Damage control resuscitation technique explained in easy way.

1. DCR: DAMAGE CONTROL
RESUSCITATION
BY
Dr. Valerio Pisano Brasca MD.

2. TECHNIQUE
EFFECTIVE IN
MANAGEMENT
OF
BLEEDING
TRAUMA

3. LETHAL TRIAD OR
LETHAL CIRCLE
- COAGULOPATHY OF TRAUMA
-ACIDOSIS
-HYPOTHERMIA

4. DAMAGE
CONTROL
RESUSCITATION
1) HAEMOSTATIC
RESUSCITATION
2)PERMISSIVE HYPOTENSION
3)DAMAGE CONTROL SURGERY

5. HAEMOSTATIC
RESUSCITATION
“FIND THE BLEEDING, STOP THE
BLEEDING”
- DIRECT PRESSURE AND ELEVATION
-HAEMOSTATIC DRESSING
-TOURNIQUETS
-REDUCE AND SPLINT LONG BONES AND PELVIC
FRACTURES
- SEARCH HELP OF SURGEON ASAP FOR CLOSED
BLEEDING WOUNDS

6. BLOOD PRODUCTS ASAP IN A RATIO OF 1:1:1 (1 U
PCRB:1 U PLASMA: 1 U PLATELETS)
ACHIEVE THIS RATIO WITHIN 6 HOURS

7. TRANEXAMIC ACID
1g IV OVER 10 MINS,
1g IV OVER 8
HOURS
FIBRINOGEN 1U
EVERY 10 KG OF
WEIGHT

8. permissive hypotension
“…. Injectionof a fluid that increase blood
pressure has dangers in itself…. If the pressure
is raised before the surgeon is ready to check
any bleeding that might place, blood that is
sorely needed maybe lost.” Cit. Walter Cannon,
1918

9. PERMISSIVE
HYPOTENSION
- Allow SBP to fall low enough to avoid exanguination but keep high
enough to maintain perfusion.
- Goal is to avoid disruption of unstable clot by higher pressure and
worsening bleeding.
-avoid cyclic over-resuscitation that can lead to rebleeding.
- Low BP is not the target; is a compromise pending emergency
surgical intervention;
- The target IS Haemorragy control (Haemostasis and Surgery)

10. PERMISSIVE
HYPOTENSION
SBP GOALS IN PERMISSIVE HYPOTENSION
APPROACH:
- PENETRATING INJURIES AND CLOSED
BLEEDING TRAUMA INJURIES: 80-90 mmHg
- IF ASSOCIATED TBI:100 mmHg
-IF ISOLATED TBI: 110 mmHg

11. PERMISSIVE
HYPOTENSION
PALPABLE RADIAL
PULSE: SBP OVER 80
mmHg
PALPABLE FEMORAL
PULSE: SBP 70-80 mmHg
PALPABLE CAROTID
PULSE:SBP 60-70 mmHg

12. DAMAGE CONTROL
SURGERY
DAMAGE CONTROL SURGERY REFERS
TO LIMITED SURGICAL INTERVENTIONS
THAT SERVE TO CONTROL
HAEMORRAGE AND MINIMIZE
CONTAMINATION UNTIL PATIENT HAS
SUFFICIENT PHYSIOLOGICAL RESERVE
TO UNDERGO DEFINITIVE
INTERVENTIONS.
THIS STRATEGY AIMS TO BRING THE
“LETHAL TRIAD” UNDER CONTROL, SO
THAT THE PATIENT WILL BE ABLE TO
TOLERATE FURTHER SURGERY ONCE
HE OR SHE IMPROVES.

13. BULLET POINTS
AIM OF DCS: KEEP UNDER CONTROL LETHAL TRIAD UNTIL DEFINITIVE TREATMENT.
PERMISSIVE HYPOTENSION: RISE SBP WITH FLUID AND/OR BLOOD PRODUCTS TO A MINIMUM
STANDARD TO AVOID PERPETRATION OF HAEMORRAGE BUT ALSO GUARANTEE PERFUSION OF
VITAL ORGANS.
HAEMOSTATIC RESUSCITATION:
- FIND THE BLEEDING, STOP THE BLEEDING.
- RESUSCITATE WITH BLOOD PRODUCTS ASAP TO AVOID DETRIMENTAL EFFECTS OF USE OF LARGE
AMOUNT OF CRISTALLOIDS.
- USE BLOOD PRODUCTS RATIO OF 1PBRC:1FFP:1PLT (TO BE ACHIEVED BY 6 HOURS).
DAMAGE CONTROL SURGERY: LIMITED SURGICAL INTERVENTIONS THAT SERVE TO CONTROL
HAEMORRAGE AND MINIMIZE CONTAMINATION UNTIL PATIENT HAS SUFFICIENT PHYSIOLOGICAL
RESERVE TO UNDERGO DEFINITIVE INTERVENTIONS.

14. FIN