1.Endocrine Surgery and Coloproctology, Military Medical Academy, Sofia, Bulgaria
2.Clinic of Abdominal Surgery, Military Medical Detachment of Emergency Response, Military Medical Academy, Sofia, Bulgaria
3.Clinic of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria
*: gerasimpopivanov@rocketmail.com
纸质出版:2014-06
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Medical aspects of terrorist bombings: A focus on damage control surgery and damage control resuscitation[J]. MMR, 2014,1(2):103-108.
Mutafchiyski et al.: Medical aspects of terrorist bombings – a focus on DCS and DCR. Mil Med Res 2014, 1: 13
Medical aspects of terrorist bombings: A focus on damage control surgery and damage control resuscitation[J]. MMR, 2014,1(2):103-108. DOI: 10.1186/2054-9369-1-13.
Mutafchiyski et al.: Medical aspects of terrorist bombings – a focus on DCS and DCR. Mil Med Res 2014, 1: 13 DOI: 10.1186/2054-9369-1-13.
Although terrorist bombings have tormented the world for a long time
currently they have reached unprecedented levels and become a continuous threat without borders
race or age. Almost all of them are caused by improvised explosive devices. The unpredictability of the terrorist bombings
leading to simultaneous generation of a large number of casualties and severe "multidimensional" blast trauma require a constant vigilance and preparedness of every hospital worldwide. Approximately 1.0%-2.6% of all trauma patients and 7% of the combat casualties require a massive blood transfusion. Coagulopathy is presented in 65% of them with mortality exceeding 50%. Damage control resuscitation is a novel approach
developed in the military practice for treatment of this subgroup of trauma patients. The comparison with the conventional approach revealed mortality reduction with 40%-74%
lower frequency of abdominal compartment syndrome (8%
vs
16%)
sepsis (9%
vs
20%)
multiorgan failure (16%
vs
37%) and a significant reduction of resuscitation volumes
both crystalloids and blood products. Damage control surgery (DCS) and damage control resuscitation (DCR) are promising new approaches
contributing for the mortality reduction among the most severely wounded patients. Despite the lack of consensus about the optimal ratio of the blood products and the possible influence of the survival bias
we think that DCR carries survival benefit and recommend it in trauma patients with exsanguinating bleeding.
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