9. Why the liver…
Large organ
Friable parenchyma, thin capsule, fixed position in
relation to spine prone to blunt injury
Wide bore, thin walled blood vessels with high
blood flow Excessive blood loss
Right lobe larger, closer to ribs more injury
In children:
compliant ribs
transmitted force
10. Mild injuries heal in 3 months.
Moderate injuries heal in 6 months.
Severe injuries in 9-15 months.
Healing
27. ATLS
Advanced Trauma Life Support
Aggressive fluid resuscitation
CVP
UO Monitoring
Avoidance of “Death Triangle”
Hypothermia
Coagulopathy
Acidosis
28. Damage Control Surgery
Stone (1980); Univ. of Pennsylvania (1983)
To avoid or deal with Danger Triad
Early recognition
Already at physiologic limit
Concepts & Sequence
Control of Hemorrhage & Contamination
Temporary closure & Return to ICU
Deal with the Triad
Return to OT Definitive repair
29. Death Triangle
Danger Triad; Bloody Vicious Cycle
Components
Hypothermia
Decreasing Temp
<34 C
Coagulopathy
Non-surgical Oozing
PT > 50% of normal
Acidosis
<7.2 despite adequate volume resuscitation