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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