Vous êtes sur la page 1sur 44

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


contamination, temporary closure, resuscitation to normal physiology in the
ICU, and subsequent re-exploration and definitive repair. This approach
reduces mortality to 50 % civilian settings

Damage Control is selective

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

Hypothermia T < 35

Acidosis pH < 7.2

Coagulopathy APTT > 60

Go

fast

Release tamponade
Gain haemostasis
Definitive repairs dictated by injury and patient

35
>
S
re
IS
u
s
o
xp
e
d
e
ng
o
l
o
r
P
tes
u
n
i
m
0
7
>
k
on
Shoc
i
s
u
f
ns
a
r
t
e
iv
s
s
a
M

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 Luas
CF. 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 SINISTRA


IRD 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)

Berapa
ya
Satu
kilonya ?

GAMBARAN MEMAR PARU SETELAH DIANGKAT

4
0
0
2
1
1
7
2
:
l
g
t
x
a
8
r
o
e
h
k
t
i
r
o
a
t
h
o
.
F
n
i
S
y
m
o
t
c
e
)
m
1
u
i
e
r
n
a
P
h
t
n
s
a
n
a
(po
k
n
i
a
r
d
t
a
k
g
n
a
Post

MULTIDICIPLINE, MULTITRAUMA SCIENTIFIC MEETING.