ABSTRACT
For this group of patients, an immediate surgical procedure to rapidly save a life is indicated, as a prolonged operation will worsen physiological impairment, typically ending in catastrophic failure (i.e. death). Those patients who have lost a significant volume of blood if not treated expeditiously will quickly become (if not already depending on injury severity, magnitude of haemorrhage and time since injury) coagulopathic, hypothermic and acidotic – the trauma triad of death. Additional decisions to perform an abbreviated laparotomy may also include;
• The number of casualties in need of emergency surgery (i.e. mass casualty situation) • Your own surgical skill set (i.e. do enough to save a life / limb, then wait for additional
skills or transfer out as appropriate)
Although there is no absolute time cut-off for damage control surgery (DCS), we always aim to have all bleeding and contamination under control within 60 minutes and transfer to the intensive care unit (ICU) within 90 minutes. Some surgeons advocate that this is even too long in the truly exsanguinating patient.
