TY  - CHAP
M1  - Book, Section
TI  - Trauma Damage Control
A1  - Ball, Chad G.
A1  - Feliciano, David V.
A2  - Feliciano, David V.
A2  - Mattox, Kenneth L.
A2  - Moore, Ernest E.
PY  - 2020
T2  - Trauma, 9e
AB  - KEY  POINTSDamage  control  is  a  US  Navy  term  defined  as  the  “capacity  of  a  ship  to  absorb  damage  and  maintain  mission  integrity.”An  abbreviated  laparotomy  with  diffuse  intra-abdominal  packing  in  patients  with  significant  intra-abdominal  injuries  and  an  intraoperative  coagulopathy  was  first  described  by  H.  Harlan  Stone,  MD,  at  Grady  Memorial  Hospital,  Atlanta,  Georgia,  in  1983.In  the  modern  era,  agreed-upon  indications  for  a  damage  control  laparotomy  include  temperature  less  than  34°C;  arterial  pH  less  than  7.2;  an  international  normalized  ratio,  prothrombin  time,  or  partial  thromboplastin  time  greater  than  1.5  times  normal;  or  a  clinically  observed  coagulopathy  in  the  pre-  or  intraoperative  setting.The  early  coagulopathy  of  trauma,  as  demonstrated  on  laboratory  testing,  is  present  upon  admission  in  over  25%  of  injured  patients  with  a  base  deficit  greater  than  –6.Examples  of  thoracic  damage  control  include  cross-clamping  the  hilum,  a  hilar  twist  after  division  of  the  inferior  pulmonary  ligament,  and  pulmonotomy  with  selective  vascular  ligation.Examples  of  abdominal  damage  control  include  perihepatic  packing,  suture  repair  and  packing  of  grade  I  or  II  splenic  injuries,  and  Whipple  procedure  or  distal  pancreatectomy  delayed  to  reoperation.Examples  of  vascular  damage  control  anywhere  in  the  body  include  insertion  of  temporary  intraluminal  shunts,  ligation  of  selected  major  veins,  and  early  fasciotomy  in  high-risk  patients  with  injuries  to  the  extremities.Abdominal  compartment  syndrome  is  defined  as  a  sustained  intra-abdominal  pressure  greater  than  20  mm  Hg  that  is  associated  with  new  organ  dysfunction  or  failure.The  temporary  silo  over  open  abdomen  technique  was  initially  described  by  Oswaldo  Borraez  G.  at  the  San  Juan  de  Dios  Hospital  in  Bogota,  Colombia,  in  1984.Indications  for  an  emergent  return  to  the  operating  room  after  a  damage  control  laparotomy  performed  in  a  patient  with  blunt  trauma  include  a  normothermic  patient  who  is  bleeding  greater  than  2  units  of  packed  red  blood  cells  per  hour  or  the  development  of  an  abdominal  compartment  syndrome  with  ongoing  blood  loss.Maintenance  of  the  peritoneal  domain  and  prevention  of  adherence  of  the  viscera  to  the  underside  of  the  abdominal  wall  are  critical  to  allow  progressive  closure  of  the  linea  alba  after  an  open  abdomen.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1175139323
ER  -