Damage control in the emergency department, a bridge to life
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Patients with hemodynamic instability have a sustained systolic blood pressure less or equal to 90 mmHg, a heart rate greater or equal to 120 beats per minute and an acute compromise of the ventilation/oxygenation ratio and/or an altered state of consciousness upon admission. These patients have higher mortality rates due to massive hemorrhage, airway injury and/or impaired ventilation. Damage control resuscitation is a systematic approach that aims to limit physiologic deterioration through a group of strategies that address the physiologic debt of trauma. This article aims to describe the experience earned by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia in the management of the severely injured trauma patient in the emergency department following the basic principles of damage control surgery. Since bleeding is the main cause of death, the management of the severely injured trauma patient in the emergency department requires a multidisciplinary team, which should perform damage control maneuvers aimed at rapidly control bleeding, hemostatic resuscitation and/or prompt transfer to the operating room, if required.
Laureano Quintero, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia.
https://orcid.org/0000-0001-8730-2447
Juan Jose Melendez-Lugo, Department of Surgery, Caja Costarricense del Seguro Social – San José, Costa Rica.
https://orcid.org/0000-0002-3351-9971
Helmer Emilio Palacios-Rodríguez, Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.
https://orcid.org/0000-0002-6684-982X
Natalia Padilla, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No. 18 - 49, Cali 760032, Colombia
Luis Fernando Pino, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
https://orcid.org/0000-0002-1179-2854
Alberto García, Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.
Adolfo Gonzalez-Hadad, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia.
https://orcid.org/0000-0001-5862-4906
Mario Alaín Herrera, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
Alexander Salcedo, Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
Jose Julián Serna, Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
https://orcid.org/0000-0001-9829-8930
Fernando Rodriguez-Holguín, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia
https://orcid.org/0000-0002-5326-2317
Michael Parra, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA
https://orcid.org/0000-0001-6496-6275
Carlos Alberto Ordoñez, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia.
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Accepted 2021-05-27
Published 2021-06-05
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