PART 2 THE MULTIPLY INJURED PATIENT THE MESSAG

PART 2 THE MULTIPLY INJURED PATIENT

THE MESSAG E DCO - EAC - ETC - WTF Early Skeletal stability = physiological assistance Biology and biomechanics Soft tissues kill Decision making tools

EVOLUTION OF PHILOSOPHY EARLY TOTAL CARE DAMAGE CONTROL EARLY APPROPRIATE CARE

Terrible triad of death Coagulopath y Death Acidosis Hypothermia

CASE 1: Cyclist runover by cement truck HR 128 BP Unrecordabl e p. H 6. 759 Lac 9. 4 Sats 60%

KEY MESSAG E CASE 1 1 Right turn resus 2 3 Damage control orthopaedic s Pelvic infected soft tissues can kill

CASE 2: EARLY APPROPRIATE CARE SKELETAL PHYSIOLOGICAL ASSISTANCE • SKELETAL PHYSIOLOGICAL ASSISTANCE

Minimally invasive techniques KEY MESSAG E CASE 2 Beware the multiple long bone patient Regular reassessment through the case Keep the surgical hit to a minimum

• ADEQUATE RESUSCITATION • DCO - PATIENT IN EXTREMIS • EAC - MINIMIZE THE INSULT THROUGH TECHNIQUE • LIVE TO FIGHT ANOTHER DAY • RESPECT THE BIOLOGY • REGULAR

MAINTAIN CAUTION Inadequate resuscitation Coagulopathy TBI ALI 2 or more long bone fractures – Fat Emboli Syndrome

• THE ISSUE WITH SUSTAINED PERMISSIVE HYPOTENSION – COMPLEMENT CASCADE DISCUSSIO N • RESUSCITATION CHANGES • BIOMARKERS PREDICTIVE BUT ARE THEY USEFUL • NUTRITIONAL SUPPORT ANTI-INFLAMMATORY DIETS FOR PICS