Damage Control Surgery

Question 1

Principles of bleeding mx?

Answer 1

Pressure, traction/splintage, sutures, splints/traction, haemostatic gauze, correct coag, resus oxygen/blood products/correct coat

Question 2

What investigations do quickly?

Answer 2

USS - FAST, CXR, Clotting screen, Blood gas - Lactate good measure

Question 3

Why do deflate REBOA quickly?

Answer 3

Reduce reperfusion injury quickly

Question 4

Where do you get reverse flow in the head?

Answer 4

From ECA to ICA (ICA ligation leads to stroke more commonly)

Question 5

What happens if children are hypo perfused more often than adults?

Answer 5

Develop collaterals, must perfuse growth plates!!

Question 6

What can be done for a femoral shaft fracture?

Answer 6

shunt plus external fixator, create bypass to allow perfusion.

Question 7

Damage Control Surgery?

Answer 7

Summary: ligation/shunting, ex fix/traction, burr holes, stapling of gut

Question 8

What might you do when reducing haemothorax?

Answer 8

Reduce circulating volume

Question 9

How might you get proximal control in bleeding lung?

Answer 9

Twist hilum/clamp

Question 10

Bleeding liver?

Answer 10

Pack liver/lobe resection?

Ligate IVC

Question 11

What is the Pringle manoeuvre?

Answer 11

Clamping of the hepatoduodenal ligament (free border of the lesser omentum) interrupting the flow of blood through the hepatic artery and the portal vein and thus helping to control bleeding from the liver. Can use manual or clamp