Ebook Surgical decision making beyond the evidence based surgery: Part 2
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Ebook Surgical decision making beyond the evidence based surgery: Part 2
Part IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2Gaby Jabbour, and Rifat LatifiIntroductionTraditionally, the common surgical practice included the completion of the operation regardless of the physiologic condition of the patient. However, in trauma patients this can be challenging. Therefore, multiple strategies were developed to avoid this dile Ebook Surgical decision making beyond the evidence based surgery: Part 2mma.While the damage control (DC) has become popular in the last few decades, this is not a new concept. Historically, the management of devastating aEbook Surgical decision making beyond the evidence based surgery: Part 2
bdominal injuries has been documented by the work of others, but the most well-known surgeon is Pringle, who described the use of packs and digital coPart IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2, Division of Trauma Surgery. Hamad General Hospital and Hamad Medical Corporation. Al Rayyan Rd.PO Box 3050. Doha. Qatar e-mail: rperaltamd@gmail.comG. Jahbour. M.D.Division of Trauma Surgery. Department of Surgery.Hamad Medical Corporation.Al Rayyan Rd. PO Box 3050. Doha. Qatar e-mail: Jabbouigaby Ebook Surgical decision making beyond the evidence based surgery: Part 29@hotmail.comR. Latifi. M.D.. F.A.C.S.Department of Surgery, Westchester Medical Center.New York Medical College. 100 Woods Road. Valhalla. NY 10595,Ebook Surgical decision making beyond the evidence based surgery: Part 2
USADepartment of Surgery. University of Arizona.Tucson. AZ. USAe-mail: Rifat.latili@gmail.comWorld War II described the use of open abdomen technique Part IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2e described the modem concept of abbreviated laparotomy in 1983 |4]: hemorrhage was controlled by tamponade: bowel injuries were resected: noncritical injured vessels were ligated: and biliopancreatic injuries were drained. Later, these patients underwent definitive repairs. The term "damage control Ebook Surgical decision making beyond the evidence based surgery: Part 2” was popularized by Rotondo in the 1990s |5J. and has become a powerful tool in the management of severely injured patients.Indications and Timing ofEbook Surgical decision making beyond the evidence based surgery: Part 2
Damage ControlDamage control includes the termination of the surgery after controlling bleeding and contamination. and before the patient physiologicPart IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2is delayed until the patient is stabilized.When a surgeon is operating in a patient with hemodynamic instability, hypothermia (<35 °C), coagulopathy, severe metabolic acidosis (pH < 7.2 or base deficit >8). multiple injuries, massive transfusion requirements (>10 units packed red blood cells), and l Ebook Surgical decision making beyond the evidence based surgery: Part 2ong operative time (>90 min) for trauma or emergency, he or she should think of abbreviating the procedure 16. 7|.© Springer International PublishingEbook Surgical decision making beyond the evidence based surgery: Part 2
Switzerland 2016R. Latifi. Surgical Decision Making, DOI 10.1007/978-3-319-29824-5_99596R. Peralta et al.The Damage Control Operation for TraumaWhile Part IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2nd blunt, in general, most frequently it is done in liver injuries and vascular injuries |4. 5]. Initial hemorrhagic control is achieved by packing of the liver, and most vascular injuries can be treated by packing, simple ligation, or temporary intraluminal shunts [6. 7|. Hollow viscus injuries are Ebook Surgical decision making beyond the evidence based surgery: Part 2 treated by resection of affected areas, and anastomosis is postponed until the patient is stabilized. The majority of bi I-iopancreatic injuries canEbook Surgical decision making beyond the evidence based surgery: Part 2
be treated with closed suction drainage [8], Pre-peritoneal packing has gained popularity in recent years and is performed when there is significant pPart IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2 close the abdomen, in order to avoid abdominal compartment syndrome due to massive fluid resuscitation.By using hemostatic resuscitation instead of massive crystalloid resuscitation, the need for leaving the abdomen open has decreased significantly, and. thus, DC. once overused, is being used less. Ebook Surgical decision making beyond the evidence based surgery: Part 2 Another new technique in the management of trauma patients that has become more popular is permissive hypotension whenever clinical conditions permitEbook Surgical decision making beyond the evidence based surgery: Part 2
.Significantly less frequently. DC is done in isolated chest injuries, with exception for a short period of DC during emergency resuscitative thoracotPart IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2 has to pack the chest wall temporarily due to massive rib fractures associated with chest wall soft tissue destruction. Other compartments where DC may be done are extremity soft tissue injuries, particularly associated with vascular injuries, requiring revascularization.Hemostatic ResuscitationDur Ebook Surgical decision making beyond the evidence based surgery: Part 2ing the initial evaluation and management, intraoperatively and following termination or abbreviated surgery, resuscitation continues. This includes rEbook Surgical decision making beyond the evidence based surgery: Part 2
esuscitation with intravenous fluids and early administration of blood products and prevention of and correction of the lethal triad. Warm room and aiPart IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, G Ebook Surgical decision making beyond the evidence based surgery: Part 2re all fluids and blood products should be infused warmed into the patient. In rare cases, described continuous arteriovenous rewarming can be Used, a technique that permits rapid rewarming of hypothermic patients without requiring cardiopulmonary bypass or heparinization in severely hypothermic pat Ebook Surgical decision making beyond the evidence based surgery: Part 2ients as described by Gentilello et al. [13, 141.Part IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, GPart IIDifficult Clinical-Based Surgical DecisionsSurgical Decision-Making Process and Damage Control: Current Principles and PracticeRuben Peralta, GGọi ngay
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