The broad indications for blood transfusion are based on the fact that transfused blood is the best substitute for blood lost in acute haemorrhages. —L. Bruce Robertson, MD, Captain, Canadian Army Medical Corp, 1916 Salt water is for cooking pasta,…
Damage control resuscitation (DCR) has become a staple of modern surgical management of traumatic injuries. Hemorrhage secondary to trauma accounts for 40% of trauma fatalities and is the leading cause of preventable death in trauma. Research in military and civilian…
Exsanguination has been defined as an extreme form of hemorrhage with ongoing bleeding that, if not surgically controlled, will lead to death. Exsanguination is second only to neurologic injury among causes of fatality after trauma. Therefore, the speed by which…
Hemorrhagic shock is the leading cause of preventable death following injury. Historically, major advances in the management of hemorrhagic shock have come during periods of armed conflict, when hemorrhage occurs at higher rates and in situations where the military is…
Few injuries are as complex as pelvic fractures in the multiply injured patient. The pelvis is a complex anatomic region—the bony pelvis provides great protection to the structures it contains and within the pelvis are vital gastrointestinal, genitourinary, vascular, and…
The female reproductive organs are protected by their location in the pelvis, making injuries uncommon, except during pregnancy or situations in which they are pathologically enlarged. Gynecologic trauma includes a large variety of relatively rare and challenging injuries from blunt…
Kidney trauma Incidence and mechanisms of injury At most urban trauma centers, mechanisms of kidney injuries are predominantly blunt (80%–90%) and uncommonly penetrating (10%–20%). The kidney is injured in up to 5% of all trauma cases. Children are more likely…
Management of colon and rectal injuries has greatly evolved over recent decades. Historically, treatment consisted of resection and end colostomy based on experience with battlefield casualties. Although a difference between civilian and military injuries was recognized, the treatment by civilian…
After blunt or penetrating abdominal trauma, the major sites of hemorrhage are the viscera, mesentery, and major abdominal vessels ( Figs. 1–3 ). “Abdominal vascular injury” refers to injury to major intraperitoneal and retroperitoneal vessels and is classified into four…
The proclivity for the spleen to bleed from blunt abdominal trauma was not lost on the Thuggee cult. A group of professional assassins who existed from the 13th to 19th centuries in India, they murdered others to worship Kali, a…