COMPLICATIONS OF TORSO TRAUMA
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Transcript of COMPLICATIONS OF TORSO TRAUMA
COMPLICATIONS OF TORSO TRAUMA
2013
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COMPLICATIONS
• AORTIC RUPTURE (DELAYED)• ABDOMINAL COMPARTMENT
SYNDROME (after aggressive resus)• WOUND DISRUPTION • DAMAGE CONTROL• FISTULAE
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AORTIC RUPTURE
• Blunt trauma - deceleration (AP, vertical)• Shock• Chest X Ray – Widened mediastinum • CXR – 100 cm
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AORTIC RUPTURE
• TREATMENT• Control blood pressure – B blockade
Hypotensive resuscitation• Transfer to trauma center • Open repair or stent • Mortality and morbidity high
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Rupture thoracic aorta
• Descending aorta– Mortality (prehospital) 85%– Hospital 50% (48hrs)– Operative 15%
• Paraplegia 8-30%
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ABDOMINAL COMPARTMENT SYNDROME
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ABDOMINAL COMPARTMENT SYNDROME
• INCREASE IN INTRA-ABDOMINAL PRESSURE
• ORGAN DYSFUNCTION• ILEUS• OLIGURIA
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ABDOMINAL COMPARTMENT SYNDROME
• DIAGNOSIS• SUSPICION• PRESSURE MEASUREMENT • INTRA-VESICAL PRESSURE
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ABDOMINAL COMPARTMENT SYNDROME
• TREATMENT- DECOMPRESSION• RESTRICT FLUID RESUS• OPEN ABDOMEN• LEAVE OPEN• TEMPORARY CLOSURE - BOGOTA BAG• SKIN GRAFTING• FINAL REPAIR-LATE
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WOUND DISRUPTION
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WOUND DISRUPTION
• Distension, ileus, compartment syndrome• Ascites, hemorrhage, peritoneal dialysis• Poor nutrition, poor reserves, weak tissue• Infection • Cancer • Technical – sutures, ischemia, tension• Post resuscitation edema
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WOUND DISRUPTION MANAGEMENT
• Resuscitation• Cover bowel to prevent drying, injury• Bogota bag, sandwich dressing• Treat cause• Closure when time is appropriate with
suturing or skin graft
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DAMAGE CONTROL
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DAMAGE CONTROL
• NAVAL TERM FROM WAR- • TO SAVE THE SHIP• CLOSE COMPARTMENTS• TRADE OFF – PREPARED TO
SACRIFICE SOME TO SAVE THE REST
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DAMAGE CONTROL
• SURGERY: TO SAVE THE PATIENT• ABBREVIATED SURGERY• UNCONVENTIONAL APPROACH• STOP BLEEDING• STOP CONTAMINATION• GET OUT (LESS THAN 1 HOUR)
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DAMAGE CONTROL
• LAPAROTOMY- CONTROL BLEEDING,CONTAMINATION
• SHORT PROCEDURE• RESUSCITATE IN ICU:TEMPERATURE,
BLOOD, CIRCULATION• RELOOK WHEN OPTIMISED(<48 HR)-
DEFINITIVE SURGERY, CLOSURE
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DAMAGE CONTROL
• SEVERE INJURIES• LONG PROCEDURES• HYPOTHERMIA• ACIDOSIS• COAGULOPATHY
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DAMAGE CONTROL
• EXTENDED TO OTHER DISCIPLINES• ORTHOPAEDIC SURGERY• NEUROSURGERY• PLASTIC AND RECONSTRUCTIVE S• MAXILLOFACIAL SURGERY• RESUSCITATION
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DAMAGE CONTROL
• DAMAGE CONTROL RESUSCITATION• LIMIT FLUIDS (CRYSTALLOIDS)• GIVE BLOOD EARLY• ADD FFP to PRBC IN RATIO 1:1• ADD PLATELETS 1:1:1 (mega-unit)• MIMIC FRESH WHOLE BLOOD• TEG CONTROL • aFVII
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DAMAGE CONTROL RESUSCITATION
• Permissive hypotention• Isotonic crystalloids vs HT Saline• Trauma related coagulopathy• Resuscitation with blood, FFP, platelets,
cryoprecipitate, aFvii• Damage control surgery
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FISTULA
• DEFINITION: AN OPENING BETWEEN TWO EPITHELIAL SURFACES
• PRACTICAL: MOSTLY AN HOLE IN THE BOWEL
• LEAKS BOWEL CONTENT INTO WOUND
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FISTULA
• METABOLIC EFFECTS: FLUID LOSS, ELECTROLYTES LOSS
• MALNUTRITION, PROTEIN LOSS• IMMUNE SUPPRESSION• INFECTION RATE HIGH• POOR WOUND HEALING
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FISTULA : TREATMENT
• NIL PER MOUTH• PARENTERAL FLUIDS,
ELECTROLYTES, NUTRITION• TREAT INFECTION• WOUND MANAGEMENT: ISOLATE
FLUID FROM BOWEL, RE-INFUSE
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FISTULA
• CAUSES FOR NON-CLOSURE– CAVITY– FOREIGN OBJECT– DISTAL OBSTRUCTION– MALIGNANCY– MALNUTRITION
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End
• Thank you
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