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COMPLICATIONS OF TORSO TRAUMA

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

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COMPLICATIONS OF TORSO TRAUMA

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  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 SYNDROME 6

  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

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