1. DAMAGE CONTROL RESUSCITATION
Duchesne JC ET al - article on clickUP
2013
Dr du Plessis 1

2. DAMAGE CONTROL QUESTIONS:
What is damage control surgery?
Why is blood necessary for resuscitation?
What is permissive hypotension?
Is there a role for hypotonic solutions?
What is the mortal triad?
Why is it bad to have it develop? 2

3. (1.) DAMAGE CONTROL SURGERY
NAVAL TERM FROM WAR-
TO SAVE THE SHIP
LIMIT DAMAGE
CLOSE COMPARTMENTS
TRADE OFF – PREPARED TO SACRIFICE SOME TO SAVE THE REST
EMERGENCY REPAIR
FINISH MISSION 3

4. (1.) DAMAGE CONTROL SURGERY
SURGERY: TO SAVE THE PATIENT
ABBREVIATED SURGERY
UNCONVENTIONAL APPROACH
CONTROL (STOP) BLEEDING
STOP CONTAMINATION
GET OUT (LESS THAN 1 HOUR) 4

5. (1.) DAMAGE CONTROL SURGERY
LAPAROTOMY- CONTROL BLEEDING,CONTAMINATION
SHORT PROCEDURE
RESUSCITATE IN ICU:TEMPERATURE, BLOOD, CIRCULATION
RELOOK WHEN OPTIMISED(<48 HR)- DEFINITIVE SURGERY, CLOSURE 5

6. DAMAGE CONTROL QUESTIONS:
What is damage control surgery?
Why is blood necessary for resuscitation?
What is permissive hypotension?
Is there a role for hypotonic solutions?
What is the mortal triad?
Why is it bad to have it develop? 6

7. (2.) BLOOD TRANSFUSION Blood loss needs replacement with blood
Cannot get whole blood from blood bank, only components
Need Packed RBC's to carry oxygen
No clotting factors: need FreshFrozenPlasma to replace clotting factors (cryoprecipitate)
No platelets: need platelets to assist ith process of clotting
Ideal ratio: 1:1:1 7

8. (2.) BLOOD TRANSFUSION 8 Store at 4 degrees Celsius
Ave age (US) 24 days
RBC: no nucleus, no mitochondria (anaerobic metabolism)
Use glucose - lactate (acidosis)
Low 2,3 DPG: less deformable (sphere)
Preserve in Citrate Phosphate Dextrose
No clotting factors
No platelets
Hemolysis of some RBC: more potassium 8

9. DAMAGE CONTROL QUESTIONS:
What is damage control surgery?
Why is blood necessary for resuscitation?
What is permissive hypotension?
Is there a role for hypotonic solutions?
What is the mortal triad?
Why is it bad to have it develop? 9

10. (3.) PERMISSIVE HYPOTENTION
Blood pressure lower than normal,but adequate for tissue perfusion
Systolic: 90mmHg
Renal perfusion usually 70mmHg
Decr resus: decr BP: incr time to clot
Incr resus: incr BP: incr bleed
Danger: eg leaking aortic aneurysm, will loose 5L in one minte (CO = 5L/min) 10

11. DAMAGE CONTROL QUESTIONS:
What is damage control surgery?
Why is blood necessary for resuscitation?
What is permissive hypotension?
Is there a role for hypotonic solutions?
What is the mortal triad?
Why is it bad to have it develop? 11

12. (4.) HYPERTONIC SOLUTIONS
Sodium is most NB for resus
Hypertonic solutions gives more sodium in a smaller volume
Reduced danger of volume overload, oedema, cardiac failure, pulmonary oedema, and dysfunction(TRALI:transfusion related acute lung injury = part of ARDS, initial stage)
Problem of hyperchloraemic acidosis (Na+Cl-) 12

13. DAMAGE CONTROL QUESTIONS:
What is damage control surgery?
Why is blood necessary for resuscitation?
What is permissive hypotension?
Is there a role for hypotonic solutions?
What is the mortal triad?
Why is it bad to have it develop? 13

14. (5.) MORTAL TRIAD 14 ACIDOSIS COAGULAPTHY HYPOTHERMIA Treatment:
Cover patient (Bair hugger)
Preheat fluids to degrees
Heat gases without H2O bath
Ringer's lactate in axilla (high blood flow area)
Stop other fluid loss 14

15. 15

16. DAMAGE CONTROL QUESTIONS:
What is damage control surgery?
Why is blood necessary for resuscitation?
What is permissive hypotension?
Is there a role for hypotonic solutions?
What is the mortal triad?
Why is it bad to have it develop? 16

17. (6.) BAD TO HAVE IT DEVELOP
Acidosis:
treat with fluids (open capillary beds) to get rid of acids
Give oxygen (aerobic metabolism) 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 IN RATIO 1:1
ADD PLATELETS
MIMIC FRESH WHOLE BLOOD
TEG CONTROL with aFVII 19

20. End
Thank you 20