scholarly journals The Berlin Acute Trauma Care Instrument Set (BATMIN) – A Selected Combination of Surgical Instruments for Damage Control and Hemostasis Surgery in Severe Acute Trauma

2020 ◽  
pp. 1-6
Author(s):  
Sven Märdian ◽  
Fitz Klein ◽  
André Solarek ◽  
Lena Nonnen ◽  
Detlef Cwojdzinski ◽  
...  
Keyword(s):  
Trauma Care ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mass Casualty ◽  
Surgical Instruments ◽  
Mass Casualties ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Acute Trauma ◽  
Injured Patients

Abstract A lack of sterile surgical instrument sets for damage control surgeries of severely injured patients became evident in a series of in-hospital mass casualty trainings in the German capital of Berlin. Moreover, the existing instrument trays contained mostly specialized instruments for elective interventions and were not well composed for the treatment of poly-traumatized patients. After a literature search on the most common injury patterns in Mass Casualty Incidents (MCIs), an expert group of surgeons from different disciplines designed an optimized instrument set. A set of 194 instruments was assembled and distributed into two containers. These 2 sets were subjected to a 6-month trial phase in our hospital, and the evaluation of usability was subsequently analyzed through feedback forms administered to the staff. After analysis of the feedback sheets, only minor alterations had to be incorporated. The Berlin Acute Trauma Care Instrument Set (BATMIN) was then made available by the state of Berlin to Berlin Hospitals providing acute trauma care. Out of the need to be prepared for mass casualties, we created an instrument set suitable for the damage control surgery of severely injured patients in individual care and MCIs.

scholarly journals Damage control surgery for splenic trauma: "preserve an organ - preserve a life"

2021 ◽  
Vol 52 (2) ◽  
pp. e4084794
Author(s):  
Carlos Serna ◽  
José Julian Serna ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Linda M Gallego ◽  
...  
Keyword(s):  
Damage Control ◽  
Abdominal Cavity ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Splenic Trauma ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Arterial Bleeding ◽  
Non Operative Management ◽  
Injured Patients

The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

scholarly journals The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

Opportunities for improved trauma care of the elderly – A single center analysis of 2090 severely injured patients

2012 ◽  
Vol 55 (3) ◽  
pp. 660-666 ◽  
Author(s):  
Amadéa Schönenberger ◽  
Adrian T. Billeter ◽  
Burkhardt Seifert ◽  
Valentin Neuhaus ◽  
Otmar Trentz ◽  
...  
Keyword(s):  
Trauma Care ◽  
The Elderly ◽  
Severely Injured ◽  
Single Center ◽  
Severely Injured Patients ◽  
Injured Patients

Vacuum-assisted closure (VAC) for craniocerebral wounds in severely injured patients: technical note of a damage control procedure

2019 ◽  
Vol 165 (6) ◽  
pp. e1-e1
Author(s):  
Christophe Joubert ◽  
A Sellier ◽  
J-B Morvan ◽  
N Beucler ◽  
J Bordes ◽  
...  
Keyword(s):  
Damage Control ◽  
Injured Patient ◽  
Technical Note ◽  
Cerebrospinal Fluid Leakage ◽  
Control Procedure ◽  
Illustrative Case ◽  
Severely Injured ◽  
Vacuum Assisted Closure ◽  
Severely Injured Patients ◽  
Injured Patients

The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described—but not exclusively trauma—cases with no secondary cerebrospinal fluid leakage encountered.

Survival analysis by inflammatory biomarkers in severely injured patients undergoing damage control resuscitation

Surgery ◽  
2021 ◽  
Author(s):  
Taylor E. Wallen ◽  
Dennis Hanseman ◽  
Charles C. Caldwell ◽  
Yao-Wei W. Wang ◽  
Charles E. Wade ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Damage Control ◽  
Inflammatory Biomarkers ◽  
Severely Injured ◽  
Damage Control Resuscitation ◽  
Severely Injured Patients ◽  
Injured Patients

Massive transfusion

2011 ◽  
Author(s):  
K. Boffard
Keyword(s):  
Intensive Care ◽  
Early Intervention ◽  
Intensive Care Units ◽  
Trauma Care ◽  
Massive Transfusion ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Surgeons ◽  
Injured Patients

♦ Treatment of anaemia has changed substantially since the early 1990s♦ Although massive transfusion may be necessary, trauma surgeons have modified their practice to provide aggressive control of haemorrhage, prevent hypothermia and acidosis, optimize haemodynamic management in intensive care units, and rationalize transfusion support in severely injured patients. The result has been an improvement in the outcomes of these patients♦ Given the importance of early intervention in the care of the injured, understanding the physiology and true indications for early massive transfusion in trauma care has the potential to save many lives.

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