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Manual Of Definitive Surgical Trauma Care

Manual Of Definitive Surgical Trauma Care

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Published by bovine splendor
More medical text info for those who cannot access conventional resources.
More medical text info for those who cannot access conventional resources.

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Published by: bovine splendor on Jul 10, 2013
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07/13/2013

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The indications for damage control generally can be
divided into the following:

•Inability to achieve haemostasis
•Combined vascular, solid and hollow organ injury
•Inaccessible major venous injury, e.g. retrohepatic
vena cava
•Anticipated need for a time-consuming procedure
•Demand for non-surgical control of other injuries, e.g.
fractured pelvis
•Inability to approximate the abdominal incision
•Desire to reassess the intra-abdominal contents
(directed relook)
•Evidence of decline of physiological reserve:
Temperature < 34°C
pH < 7.2
Serum lactate > 5mmol/L
Prothrombin time (PT) > 16 s
Partial thromboplastin time (PTT) > 60 s
> 10 units blood
Systolic BP < 90mmHg, for > 60 min
Operating time > 60 min.

Irrespective of setting, a coagulopathy is the single
most common reason for abortion of a planned proced-
ure, or the curtailment of definitive surgery. It is import-
ant to abort the surgery beforethe coagulopathy becomes
obvious.

The technical aspects of the surgery are dictated by
the injury pattern.

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