Professional Documents
Culture Documents
RH/JA/RK
Definition of Polytrauma
A syndrome of multiple injuries (ISS>17), with systemic
traumatic reaction, which may lead to dysfunction or
failure organs and vital system, which had not
themselves been directly injured.
Damage Control Orthopaedics. Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic
Trauma,J Bone Joint Surg Am. 87:434-449, 2005.
Polytrauma
Injury to 2 or more organ systems leading
potentially to a life threatening condition
Physiological response to injury
Inflammatory immune response
Innateimmune response : Systemic Inflammatory
Response Syndrome (SIRS)
2 of 4 parameters = SIRS
Delayed adaptive immune response
Non-apoptotic necrotic/dead cells produce
alarmins plus Endogenous triggers (DAMPs =
damage-associated molecular patterns)
CD5+ B-cells to produce natural antibody
without prior exposure and subsets of T-cells to
inflict self-reactivity autoimmune tissue
destruction
Considered the immunosuppression period or
CARS
Systemic Response
Anti-inflammatory Pro-inflammatory
Insult
SIRS
CARS
D7
Response
Response
Innate Immune
Adaptive Immune
D14
Homeostasis
Mild-Moderate Injury
Severe Injury
Anti-inflammatory Pro-inflammatory
SIRS
Systemic Response
Insult
Innate Immune
Response
Adaptive Immune
Response
CARS
SIRS
2nd Hit
Systemic Response
Insult
Innate Immune
Response
Adaptive Immune
Response
CARS
Fluid Replacement Crystalloid Crystalloid Crystalloid and blood Crystalloid and Blood
Coagulopathy
Lethal
Voluminous crystalloid Triad of
dilutes coagulation factors Death
causes hyperchloremic and lactate acidosis
supplies inadequate O2 to under-perfused Hypothermia Acidosis
tissue
DCR Priorities Beyond ABCDE of ATLS
On-going Bleeding
Hypoperfusion
Exposure
SIRS/CARS
Resuscitation
Contamination
2. Haemostatic Resuscitation
Early blood versus HBOC (Hemoglobin based oxygen carrier)
transfusion decreases MODS
Packed RBC, FFP and Platelets in 1:1:1 ratio
Cryoprecipitate, Tranexamic acid, Recombinant factor-VIIa
Storage blood of < 2 weeks to minimise TRALI, MODS
Non-surgical DCR
Stable Uncertain
Stage 1
Stage 2 Stage 3
AO Philosophy
Damage Control Orthopaedics. Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic
Trauma,J Bone Joint Surg Am. 87:434-449, 2005.
Algorithm initial assessment, life support
& day 1 surgery
Damage Control Orthopaedics. Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic
Trauma,J Bone Joint Surg Am. 87:434-449, 2005.
Fixation method (Pro and Cons)
Nailing
Pro : the method of choice for shaft femur or tibia fracture
Cons : Reamed or unreamed Has an adverse effect pulmonary embolism
Platting
Pro : allow better bleeding control, permit debridement and
fasciotomies
Cons : Requires major surgical access
External fixation
Pro : its fast !!!
Cons : insufficient for definitive treatment, pin track infection
Damage Control Orthopaedics. Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic
Trauma,J Bone Joint Surg Am. 87:434-449, 2005.
THANK YOU