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Question 20 from the first paper of 2011 and Question 21 from the second paper of 2008 discuss the principles of damage control surgery in trauma, the practice of repairing lifethreatening injuries quickly, and leaving the definitive management until physiological normality is restored.
The LITFL page on damage control surgery is an excellent introduction to the subject. Godat et al (2013) cover the topic with satisfactory detail, which is perhaps excessive when it comes to last minute cramming; it was the major source for this summary chapter. A good article on this is also vailable from 2004 (Critical Care Clinics). For a complete bibliography on this subject, one is directed to trauma.org.
Historically, much of the mortality and morbidity from trauma was associated with the early attempt at repair. Attempts were made to complete the definitive management early, in the first operation. The repair attempts turned into prolonged procedure,s lasting many hours. Frequently such rescues were attempted by teams composed of mainly junior staff, and out of normal working hours. Attempts to subject unstable trauma patients to these "classical" long laparotomies were frustrated by failure. This is because hypothermia, acidosis, and coagulopathy render attempts at definitive surgical repair less likely to succeed. Thus, the rationale for damage control surgery is early surgical control of immediately lifethreatening injuries and the establishment of haemostasis. Definitive management can be delayed in most cases; the patient can spend some time in ICU getting their physiology un-deranged. Definitive management can take place safely (and is more likely to succeed) once the physiological abnormalities are corrected. The timing can be negotiated with the surgical teams, so that the optimum level of expertise can be present.
This has had a marked effect on mortality. The first publication on this topic (Stone et al, 1983) offers a nightmarish glimpse of the bloodied hell-scape that was early trauma surgery. Thirty one patients who developed lethal coagulopathy in theatre were enrolled. Of the "traditional" surgical approach, the mortality rate was 98%. The others were quickly clamped and packed, and taken to ICU with their abdomens open. Their return to theatre was dictated by the resolution of their coagulopthy. The abdominal packs were left in for an average of about 27 hours; then definitive management took place.
The mortality rate from this was 35%.
I was able to find this list of indications in Godat's 2013 position paper. It, in turn, draws on Rotondo and Zonies' "The damage control sequence and underlying logic" (1997). In trauma patients, the pre-operative indications include the following:
Remember that the patient was not being definitively managed in theatre; if you are lucky they are bleeding slightly less than they were before they went to theatre, but in general the resuscitation is only half-complete. Not only that, but they were probably rushed through the ED, and a secondary survey (or trauma CT) may not have been performed.
Thus, one can anticipate the following:
While recovering from one horrendoplasty and while waiting for the next one, the ICU team has several jobs to do. The emphasis for rescuing the patient has shifted from ED procedures (who now merely triage the trauma) and from the surgical team (who do a quick clamp-and-burn). Now, the ICU is in charge of the bulk of the resuscitation, which - some might argue - is how it should be.
An excellent 2006 article by Sagraves et al ("Damage control surgery—the intensivist's role") does this topic justice with the appropriate amount of detail. The domains of ICU management can be discussed in a familiar sequence, starting with the airway.
Kaafarani, H. M. A., and G. C. Velmahos. "Damage Control Resuscitation In Trauma." Scandinavian Journal of Surgery (2014): 1457496914524388.
Jaunoo, S. S., and D. P. Harji. "Damage control surgery." International Journal of Surgery 7.2 (2009): 110-113.
Schreiber, Martin A. "Damage control surgery." Critical care clinics 20.1 (2004): 101-118.
ATLS student course manual, 8th edition (Chapter 5) - American College of Surgeons Committee on Trauma
Stone, H. Harlan, Priscilla R. Strom, and Richard J. Mullins. "Management of the major coagulopathy with onset during laparotomy." Annals of surgery 197.5 (1983): 532.
Godat, Laura, et al. "Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper." World J Emerg Surg 8.1 (2013): 53.
Sagraves, Scott G., Eric A. Toschlog, and Michael F. Rotondo. "Damage control surgery—the intensivist's role." Journal of intensive care medicine 21.1 (2006): 5-16.
Rotondo, Michael F., and David H. Zonies. "The damage control sequence and underlying logic." Surgical Clinics of North America 77.4 (1997): 761-777.