Presentation Damage Control in Thoracic Surgery.ppt

•The traditional approach to combat injury care is surgical exploration with definitive repair of all injuries

•This approach is successful when there are a limited number of injuries

•Prolonged operative times and persistent bleeding lead to the lethal triad of coagulopahty, acidosis, and hypothermia, resulting in a mortality of 90 %

•Developed from successes in rapid liver packing in early 1980.

•Transition to packing of other injuries in the cold, acidotic, exsanguinating patient.

•The concept has extended to thoracic, neck, orthopaedic, urologic and gynae trauma.

•DC is a continuous process from the field to definitive care

Damage control is defined as the rapid initial control of hemorrhage and Damage control is defined as the rapid initial control of hemorrhage and

contamination, temporary closure, resuscitation to normal physiology in thecontamination, temporary closure, resuscitation to normal physiology in the

ICU, and subsequent re-exploration and definitive repair. ICU, and subsequent re-exploration and definitive repair. This approachThis approach

reduces mortality to 50 % civilian settingsreduces mortality to 50 % civilian settings

•Damage Control is deliberate and calculated surgical approach requiring mature surgical judgement

•DC should be employed at any stage the indication for it become apparent

•Make the decision early and do it

•Avoid the three dark angels

Damage Control is selectiveDamage Control is selective

Hypothermia T < 35

Acidosis pH < 7.2

Coagulopathy APTT > 60

• Go fast

• Release tamponade

• Gain haemostasis

• Definitive repairs dictated by injury and patient

•ISS > 35

•Prolonged exposure

•Shock > 70 minutes

•Massive transfusion

1. Prehospital

2. Operative

3. ICU

4. Definitive Care

•Lateral, clamshell or midline incision

•Evacuate clot

•Pack apex

•Open pericardium

•Incise inferior pulmonary ligament

•Definitive procedures as appropriate : heart, lungs, aorta, chest wall, vascular

•Chest wall : fist to apex, apical and costophrenic packs, suture

•Lung : hilar twist, hilar clamp, stapled tractotomy, lobectomy

•Heart : long pericardiotomy, pledgeted sutures, clips, foley, finger

•Oesophagus : diversion and wide drainage

•Vascular : clamp, ligate, suture, shunt

bedah jantung 006.WMV

bedah jantung 006.WMV

Nn. Wwk/♀/ 20 th MRS : 12/11/2004

Dx masuk :

Pneumothorax bilateral + Tension Pneumothorax S + Emfisema Subkutis LuasCF. Costa 2,5,6,7,8,9 (S) posterior

MRS : 12/11/2004

Foto thorax tgl : 11-11-2004(foto inisial)

Foto thorax tgl : 11-11-2004(post pasang BD kiri)

Foto thorax tgl : 11-11-2004(post pasang BD kanan)

Foto thorax tgl : 12-11-2004(post pasang BD hari 1)

Foto thorax tgl : 16-11-2004(post pasang drain hari 5)

BRONCHOSCOPY IRD LT 5, 17/11/2004

Foto thorax tgl : 18-11-2004(post Bronchoscopy 1)

THORACOTOMY LATERAL SINISTRAIRD LT 5, 19/11/2004

TAMPAK PARU KIRI YANG KOLAPS DAN PARENKIM PARU ROBEK KARENA FRAGMEN TULANG KOSTA YANG MENUSUK PARENKIM PARU

TAMPAK BRONKUS UTAMA KIRI YANG RUPTUR TOTAL (1,5 cm dari carina, permukaan tidak teratur)

GAMBARAN MEMAR PARU SETELAH DIANGKAT

Berapa ya

Satu kilonya ?

Foto thorax tgl : 27-11-2004

(post Pneumectomy Sin. hari ke-8

Post angkat drain kanan hari 1)

MULTIDICIPLINE, MULTITRAUMA SCIENTIFIC MEETING.