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DAMAGE CONTROL RESUSCITATION

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

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DAMAGE CONTROL RESUSCITATION

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  1. DAMAGE CONTROLRESUSCITATION • Duchesne JC ET al - article on clickUP • 2013 • Dr du Plessis 1

  2. DAMAGE CONTROLQUESTIONS: • 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 CONTROLQUESTIONS: • 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 • 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 CONTROLQUESTIONS: • 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 CONTROLQUESTIONS: • 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 CONTROLQUESTIONS: • 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 • ACIDOSIS • COAGULAPTHY • HYPOTHERMIA • Treatment: • Cover patient (Bair hugger) • Preheat fluids to 40-42 degrees • Heat gases without H2O bath • Ringer's lactate in axilla (high blood flow area) • Stop other fluid loss 14

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  16. DAMAGE CONTROLQUESTIONS: • 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

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