[Damage control: a tactical alternative for the management of exanguinating trauma patients].
BACKGROUND
Despite the advances in the treatment of exanguinating patients, hemorrhage remains as the leading cause of early deaths. A great deal of attention has been given to "damage control" as a therapeutic alternative in this scenario.


OBJECTIVE
To appraise the definition, indications, operative techniques and results of damage control for the treatment of exanguinating trauma patients.


METHODS
Bibliographic review.


RESULTS
Damage control introduces the concept of breaking the vicious cycle of metabolic acidosis, hypothermia and coagulopathy which results from hemorrhagic shock. Thus, the operation has to be interrupted before this irreversible stage, even if the injured organs were not given the definitive treatment at this moment. So, damage control involves three steps: an abbreviated operation, a recovering period in the intensive care unit, and the reoperation for the definitive treatment. At the abbreviated operation, operative techniques as stapling intestinal injuries or packing liver wounds are applied, allowing rapid control of the bleeding and spillage. In the intensive care unit, the patient is warmed, oxygen delivery and consumption are restored and coagulation factors administered. As soon as the hemodynamic stability, ideal body temperature and coagulation status are reached, the definitive operation is carried out. Damage control is a helpful option if correctly used. However, there are also severe complications that can occur. Therefore, it should be employed only in centers that could provide optimum resources.


CONCLUSIONS
Damage control is an important tactical alternative for the treatment of exanguinating trauma patients.
Parreira
José Gustavo
JG
Serviço de Emergência do Departamento de Cirurgia, Faculdade de Ciências Mêdicas, Santa Casa de São Paulo, Brasil. jgparreira@uol.com.br
Soldá
Silvia
S
Rasslan
Samir
S
D006489:Hemostatic Techniques; D006801:Humans; D012086:Reoperation; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods*; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery