Damage control surgery is a lifesaving strategy for critically ill patients whose injuries and blood loss threaten their physiology. This lesson introduces its purpose, the lethal triad, the importance of teamwork, and the development and outcomes of the approach.
Damage control surgery prioritizes keeping the patient alive over correcting every injury during one operation. Severe hemorrhage and injury can disrupt homeostasis and contribute to three mutually worsening problems: metabolic acidosis, hypothermia, and coagulopathy. Together, these are known as the lethal triad.
All flashcards
What is damage control surgery?
A staged operative strategy that controls immediate threats to life, allows physiologic stabilization, and defers definitive reconstruction.
What is the lethal triad?
Metabolic acidosis, hypothermia, and coagulopathy, which can worsen one another after severe injury.
What does damage control ground zero (DC0) mean?
Preparing personnel, equipment, resources, and protocols in advance for damage control care.
What is permissive hypotension?
Maintaining a lower blood pressure while preserving end-organ perfusion until hemorrhage can be controlled.
How is massive transfusion defined in these notes?
Receiving at least 10 units of packed red blood cells within 24 hours.
Quiz questions
Which objectives guide the initial laparotomy in damage control surgery?Answer: Control hemorrhage and contamination, pack the abdomen when indicated, and apply temporary closure.
Why is the abdominal fascia generally left unreapproximated during temporary closure?Answer: Fascial closure can raise intra-abdominal pressure and contribute to abdominal compartment syndrome.
When is definitive reconstruction commonly considered after the initial operation?Answer: After physiologic abnormalities improve, commonly within 24–48 hours.
What did the PROPPR trial find when comparing 1:1:1 with 1:1:2 transfusion groups?Answer: There was no difference in 24-hour or 30-day mortality between the groups.
What advantage do thromboelastography and rotational thromboelastometry offer in resuscitation?Answer: They provide a broader assessment of coagulation than INR alone and can help target deficiencies.