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Trauma Laparotomy and Damage Control Laparotomy
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
The decision to perform a damage control trauma laparotomy is determined by several factors, including inbound trauma operative workload, anatomical and physiological factors, major incidents, and mass casualty situations. Anatomical factors include injury burden, complex injuries (likely to fail at the index procedure such as complex duodenal/pancreatic injuries, need for prolonged vascular bypass, other more compelling injuries in need of treatment (e.g., traumatic brain injury [TBI]) or any injury that may require a relook procedure, e.g. bowel of questionable viability). Physiologic factors are determined by the metabolic state of end-organ tissue perfusion, determined by the presence of acidosis, hypothermia, and evidence of coagulopathy. For these groups of patients, an immediate surgical procedure to rapidly save a life is indicated, as a prolonged operation would worsen physiological impairment, typically ending in catastrophic failure. Patients who have lost a significant volume of blood, if not treated expeditiously, will quickly become coagulopathic, hypothermic and acidotic — the trauma triad of death. Additional decisions to perform a damage control trauma laparotomy include the number of casualties in need of surgery and your own surgical skill set.
Major Trauma
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
The Trauma Triad of Death:➣ Adjuncts to primary surveyMonitoring. Pulse, non-invasive BP, ECG, pulse oximetry.Urinary catheter (after ruling out urethral injury).Diagnostic studies. X-rays (lateral cervical spine, AP chest, and AP pelvis), ultrasound scan, CT scan, diagnostic peritoneal lavage.➣ Secondary surveyBegin the above only after the primary survey is completed and while sufficient resuscitation is being carried out.Take history using AMPLE method (Allergy, Medication, Past medical history, Last meal, Events of the incident).Perform a head-to-toe physical examination and continue to reassess all vital signs. Perform any specialized diagnostic tests that may be required.
Predictors of Hypothermia upon Trauma Center Arrival in Severe Trauma Patients Transported to Hospital via EMS
Published in Prehospital Emergency Care, 2020
Chantal Forristal, Kristine Van Aarsen, Melanie Columbus, James Wei, Kelly Vogt, Sameer Mal
Hypothermia is a relatively common and ominous finding in patients who have suffered severe trauma. The incidence of hypothermia upon emergency department (ED) arrival has been reported to be anywhere from 10–50% in the literature. Most studies report an incidence of 15 to 30% (1–7); however, it can be as high as 30–50% in severe, polytrauma patients (8) and those presenting with the trauma triad of death: hypothermia, coagulopathy, and acidosis (9). Trauma-induced hypothermia is thought to be a multi-factorial condition resulting from a combination of hemorrhagic shock, environmental exposures, and treatment consequences (i.e., anesthetic medications and intravenous fluids) (8). Physiologically, this manifests as hemodynamic instability, immunosuppression, poor metabolism of medications, and impaired hemostasis (10).