Damage control in the emergency department, a bridge to life

Quintero, Laureano; Meléndez-Lugo, Juan José; Palacios-Rodríguez, Helmer Emilio; Caicedo, Yaset; Padilla, Natalia; Gallego, Linda M; Pino, Luis Fernando; García, Alberto; González-Hadad, Adolfo; Herrera, Mario Alain; Salcedo, Alexander; Serna, José Julián; Rodríguez-Holguín, Fernando; Parra, Michael W.; Ordóñez, Carlos A.

doi:10.25100/cm.v52i2.4801

Cited by 3 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, REBOA could be a bridge between hemodynamic support and final hemorrhage control. 9,32,40,41 This strategy must rely on ongoing endovascular skills training and the formation of a multidisciplinary team with a well-trained trauma surgeon at its head. [41][42][43]…”

Section: Discussionmentioning

confidence: 99%

Critical systolic blood pressure threshold for endovascular aortic occlusion—A multinational analysis to determine when to place a REBOA

Ordoñez,

Parra,

Caicedo

et al. 2023

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

Background Systolic blood pressure (SBP) is a potential indicator that could guide when to use a resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma patients with life-threatening injuries. This study aims to determine the optimal SBP threshold for REBOA placement by analyzing the association between SBP pre-REBOA and 24-hour mortality in severely injured hemodynamically unstable trauma patients. Methods We performed a pooled analysis of the Aortic Balloon Occlusion (ABO) trauma and AORTA registries. These databases record the details related to the use of REBOA and include data from 14 countries worldwide. We included patients who had suffered penetrating and/or blunt trauma. Patients who arrived at the hospital with a SBP pre-REBOA of 0 mm Hg and remained at 0 mm Hg after balloon inflation were excluded. We evaluated the impact that SBP pre-REBOA had on the probability of death in the first 24 hours. Results A total of 1107 patients underwent endovascular aortic occlusion, of these, 848 met inclusion criteria. The median age was 44 years [IQR, 27-59 years] and 643(76%) were male. The median injury severity score was 34 [IQR, 25-45]. The median SBP pre-REBOA was 65 mm Hg [IQR: 49-88 mm Hg]. Mortality at 24-hours was reported in 279 (32%) patients. Math modelling shows that predicted probabilities of the primary outcome increased steadily in SBP pre-REBOA below 100 mm Hg. Multivariable mixed-effects analysis shows that when SBP pre-REBOA was lower than 60 mm Hg, the risk of death was more than 50% (relative risk, 1.5; 95%CI, 1.17-1.92; P = .001) Discussion In patients who do not respond to initial resuscitation, the use of REBOA in SBP’s between 60- and 80-mm Hg may be a useful tool in resuscitation efforts before further decompensation or complete cardiovascular collapse. The findings from our study are clinically important as a first step in identifying candidates for REBOA. Study Type Observational Study Level of Evidence Level IV

show abstract

Section: Discussionmentioning

confidence: 99%

Critical systolic blood pressure threshold for endovascular aortic occlusion—A multinational analysis to determine when to place a REBOA

Ordoñez,

Parra,

Caicedo

et al. 2023

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…The intervention of emergency trauma patients in MDT mode and damage control surgery when necessary can significantly reduce the mortality rate and improve the prognosis of patients. [ 20 ] As a basic treatment model for modern diseases, MDT is conducive to the development of a multidisciplinary mindset, and trainees can integrate theoretical medical knowledge and clinical specialty practice by participating in the treatment process of emergency trauma patients. [ 21 , 22 ] In our teaching study, we found that both groups of trainees had significantly improved their assessment scores after participating in the MDT model of emergency trauma teaching, suggesting that this method is practical and feasible to be applied to the training teaching.…”

Section: Discussionmentioning

confidence: 99%

Application of symptom-based mind mapping combined with PBL teaching method in emergency trauma standardized resident training in MDT model

Liu

Zhang

et al. 2022

Medicine

View full text Add to dashboard Cite

Explore the feasibility and effectiveness of accepting mind mapping combined with problem-based learning (PBL) teaching method in the standardized training of emergency surgery residents in the multi-disciplinary team (MDT) model of emergency trauma. Eighty-nine doctors under training who rotated in the Department of Emergency Surgery of the First Affiliated Hospital of Anhui Medical University from January 2021 to January 2022 were selected as the study subjects, and randomly divided into a group receiving mind mapping combined with PBL teaching and a group receiving traditional lecture-based learning teaching. Mini-clinical evaluation exercise (Mini-CEX), direct observation of procedural skills (DOPS), teaching adherence, and satisfaction assessments were completed at the time of discharge from the department. There were no significant differences between the observation and control group trainees in terms of gender, age, education, and entry grades. Both groups of doctors were better able to participate in their respective teaching modes and made significant progress. The participants in the observation group had significantly higher Mini-CEX, DOPS, and teaching satisfaction scores than the control group (P < .05). Under the MDT model of emergency trauma, the combination of mind mapping and PBL teaching can improve the comprehensive clinical ability of the trainees more than participating in the traditional lecture-based learning teaching, which is worth promoting and implementing in the clinical standardized training.

show abstract

“…Bleeding is the main cause of death. The management of the severely injured trauma patient in the emergency department requires a multidisciplinary team that performs damage control maneuvers aimed at rapidly controlling bleeding, hemostatic resuscitation, and/or prompt transfer to the operating room, if required [ 22 ]. Therapeutic tactics for “damage control” are divided into three phases [ 7 ].…”

Section: Special and Non-specialized Diagnostic Methodsmentioning

confidence: 99%

Diagnostic methods and surgical treatment of patients with thoracoabdominal traumas (review of the literature)

Yahyoev¹,

Khodzhimatov²

2022

kitp

View full text Add to dashboard Cite

Thoracoabdominal traumatism is a topical problem of modern medicine due to its wide prevalence, severe course and unfavorable outcome. This article presents an overview of the epidemiology, diagnosis, and surgical treatment of patients with thoracoabdominal injuries. It showed that the current incidence of thoracoabdominal injuries reaches 13.7-16.4% of all chest and abdominal injuries. Lethality in thoracoabdominal injuries ranges from 3.13% to 20%. In most cases these are patients of working age, with an average age of 27.5-34.8 years, men comprising 71.2%. Nowadays, the number of patients with thoracoabdominal injuries tends to increase in Uzbekistan and other economically developing countries of the world because of increasing transportation, construction and crime. Video-thoracoscopy and video-laparoscopy are among the widespread methods of diagnosis and treatment of thoracoabdominal traumas. According to many authors, the specificity of video-laparoscopy and video-thoracoscopy is 100%, and the sensitivity is 87.5-99.3%.

show abstract

Damage control in the emergency department, a bridge to life

Cited by 3 publications

References 24 publications

Critical systolic blood pressure threshold for endovascular aortic occlusion—A multinational analysis to determine when to place a REBOA

Critical systolic blood pressure threshold for endovascular aortic occlusion—A multinational analysis to determine when to place a REBOA

Application of symptom-based mind mapping combined with PBL teaching method in emergency trauma standardized resident training in MDT model

Diagnostic methods and surgical treatment of patients with thoracoabdominal traumas (review of the literature)

Contact Info

Product

Resources

About