- Involves staging and defininitive management to avoid adding trauma to patient during vulnerable period.
- The decision to operate and surgical timing on multiple injured trauma patients remains controversial
- Intra-operative hypotension increases mortality rate in patients with head injury
- Parameters that help decide who should be treated with DCO
- ISS >40 (without thoracic trauma)
- ISS >20 with thoracic trauma
- Multiple injuries with severe pelvic/abdominal trauma and hemorrhagic shock
- Bilateral femoral fractures
- Pulmonary contusion noted on radiographs
- Hypothermia <35 degrees C
- Head injury with AIS of 3 or greater
- Optimal time of surgery
- Patients are at increased risk of ARDS and multisystem failure during acute inflammatory window (period from 2 to 5 days characterized by a surge in inflammatory markers)
- Therefore only potentially life-threatening injuries should be treated in this period including :
- compartment syndrome
- fractures with vascular injuries
- unreduced dislocations
- long bone fractures
- unstable spine fractures
- open fractures
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sir i am really a fan of ur teaching. i m amazed how u make every thing so simple and interesting. u r like a god of orthopaedics. all teachers should be like u.