title: Damage control strategies in the management of acute injury.
abstract: Traumatic injury is the leading cause of death worldwide. The rapid evaluation and correction of injuries in these patients is paramount to preventing uncontrolled decompensation and death. Damage control strategies are a compendium of techniques refined over decades of surgical care that focus on the rapid correction of deranged physiology, control of contamination and blood loss, and resuscitation of critical patients. Damage control resuscitation (DCR) focuses on the replacement of lost blood volume in a manner mimicking whole blood, control of crystalloid administration, and permissive hypotension. Damage control laparotomy controls gastrointestinal contamination and bleeding in the operative suite, allowing rapid egress to the intensive care unit for ongoing resuscitation. Pelvic packing, an adjunct to DCR, provides a means to control hemorrhage from severe pelvic fractures. Temporary vascular shunts restore perfusion, while resuscitation and reconstruction are ongoing. Taken together, these strategies provide the trauma surgeon with a powerful arsenal to preserve life in the transition from injury to the shock trauma room to the intensive care unit.
authors.affiliation: University of Tennessee Health Sciences Center, 910 Madison Ave., Suite 220, Memphis, TN, 38163, USA. ssavage1@uthsc.edu.
authors.forename: S A
authors.initials: SA
authors.lastname: Savage
authors.affiliation: University of Tennessee Health Sciences Center, 910 Madison Ave., Suite 220, Memphis, TN, 38163, USA. tfabian@uthsc.edu.
authors.forename: T C
authors.initials: TC
authors.lastname: Fabian
keywords: Damage control; Hemorrhage; Resuscitation
references.citation: JAMA Surg. 2013 Oct;148(10):955
references.pmid: 23966234
references.citation: N Engl J Med. 1994 Oct 27;331(17):1105-9
references.pmid: 7935634
references.citation: J Trauma. 2010 Apr;68(4):942-8
references.pmid: 20173661
references.citation: J Trauma. 2011 Aug;71(2 Suppl 3):S358-63
references.pmid: 21814104
references.citation: J Trauma. 1997 May;42(5):857-61; discussion 861-2
references.pmid: 9191667
references.citation: Surg Clin North Am. 2007 Feb;87(1):73-93, vi
references.pmid: 17127124
references.citation: Arch Surg. 2004 Feb;139(2):209-14; discussion 215
references.pmid: 14769582
references.citation: JAMA Surg. 2013 Oct;148(10):947-54
references.pmid: 23965658
references.citation: J Trauma. 2011 Oct;71(4):E79-86
references.pmid: 21610537
references.citation: J Surg Res. 2012 Jun 15;175(2):e75-82
references.pmid: 22316678
references.citation: J Trauma. 1995 Feb;38(2):185-93
references.pmid: 7869433
references.citation: Ann Surg. 2008 Sep;248(3):447-58
references.pmid: 18791365
references.citation: J Orthop Trauma. 2001 Sep-Oct;15(7):468-74
references.pmid: 11602828
references.citation: Ann Surg. 1992 May;215(5):467-74; discussion 474-5
references.pmid: 1616383
references.citation: J Trauma. 2011 Mar;70(3):652-63
references.pmid: 21610356
references.citation: J Am Coll Surg. 2011 Apr;212(4):628-35; discussion 635-7
references.pmid: 21463801
references.citation: Transfusion. 2007 Apr;47(4):599-607
references.pmid: 17381617
references.citation: Am J Surg. 1996 Nov;172(5):405-10
references.pmid: 8942535
references.citation: Transfusion. 2009 Mar;49(3):440-52
references.pmid: 18980623
references.citation: Ann Surg. 1992 May;215(5):476-83; discussion 483-4
references.pmid: 1616384
references.citation: J Trauma. 2006 Jul;61(1):8-12; discussion 12-5
references.pmid: 16832244
references.citation: Surgeon. 2013 Dec;11(6):344-51
references.pmid: 23932669
references.citation: Curr Probl Surg. 2011 Aug;48(8):531-64
references.pmid: 21718901
references.citation: J Trauma Acute Care Surg. 2013 Aug;75(2 Suppl 2):S221-7
references.pmid: 23883912
references.citation: J Trauma. 2010 Jul;69(1):174-8
references.pmid: 20622589
references.citation: Am J Surg. 2001 Dec;182(6):743-51
references.pmid: 11839351
references.citation: US Army Med Dep J. 2011 Apr-Jun;:38-48
references.pmid: 21607905
references.citation: J Trauma. 2008 Aug;65(2):316-24; discussion 324-6
references.pmid: 18695465
references.citation: World J Surg. 2009 Feb;33(2):199-207
references.pmid: 19089494
references.citation: J Trauma Acute Care Surg. 2012 Jul;73(1):282-5
references.pmid: 22743396
references.citation: J Trauma Acute Care Surg. 2012 Dec;73(6):1517-24
references.pmid: 23188245
references.citation: J Trauma. 2011 Dec;71(6):1869-72
references.pmid: 22182896
references.citation: J Trauma. 2010 Jul;69 Suppl 1:S55-63
references.pmid: 20622621
references.citation: J Vasc Surg. 2010 Nov;52(5):1405-9
references.pmid: 20615647
references.citation: Surgery. 2011 Sep;150(3):400-9
references.pmid: 21878225
references.citation: Ann Surg. 1983 May;197(5):532-5
references.pmid: 6847272
references.citation: J Trauma. 2011 Feb;70(2):398-400
references.pmid: 21307740
references.citation: JAMA Surg. 2013 Sep;148(9):834-40
references.pmid: 23864019
references.citation: J Trauma. 2006 Jul;61(1):181-4
references.pmid: 16832268
references.citation: J Trauma. 2011 Mar;70(3):603-10
references.pmid: 21610349
references.citation: Ann Surg. 2011 Oct;254(4):598-605
references.pmid: 21918426
references.citation: Anesth Analg. 2011 Jun;112(6):1289-95
references.pmid: 21346161
references.citation: J Trauma. 2008 Sep;65(3):595-603
references.pmid: 18784573
references.citation: J Trauma. 2008 Aug;65(2):272-6; discussion 276-8
references.pmid: 18695461
references.citation: J Trauma Acute Care Surg. 2013 Feb;74(2):396-400; discussion 400-2
references.pmid: 23354230