Damage Control Resuscitation

Damage control resuscitation is aimed at helping to avoid or diminish the Lethal Triad of Trauma Management: Acidosis, Hypothermia, Coagulopathy. It has three core concepts:

  1. Acute Coagulopathy of Trauma
  2. Permissive Hypotension
  3. Massive Transfusion & Hemostatic Resuscitation

Anaesthesia, Trauma & Critical Care

Topics covered in the manual:-

  • Primary Survey
  • Kinematics of Trauma
  • Airway Trauma
  • Cardio-Thoracic Trauma
  • Shock & Circulation Preservation (including fluid resuscitation, permissive hypotension &massive transfusion protocol)
  • Abdominal Trauma
  • Pelvic Trauma
  • Neuro Trauma
  • Spinal Trauma
  • Extremity Trauma
  • Burns & Thermal Injury
  • Bombs, Blasts & Ballistics
  • Drowning
  • Crush Injury & Suspension Trauma
  • Paediatric & Obstetric Trauma
  • Special Circumstances in Trauma
  • Damage Control Surgery
  • Emergency/Pre-Hospital Surgery
  • Management of Trauma Patients on ITU/Critical Care
  • Transfer of the Critically Ill Patient
  • Trauma Radiology
  • Pre-Hospital Care of the Trauma Patient
  • Mass casualty management/major civilian disasters
  • Casualty triage

 

Adrenaline: It’s just a suggestion

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Epinephrine and other ACLS drugs lead to more patients with ROSC but no increase in the number of patients with good neurologic outcomes after OHCA.

Something that’s very interesting is the actual 2015 ACLS recommendation for epinephrine. It reads, “it is reasonable to consider administering a 1 mg dose of IV/IO epinephrine every 3 to 5 minutes during adult cardiac arrest.” This actually leaves room to not give the medication if the physician thinks it should be withheld.

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Size does matter

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If you want to get big water into your patient, observe the following recommendations:

  1. Gauge is king. Choose the fattest tube you can stick into the patient.
  2. When it comes to catheter length, it’s not the size… it’s how you use it. Shorter catheter lengths mean less resistance.
  3. Consider plugging your drip set directly into the catheter hub instead of using a needle-free adapter or saline lock. The aforementioned study reports significant loss of flow through these types of connectors.
  4. Optimize the pressure difference between the bag and the vein. Place the bag high above the patient and use a compression sleeve, if indicated.

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