Not all bleeding stops: acute coagulopathy of trauma by Brohi
Damage Control in Trauma by Brohi
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DAMAGE CONTROL RESUSCITATION Centre for Trauma Sciences Queen Mary University of London www.c4ts.qmul.ac.uk Royal London Major Trauma Centre Barts Health NHS Trust KARIM BROHI, FRCS FRCA Professor of Trauma Sciences, QMUL
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Damage control strategies. Karim Brohi outlines the critical concepts for the managment of the actively bleeding patient.
Transcript of Damage Control in Trauma by Brohi
DAMAGE CONTROL RESUSCITATION
Centre for Trauma SciencesQueen Mary University of Londonwww.c4ts.qmul.ac.uk
Royal London Major Trauma CentreBarts Health NHS Trust
KARIM BROHI, FRCS FRCAProfessor of Trauma Sciences, QMUL
National Trauma Haemorrhage Mortality Rates
43%
0
10
20
30
40
50
60
70
ISS > 15 ISS > 24Injury Severity Score
Mo
rta
lity
(%
)
RLHMSHCH
*
*
Comparative Mortality
Damage Control Resuscitation
Damage Control Resuscitation
MAINTAIN HAEMOSTATICCOMPETENCE
Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
Haemorrhage Control
Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
Haemorrhage ControlManage Sepsis
Protect from further injury
Trauma patients are more likely to die from intra-operative metabolic failure than from a failure to complete operative repairs.
Restoration of Physiology(ICU)
What is it really?
FAILURE:
FAILURE: to maintain homeostasis
FAILURE: to protect cells, tissues & organs
FAILURE: to preserve endothelial integrity
What’s bad about DCS?
Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
Trauma
Hemorrhage
Shock
ATC
TRAUMA-INDUCED COAGULOPATHY (TIC)
Trauma
Hemorrhage
Genetics
Shock
Fibrinolysis Inflammation Hypothermia Acidemia
Loss, Dilution
ATC
TRAUMA-INDUCED COAGULOPATHY (TIC)
750 ml crystalloid
1U PRBC
750 ml crystalloid
4U PRBC2 FFP
4500 ml crystalloid500 colloid8U PRBC7U FFP1 PLT, 2 CRYO
7500 ml crystalloid1000 colloid12U PRBC8U FFP1 PLT, 2 CRYO
0.3 0.4 0.5 0.6 0.7 0.8 0.9
30
40
50
60
70
80
Center Mean FFP:RBC
Pe
rce
nt S
urv
ivin
g
AB
BC
FF
GH
HI
IJ
LM
MM
OP
PP
ST
VX
WWWX
XY
p = 0.05R2 = 0.19
34 ISS 4427 ISS 3422 ISS 27
*
*
0
10
20
30
40
50
60
70
ISS > 15 ISS > 24Injury Severity Score
Mo
rta
lity
(%
)
RLHMSHCH
*
*
Comparative Mortality
Damage Control Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
