[Damage control in trauma patients with hemodynamic instability].
The term "Damage-control" is borrowed from naval terminology. It means the initial control of a damaged ship. Because of the lethal triad in multiple injured patients the classical concept of definitive surgically therapy in the acute phase of the injury has a high rate of complications such as exsanguination, sepsis, heart failure and multiple organ failure. The core idea of the damage control concept was to minimize the additional trauma by surgical operations in these critical patients in the first phase. This means temporary control of a hemorrhage and measures for stopping abdominal contamination. After 24 - 48 hours in the intensive care unit and correction of physiological disturbances further interventions are performed for definitively treatment of the injuries. Summarized, the damage control strategy comprises an abbreviated operation, intensive care unit resuscitation, and a return to the operating room for the definitive operation after hemodynamic stabilisation of the patient.
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie am Universitätsklinikum Giessen und Marburg GmbH, Standort Marburg. thmuelle@med.uni-marburg.de
Thorben
T
Müller
Dietrich
D
Doll
Frank
F
Kliebe
Steffen
S
Ruchholtz
Christian
C
Kühne
D000005:Abdomen / Q000601:surgery; D000007:Abdominal Injuries / Q000503:physiopathology* / Q000601:surgery*; D000465:Algorithms; D003161:Compartment Syndromes / Q000503:physiopathology / Q000601:surgery; D003422:Critical Care / Q000379:methods*; D016267:External Fixators; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology*; D006465:Hemoperitoneum / Q000503:physiopathology / Q000601:surgery; D006470:Hemorrhage / Q000503:physiopathology*; D006801:Humans; D009102:Multiple Organ Failure / Q000503:physiopathology* / Q000517:prevention & control*; D009104:Multiple Trauma / Q000503:physiopathology* / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications / Q000503:physiopathology* / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods*; D012086:Reoperation; D012151:Resuscitation / Q000379:methods*; D018805:Sepsis / Q000503:physiopathology* / Q000517:prevention & control*; D015599:Trauma Severity Indices