION ILEUS OLIGURIA 7

ABDOMINAL COMPARTMENT SYNDROME DIAGNOSIS SUSPICION PRESSURE MEASUREMENT INTRA-VESICAL PRESSURE 8

ABDOMINAL COMPARTMENT SYNDROME TREATMENT- DECOMPRESSION RESTRICT FLUID RESUS OPEN ABDOMEN LEAVE OPEN TEMPORARY CLOSURE - BOGOTA BAG SKIN GRAFTING FINAL REPAIR-LATE 9

WOUND DISRUPTION 10

WOUND DISRUPTION Distension, ileus, compartment syndrome Ascites, hemorrhage, peritoneal dialysis Poor nutrition, poor reserves, weak tissue Infection Cancer Technical – sutures, ischemia, tension Post resuscitation edema 11

WOUND DISRUPTION MANAGEMENT Resuscitation Cover bowel to prevent drying, injury Bogota bag, sandwich dressing Treat cause Closure when time is appropriate with suturing or skin graft 12

DAMAGE CONTROL 13

DAMAGE CONTROL NAVAL TERM FROM WAR- TO SAVE THE SHIP CLOSE COMPARTMENTS TRADE OFF – PREPARED TO SACRIFICE SOME TO SAVE THE REST 14

DAMAGE CONTROL SURGERY: TO SAVE THE PATIENT ABBREVIATED SURGERY UNCONVENTIONAL APPROACH STOP BLEEDING STOP CONTAMINATION GET OUT (LESS THAN 1 HOUR) 15

DAMAGE CONTROL LAPAROTOMY- CONTROL BLEEDING,CONTAMINATION SHORT PROCEDURE RESUSCITATE IN ICU:TEMPERATURE, BLOOD, CIRCULATION RELOOK WHEN OPTIMISED(<48 HR)- DEFINITIVE SURGERY, CLOSURE 16

DAMAGE CONTROL SEVERE INJURIES LONG PROCEDURES HYPOTHERMIA ACIDOSIS COAGULOPATHY 17

DAMAGE CONTROL EXTENDED TO OTHER DISCIPLINES ORTHOPAEDIC SURGERY NEUROSURGERY PLASTIC AND RECONSTRUCTIVE S MAXILLOFACIAL SURGERY RESUSCITATION 18

DAMAGE CONTROL DAMAGE CONTROL RESUSCITATION LIMIT FLUIDS (CRYSTALLOIDS) GIVE BLOOD EARLY ADD FFP to PRBC IN RATIO 1:1 ADD PLATELETS 1:1:1 (mega-unit) MIMIC FRESH WHOLE BLOOD TEG CONTROL aFVII 19

DAMAGE CONTROL RESUSCITATION Permissive hypotention Isotonic crystalloids vs HT Saline Trauma related coagulopathy Resuscitation with blood, FFP, platelets, cryoprecipitate, aFvii Damage control surgery 20

FISTULA DEFINITION: AN OPENING BETWEEN TWO EPITHELIAL SURFACES PRACTICAL: MOSTLY AN HOLE IN THE BOWEL LEAKS BOWEL CONTENT INTO WOUND 21

FISTULA METABOLIC EFFECTS: FLUID LOSS, ELECTROLYTES LOSS MALNUTRITION, PROTEIN LOSS IMMUNE SUPPRESSION INFECTION RATE HIGH POOR WOUND HEALING 22

FISTULA : TREATMENT NIL PER MOUTH PARENTERAL FLUIDS, ELECTROLYTES, NUTRITION TREAT INFECTION WOUND MANAGEMENT: ISOLATE FLUID FROM BOWEL, RE-INFUSE 23

FISTULA CAUSES FOR NON-CLOSURE CAVITY FOREIGN OBJECT DISTAL OBSTRUCTION MALIGNANCY MALNUTRITION 24

End Thank you 25