Update
XII Edition
The Late Warko Karnadihardja
Kiki Lukman
Division of Digestive Surgery
Department of Surgery,
Medical Faculty of UNPAD/ Hasan Sadikin Hospital
Bandung
Objectives :
ATLS
Definitive Surgery for Trauma Care
TNT
LLL ESPEN Courses
Perioperative Care for Acute Care
Surgery Courses
Introduction
Abdominal injuries
ee ks e eks
2w 4w
1 hour 3 hours
Decreased Incidence of
Preventable Death due to Traffic
Accidents in Australia
Introduction
Associated with
Severe hemorrhage
Low-flow conditions
Tissue destruction and debris
Gut bacterial translocation
Leading to:
Massive dyshomeostasis of
immunoinflammatory response
MASSIVE DYSHOMEOTASIS INDUCED
BY MAYOR TRAUMA
Stop hemorrhage
Check for:
1. Peripheral perfusion
2. Motor/sensory function
3. Bone integrity
4. Soft tissue integrity
Three or more
Components
involved
no yes
DCO:
no successful unsuccessful
yes
Definitive Early
repair amputation
Chiara, O, Cimbanasi S and Vesconi S : Critical Bleeding in Blunt Trauma Patients in 2006 Year Book of Intensive Care and Emergency Medicine,Springer 2006
MANAGEMENT TREE FOR BLEEDING
INTRAPERITONEAL INJURIES
Hemodynamically Hemodynamically
ATLS protocol
stable unstable
If:
Acidosis
Hypothermia
Ongoing
Angiography-embolization > 8 PRBC
bleeding
coagulopathy
N.O.M D.C.S
NOM: nonoperative management
DCS:damage control surgery
Chiara, O, Cimbanasi S and Vesconi S : Critical Bleeding in Blunt Trauma
US : Ultrasound
Patients in 2006 Year Book of Intensive Care and Emergency Medicine,
PRBC: Pached red blood cells Springer 2006
Writtened report on wound
dressing