Jump to content


Photo

"damage Control Resuscitation"


  • Please log in to reply
4 replies to this topic

#1 Gila

Gila

    Advanced Member

  • Members
  • PipPipPip
  • 588 posts

Posted 22 January 2008 - 03:47 PM

I read a case study on a marine who received thoracic and abdominal injuries while serving OCONUS. He ended up developing DIC and ARDS along with other post trauma complications. The article talked about using "Damage Control Resuscitation" with this soldier and other soldiers. Crystalloids and isotonic fluids are avoided. From what I gather, PRBC's and thawed plasma is given at a 1:1 ratio.

I have known about the concept of permissive hypotension and avoiding aggressive fluid therapy for uncontrolled internal hemorrhage. However, I would like to hear how this "Damage Control Resuscitation" is working out from the people who are serving or have served.

I would be happy to quote the source of the case review if it would be helpful.
  • 0
Christopher Bare
"Non fui, fui, non sum, non curo "

#2 SickPuppy

SickPuppy

    Advanced Member

  • Members
  • PipPipPip
  • 116 posts

Posted 23 January 2008 - 02:22 PM

Great case topic- thanks for bringing this up.

As for what practices I encountered in Balad- there was no exact science to it. We did give PRBC and FFP in 1:1 ratios to anybody with severe injuries, but there wasn't a science to the crystaloids (some would get 1 liter, others would get 4 liters). Antecdotally, I didn't see any greater instance of DIC with either patients that received greater amounts of crystaloids. There seemed to be some other factor that came into play (we would give Factor VII to patients who were bleeding really badly) in the cases of DIC that I saw (there didn't seem to me to be any direct correlation between the amount of crystaloids and incidence of DIC). These are just my observations, though.
  • 0
"Education is only the further realization of your own ignorance." Albert Einstein

GO GATORS!!!

#3 Gila

Gila

    Advanced Member

  • Members
  • PipPipPip
  • 588 posts

Posted 23 January 2008 - 02:29 PM

Thanks for the reply. So, crystalloids are given to these patients in additon to colloids? Did you start off with the 1:1 colloids or did you transition to this modality only after the development of DIC and other complications?
  • 0
Christopher Bare
"Non fui, fui, non sum, non curo "

#4 SickPuppy

SickPuppy

    Advanced Member

  • Members
  • PipPipPip
  • 116 posts

Posted 24 January 2008 - 11:56 PM

Thanks for the reply. So, crystalloids are given to these patients in additon to colloids? Did you start off with the 1:1 colloids or did you transition to this modality only after the development of DIC and other complications?

The colloids were started immediately if the injury was severe. The crystaloids were just an addition to the colloids (if the pt was too hypovolemic). Like I said- DIC seemed to be from some other insult.
  • 0
"Education is only the further realization of your own ignorance." Albert Einstein

GO GATORS!!!

#5 sammedic

sammedic

    Member

  • Members
  • PipPip
  • 17 posts

Posted 25 January 2008 - 01:39 AM

I cannot comment on "damage control resuscitation." However, when I used to work in the blood bank department of the lab when I was a generalist, I would get the occasional patient in DIC. A day in blood bank with a patient in DIC is definitely a BAD day. I had one patient that I crossmatched and released 108 different blood products within a 24-hr period (I worked 16-hr shifts on weekends). He died anyway but I digress ...

After identifying and attempting to reverse the CAUSE of the DIC ... since treating the DIC without treating the cause is a pointless effort, lots of products from the blood bank are appropriate therapy. Plus, if you can catch it early enough, heparin therapy is indicated too. Anyhooooo ... many of the DIC patients that I worked with received PRBCs, FFP, cryoprecipitate and platelets. Lots and lots of all of these based on a case-by-case basis of progression and resolution.

Don't know if this helps at all to muddy the waters here, but it is my humble contribution to one of the more interesting and complex pathological phenomenon out there ... DIC (we always referred to it as Death Is Coming).
  • 0