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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Trauma patients who receive exsanguinating torso injuries often develop hypothermia, metabolic acidosis, and coagulopathy before death. A new strategy for trauma surgery has been developed to avoid the occurrence of these events and hence prevent trauma deaths. The strategy is called "damage control surgery" and consists of three maneuvers: a) damage control; b) restoration of physiologic stability; and c) definitive surgery. The goals of damage control are to: a) identify injuries; b) control ongoing hemorrhage; and c) control intestinal spillage. Damage control is followed by intensive care to restore the physiologic reserve. Once secondary resuscitation in the ICU is accomplished, planned reoperation should be performed to repair anatomic injuries. Planned reoperation is usually possible within 36 hours after the initiation of intensive care. Some patients who undergo damage control develop abdominal compartment syndrome characterized by increased intraabdominal pressure, increased peak airway pressure, decreased urine output, and decreased cardiac output. Early decompression surgery should be considered in such patients.
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PMID:[Damage control surgery]. 1048 48

Management of Blunt hepatic injuries is dramatically modified since early 80's. Non operative management is presently used in over 80% of all cases, irrespective of haemoperitoneum and grade of injury. Close observation of the patient is requested. Laparotomy or laparoscopy must be decided in any case of suspected missed injury. Laparotomy is used for worse hemodynamic status. Peroperative mortality is mainly attributed to haemorrhage. Aggressive surgery has progressively given place to more conservative techniques. Understanding of coagulopathy related to massive transfusions, acidosis and hypothermia led to enhance efficacy of manual compression of the injured liver and of perihepatic packing and planned reoperation. In survivors this abbreviated laparotomy has pitfalls and complications which must be known, mainly rebleeding and abdominal compartment syndrome. Decision of very early reoperation is most difficult to take.
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PMID:[Treatment of blunt trauma to the liver]. 1054 8

The decision to perform damage control laparotomy in a critically injured patients depends on the risk of life-threatening coagulopathy. The main decision criteria are: presence of concomitant injuries, patient history, shock, transfusion volume, hypothermia and acidosis. The aim of surgery is to achieve satisfactory hemostasis, limit peritoneal thermal loss, and perform physiological restoration as rapidly as possible in the intensive care unit. This includes gauze packing of major liver or retroperitoneal injuries and ligation of injured blood vessels. Injuries to the intestine and the urinary tract are sutures, stapled or drained. If the skin borders cannot be reapproximated because of excessive abdominal tension, a wall prosthesis should be used to avoid abdominal compartment syndrome. Reoperation is a dangerous procedure in the immediate postoperative period but must be proposed later for reexploration or damage repair.
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PMID:[Abbreviated laparotomy]. 1091 79

The surgical approach to the most injured patients has changed in recent years. Many patients arrive in the intensive care unit with problems that in the past would have been definitively addressed in the operating room, or led to the patient's demise due to continued attempts to complete all surgical procedures, despite deteriorating physiology. As a result, the triad of hypothermia, acidosis, and coagulopathy, along with the frequent complication of abdominal compartment syndrome, are critical factors that require correction in the intensive care unit. Prompt correction is necessary not only to allow expeditious completion of required surgical procedures, but because this triad, unless interrupted, invariably leads to death during resuscitation.
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PMID:Trauma critical care. 1125 11

The technique or approach of damage control surgery in trauma is not new; packing liver injuries has been an accepted treatment strategy for some time. What is new is the realization that an abbreviated laparotomy, or completion of only the essential portions of the operation, is often the best treatment for the patient as a whole. Recent developments include strategies in the operating room and the intensive care unit to manage patients undergoing trauma laparatomy, including prevention of hypothermia, methods to accurately assess resuscitation status with right ventricular catheters and measurements of end-organ perfusion, and recognition of abdominal compartment syndrome, with emphasis on prevention.
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PMID:Damage control in trauma surgery. 1132 12

Pediatric trauma management requires both operative and nonoperative (supportive) care. Fewer than 15% of pediatric trauma patients require surgery (Children's Hospital of Michigan Registry Data, excluding fractures), and the primacy of closed head injury and the multisystem nature of pediatric trauma dictate assessment and therapy. Complications arise at every level, including fluid resuscitation (too much or too little), antibiotics (too late), or pain control (inadequate). The institution of mechanical ventilation that is usually life-saving carries its own risks including those associated with intubation (perforation, aspiration, pro longed endotracheal intubation (stricture, pneumonia), and barotrauma (ventilator-induced lung injury). Minor procedures, such as thoracentesis, chest tube insertion, and pericardiocentesis, can all be complicated by perforation and hemorrhage. Major interventions, including laparotomy and thoracotomy, can result in hemorrhage, air leak, abdominal compartment syndrome, phrenic nerve and thoracic duct injury, postoperative abscess, and septicemia. Transfusion, cardiopulmonary bypass, and invasive monitoring can result in coagulopathy and vascular injury. Prolonged resuscitation and operative explorations can cause hypothermia and coagulopathy and initiate a cascade of multiorgan failure and ARDS. There is no doubt that rapid evacuation, prompt resuscitation, and organized systems of pediatric trauma care have reduced the overall mortality of childhood trauma. The higher velocity of travel and an increasingly chaotic urban environment have resulted in more multitrauma cases and in injuries of higher severity requiring more sophisticated and complicated diagnostic and therapeutic modalities. Our ability to identify life-threatening injuries, to provide expedited and definitive care, and to reduce and detect the complications predicted by these injuries and their treatment will result in long-term improvements in survival and significant reductions in morbidity.
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PMID:Pulmonary and respiratory complications of pediatric trauma. 1158 5

Lower limb compartment syndrome is an unusual but severe complication of prolonged surgery more than four hours in lithotomy position. It is usually a consequence of hypoperfusion of the lower extremities and muscle necrosis may occur. Several risk factors are pointed out: trendelenburg, the hardness of operating table, hypothermia, control hypotension, occlusion of arterial blood flow of the lower extremity, arteritis (and smoking), diabetes, obesity, arterial hypertension, myopathy and an important muscle mass. The symptoms are postoperative pain with neurological signs. A rapid diagnosis and aggressive management (i.e. resuscitation and aponevrotomy) is recommended. Neurological sequelae are sometimes invalidating. Reporting a case of bilateral syndrome, we reviewed the literature and describe the present diagnosis and therapeutic management as well as prevention modalities of this iatrogenic complication.
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PMID:[Bilateral compartment syndrome after colorectal surgery in the lithotomy position]. 1240 49

Multivisceral trauma and exanguinating hemorrhage lead to hypothermia, coagulopathy and acidosis. Formal resections and reconstructions in these unstable patient is often result in irreversible physiologic insult. For the patients with life-threatening injuries the staged control and repair of injuries may be a saving surgical strategy. The initial phase of "damage control" involves an abbreviated laparotomy, which entails temporary hemorrhage control, perfusion of vital organs and avoidance of enteric or urinary spillage. The surgical procedure is rapidly terminated, with emphasis on a temporary physiologic equilibrium rather than anatomic integrity. That is, the damage control surgery represents an extension of resuscitation phase of trauma in the operating room. The second therapeutic phase involves standard resuscitation and control of hypothermia, coagulopathy and acidosis, combined with surveillance and management of the abdominal compartment syndrome. The last phase involves the definitive repair of all temporized injuries, homeostasis, vascular reconstruction and abdominal wall repair.
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PMID:[Serial repeated laparatomy in severe trauma]. 1273 Dec 11

Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in Damage Control Surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. It's possible too applying packs in organ-specific techniques (early abdominal packing). A wide review of the literature has allowed to emphasize the most common problem of this technique, the adequacy of the particular indications, their evolution, timing, the results in general and particular which multiple critical situations and not always predictable when an intensive diagnostic and methodological approach is necessary in. The principal indications are when complex anatomic lesions are diagnosed with not ruleable hemorrhages, in presence of metabolic failure--like hypothermia < 35 degrees C, acidosis > 7.2, coagulopathy PTT > 16 seconds: these three derangements become established quickly in the exsanguinating trauma patient and, once established, form a vicious circle which may be impossible to overcome. The results are encouraging and we can evaluate a median survival of the 60%, certainly superior to the obtainable survival with immediate surgical repair. Immediate failures are substantially due to bleeding, especially in "underpacking" case, and remote: these last can be premises, fundamentally septic and bound at the time of stay (above the 72 hours) and associated by the coexistence of lesions; in these situations is possible a MOF syndrome due to excessive intraabdominal pressure (overpacking) or to an abdominal compartment syndrome.
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PMID:[Packing: current concepts of "life-saving" surgery]. 1466 91

Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in damage control surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. Its possible too applying packs in organ-specific techniques (early abdominal packing). A wide review of the literature has allowed to emphasize the most common problem of this technique, the adequacy of the particular indications, their evolution, timing, the results in general and particular which multiple critical situations and not always predictable when an intensive diagnostic and methodological approach is necessary in. The principal indications are when complex anatomic lesions are diagnosed with not ruleable hemorrhages, in presence of metabolic failure (hypothermia < 35 degrees C, acidosis > 7.2, coagulopathy PTT > 16 seconds: These three derangements become established quickly in the exsanguinating trauma patient and, once established, form a vicious circle which may be impossible to overcome. The results are encouraging and we can evaluate a median survival of the 70%, certainly superior to the obtainable survival with immediate surgical repair. Immediate failures are substantially due to bleeding, especially in "underpacking" case, and remote: these last can be premises, fundamentally septic and bound at the time of stay (above the 72 hours) and associated by the coexistence of lesions: in these situations is possible a MOF syndrome due to excessive intra-abdominal pressure (overpacking) or to an Abdominal Compartment Syndrome.
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PMID:[Abdominal "packing": indications and method]. 1513 9


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