1. COMPLICATIONS OF TORSO TRAUMA
2013 1

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

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

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

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

6. ABDOMINAL COMPARTMENT SYNDROME6

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

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

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

10. WOUND DISRUPTION 10

11. 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

12. 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

13. DAMAGE CONTROL 13

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

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

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

17. DAMAGE CONTROL SEVERE INJURIES LONG PROCEDURES HYPOTHERMIA ACIDOSIS
COAGULOPATHY 17

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

19. 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

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

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

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

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

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

25. End
Thank you 25