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GSW to abdomen

Avi Roy Shapira trauma-list@trauma.org
Mon, 7 Apr 2003 10:24:19 +0300 (IDT)


Damage control should have ben decided upon in the emergency room, before
the patient was taken to the OR.  

You don't switch to DC mode in the middle of an operation, or when you see
that the patient had lost his physiologic reserves.  The purpose of DC is
to prevent the lose of these reserves.

A good DC operation should last 30-40 min skin to skin. If much longer
than that, it is no longer DC but an abbreviated laparotomy. 

Avi 


On Sat, 5 Apr 2003, azonic75 wrote:

> Would like some feedback/wisdom/criticism regarding a
> recent case....
> 
> 26 y/o male presents with multiple GSW, one to the
> left chest mid axillary line 9th ICS, another on the
> left just below the costal margin. Combative in ED,
> intubated, left chest tube placed with minimal output,
> HR 140, SBP 60. Taken to OR where laparotomy reveals
> ~2L blood in belly, 6 SB enterotomies, enterotomy in
> transverse colon near the splenic flexture, injury to
> distal left iliac vein and artery and diaphragmatic
> injury. 
> 
> We performed a colonic resection with ostomy, resected
> the area of SB with the enterotomies (~2 feet) and
> made one anastomosis. Iliac injuries were repaired
> after  obtaining proximal control at the aorta and
> distally with compression
> 
> As expected pt became cold, acidotic, coagulopathic
> and eventually arrested
> 
> What may have been done differently? At what point
> would you apply damage control principles? The
> vascular injuries did not appear amenable to
> packing....Any thoughts?
> 
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==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel
 
email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390