Algoritma & Tatalaksana

Trauma Abdomen Pada

Korban Bencana

www.allquakes.com

dr. Irwan, SpB, Subsp.BD(K)

Divisi Bedah Digestif RSUP dr. M. Djamil/FK Universitas Andalas
 Background

 10% of all traumatic deaths are the direct

consequences of abdominal trauma
 Trauma is the direct cause of 9 % of the mortality
worldwide (WHO)
 In Europe, abdominal trauma accounts for 10 % of
the burden injury
 The mortality rate of trauma laparotomy is 7 – 21
%

www.sciencefocus.com
 Guidelines and algorithms in
trauma care
Eastern Association for the Surgery of Trauma
(EAST)
http://www.east.org/resources/treatment-guidelines
Western Trauma Association (WTA)
http://westerntrauma.org/algorithms/algorithms.html
Society of Critical Care Medicine (SCCM)
http://www.learnicu.org/Pages/Guidelines.aspx
Western Trauma Association

injury’
‘Penetrating
Western Trauma Association

‘GSW’
Western Trauma Association
Western Trauma Association

bowel
‘Blunt

injury’
 Where ?
n ? How ? Wh0 ?
he
W Operation
What ?
Why ?
 “The Lethal Triad Flowchart”

DCR
Permissive hypotention
Hemostatic resuscitation
+
DCS

J.C. Duchesne et al. Trauma Surgery vol. 1

 Damage Control Surgery

“Phylosophy; contingent upon an understanding

of the negative impact that metabolic failure has
on the ability of the trauma patient to tolerate
further surgical insult”

https://www.liveabout.com/career-profile-navy-damage-controlman-2356445
 History 1983-1993

1976-1979
Stone, et al
Rotondo &
Lucas & Schwab
Early 20th Ledgerwood
century Moore
Calne &
Pringle Feliciano
“Damage
reports
Halstead- Control”
utility of packing
for managing liver
trauma
Damage Control Surgery Stages
1. Patient selection
for abbreviated
laparotomy

5. Abdominal 2. Reassessment
Wall for hemorrhage
Reconstruction control

4. Return to the 3. Physiologic

OR for definitive restoration in the
procedures ICU
Moore, et al
Patient selection for abbreviated laparotomy

Case in which damage control should be considered preoperatively

F.M. Pieracci & E.E. Moore in Trauma Surgery

Patient selection for abbreviated laparotomy

Case in which damage control should be considered intraoperatively

F.M. Pieracci & E.E. Moore in Trauma Surgery

 3 sequential step in
the initial damage control
Hemorrhage

Gastrointestinal
contamination
When transfer to ICU ?

Temporary “Acceptable” hemorrhage ?

closure

Temporary closure
 3. Physiologic
restoration in
4. Return to the
the ICU
OR for
definitive
procedures

Think about ‘earlier return to the OR’

Ongoing surgical bleeding
Morris, et al :
- Blunt trauma - normothermia with a rate of
hemorrhage of >2 units pRBC/h
- Penetrating trauma – the same + hypothermia with a rate of
hemorrhage of >15 units pRBC/h
Laparotomy
Indications for early trauma laparotomy

G.P. Fraga & S. Rizoli in Trauma surgery

Laparotomy

Incision

Exploring the abdomen

Closure of abdominal incision

Missed Injuries & Nontherapetic Laparotomy

 The incidence ; 1 – 9 %

 Caused by ; incomplete exploration,

inexperience / poor surgical technique of
the surgeon

 NTL complication > 41 %

*Source; Trauma surgery

 Important maneuvers

Kocher
Cattel-Braasch
Mattox
Source: Trauma Surgery
Laparoscopy
Penetrating
Blunt Trauma
Trauma
• Unclear abdomen • Determination of
• Free fluid from an peritoneal
unclear source penetration
• Suspected • Exploration of the
intestinal injury abdomen
• Mesenteric injury
+/- vascular
damage
• Solid organ injury

Source: Trauma Surgery

 Thank You

https://www.nrdc.org/experts/anna-weber/next-step-national-disaster-safety-board