Damage Control Laparotomy

Modified on 2009/07/20 21:24 by Ole Losvik — Categorized as: Circulation

The aim of damage control laparotomy is to stop the bleeding from the abdominal organs – not to repair the injuries. That repair is difficult, and is done by the hospital surgeon at a second-look laparotomy 24-72 hours after the injury when the patient has good blood circulation, is warm and not in pain.

When

First try to stop the bleeding without laparotomy. Don’t rush off to the hospital if it is far away. Take time to warm the IV infusions. Take the BP every 5 minutes while flushing in warm IV infusions rapidly through two large-caliber IV lines. Use IV ketamine analgesia, as ketamine helps increase the BP.

If the BP is still falling despite 6 liters of Ringer – and the victim is warm – you have no choice but to do a damage control laparotomy.

Don’t delay the decision. The more IV infusions you give ahead of the laparotomy, the more diluted the patient’s blood becomes. And the more difficult it will be to stop the bleeding during the laparotomy. So, when the decision is made, start preparing for laparotomy at once. Damage control laparotomy can be done in any hut – provided you are trained for it.

Preparations

Examine the front, back, and groin carefully. Find the inlet wounds of mine fragments so that it is easier to locate the bleeding source inside the abdomen.

Warm infusions and two IV lines. The patient loses a lot of heat when the abdomen is opened during the laparotomy. So the IV infusions must be given warm (40-42° C). When you cut open the abdomen, the pressure inside the abdomen suddenly falls. This may rapidly cause more bleeding. Have two large-caliber IV lines running.

Bladder catheter and stomach tube. If there is no blood in the urine, there is no injury to the kidneys or the urinary tract. Similarly no blood during suction by the stomach tube shows there is no stomach injury. Explore the rectum with one finger up the anus. Blood on the glove means injury to the rectum.

You need three assistants. One assistant looks after the airways and gives ketamine and IV infusions. Another retracts the abdominal wall. And one more assists you during the surgery. Give all three exact instructions before you start.

How?



Definitive treatment

The bleeding is now under control, but the injuries should be repaired at least within 72 hours. Concentrate on good life support during the transport: