Hypothermia-Coagulopathy-Acidosis Syndrome: When to Operate/When to Stop Operating

  • Asher Hirshberg
  • Kenneth L. Mattox

Abstract

Determining when to operate has traditionally been the most problematic decision when managing critically injured patients. Today the advent of aggressive trauma management algorithms now makes the decision to operate relatively straightforward. With few exceptions, the trauma patient in hemorrhagic shock is taken to the operating room within minutes of arrival at the hospital. Point of service adjuncts, including focused abdominal sonography, assist in the decision to operate.

Keywords

Lactate Transportation Cocaine Lime Stein 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hirshberg A, Mattox KL: Planned reoperation for severe trauma. Ann Surg 1995; 222: 3–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Rotondo MF, Schwab CW, McGonigal MD, et al: “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35: 375–382.PubMedCrossRefGoogle Scholar
  3. 3.
    Rotondo MF, Zonies DH: The damage control sequence and underlying logic. Surg Clin North Am 1997; 77: 761–777.PubMedCrossRefGoogle Scholar
  4. 4.
    Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan GL Jr.: Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg 1992; 215: 476–482.PubMedCrossRefGoogle Scholar
  5. 5.
    Hewson JR, Neame PB, Kumar N, et al: Coagulopathy related to dilution and hypotension during massive transfusion. Crit Care Med 1985; 13: 387–391.PubMedCrossRefGoogle Scholar
  6. 6.
    Patt A, McCroskey BL, Moore E: Hypothermia-induced coagulopathies in trauma. Surg Clin North Am 1988; 68: 775–785.PubMedGoogle Scholar
  7. 7.
    Villalobos T, Adelson E, Barilia T: Hematolytic changes in hypothermic dogs. Proc Soc Exp Biol Med 1955; 89: 192–196.PubMedGoogle Scholar
  8. 8.
    Hessel E, Schmer G, Dillard D: Platelet kinetics during deep hypothermia. J Surg Res 1980; 28: 23–27.PubMedCrossRefGoogle Scholar
  9. 9.
    White T, Krivit W: An ultrastructural basis for the shape changes induced in platelets by chilling blood. Blood 1967; 30: 635–675.Google Scholar
  10. 10.
    Michelson AD, MacGregor H, Barnard MR, Kestin AS, Rohrer MJ, Valeri CR: Reversible inhibition of human platelet activation by hypothermia in vivo and in vitro. Thromb Haemost 1994; 71: 633–640.PubMedGoogle Scholar
  11. 11.
    Watts DD, Trask A, Soeken K, Perdue P, Dols S, Kaufmann C: Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma 1998; 44: 846–854.PubMedCrossRefGoogle Scholar
  12. 12.
    Rohrer MJ, Natale AM: Effects of hypothermia on the coagulation cascade. Crit Care Med 1992; 20: 1402–1405.PubMedCrossRefGoogle Scholar
  13. 13.
    Reed RL II, Johnson TD, Hudson JD, Fischer RP: The disparity between hypothermic coagulopathy and clotting studies. J Trauma 1992; 33: 465–470.PubMedCrossRefGoogle Scholar
  14. 14.
    Wildenthal K, Mierzwiak DS, Myers RW: Effects of acute lactic acidosis on left ventricular performance. Am J Physiol 1968; 214: 1352–1359.PubMedGoogle Scholar
  15. 15.
    Yudkin J, Cohen RD, Slack B: The haemodynamic effects of metabolic acidosis in the rat. Clin Sci Mol Med 1976; 50: 177–184.PubMedGoogle Scholar
  16. 16.
    Porter JM, Ivatury RR: In search of the optimal end points of resuscitation in trauma patients: a review. J Trauma 1998; 44: 908–914.PubMedCrossRefGoogle Scholar
  17. 17.
    Bickell WH, Wall MJJr., Pepe PE, et al: Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994; 331: 1105–1109.PubMedCrossRefGoogle Scholar
  18. 18.
    English MJM, Papenberg R, Farias E, Scott WAC, Hinchey J: Heat loss in an animal experimental model. J Trauma 1991; 31: 36–38.PubMedCrossRefGoogle Scholar
  19. 19.
    Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, O’Keefe GE: Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg 1997; 226: 439–447.PubMedCrossRefGoogle Scholar
  20. 20.
    Jurkovich GJ, Greiser WB, Luterman A, Curreri PW: Hypothermia in trauma victims: an ominous predictor of survival. J Trauma 1987; 27: 1019–1022.PubMedCrossRefGoogle Scholar
  21. 21.
    Michenfelder JD, Uihlein A, Saw EF, Theye RA: Moderate hypothermia in man: hemodynamic and metabolic effects. Br J Anaesth 1965; 37: 738–745.PubMedCrossRefGoogle Scholar
  22. 22.
    Coniam SW: Accidental hypothermia. Anesthesia 1979; 34: 250–256.CrossRefGoogle Scholar
  23. 23.
    Hirshberg A, Wall MJ Jr., Mattox KL: Planned reoperation for trauma: a two year experience with 124 consecutive patients, J Trauma 1994; 37: 365–369.PubMedCrossRefGoogle Scholar
  24. 24.
    Hirshberg A, Walden R: “Damage control” for abdominal trauma. Surg Clin North Am 1997; 77: 813–820.PubMedCrossRefGoogle Scholar
  25. 25.
    Garrison JR, Richardson JD, Hilakos AS, et al: Predicting the need to pack early for severe intra-abdominal hemorrhage. J Trauma 1996; 40: 923–927.PubMedCrossRefGoogle Scholar
  26. 26.
    Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch J, Galloway B: Predicting life threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma 1997; 42: 857–862.PubMedCrossRefGoogle Scholar
  27. 27.
    Cushman JG, Feliciano DV, Renz BM, et al: Iliac vessel injury: operative physiology related to outcome. J Trauma 1997; 42: 1033–1040.PubMedCrossRefGoogle Scholar
  28. 28.
    Burch JM, Denton JR, Noble RD: Physiologic rationale for abbreviated laparotomy. Surg Clin North Am 1997; 77: 779–782.PubMedCrossRefGoogle Scholar
  29. 29.
    Hirshberg A, Stein M, Walden R: A computer simulation of hypothermia during “damage control” laparotomy. World J Surg 1999; 23: 960–963.PubMedCrossRefGoogle Scholar
  30. 30.
    Forstot RM: The etiology and management of inadvertent perioperative hypothermia. J Clin Anesth 1995; 7: 657–674.PubMedCrossRefGoogle Scholar
  31. 31.
    Ereth MH, Lennon RL, Sessler DI: Limited heat transfer between thermal compartments during rewarming in vasoconstricted patients. Aviat Space Environ Med 1992; 63: 1065–1069.PubMedGoogle Scholar
  32. 32.
    Little RA, Stoner HB: Body temperature after accidental injury. Br J Surg 1981; 68: 221–224.PubMedCrossRefGoogle Scholar
  33. 33.
    Abikhaled JA, Granchi TS, Wall MJ, Hirshberg A, Mattox KL: Prolonged abdominal packing for trauma is associated with increased morbidity and mortality. Am Surg 1997; 63: 1109–1112.PubMedGoogle Scholar
  34. 34.
    Hirshberg A, Stein M, Adar R: Reoperation: planned and unplanned. Surg Clin North Am 1997; 77: 897–907.PubMedCrossRefGoogle Scholar
  35. 35.
    Hirshberg A, Wall MJ Jr., Ramchandani MK, Mattox KL: Reoperation for bleeding in trauma. Arch Surg 1993; 128: 1163–1167.PubMedCrossRefGoogle Scholar
  36. 36.
    Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL: Abdominal compartment syndrome. J Trauma 1998; 45: 597–609.PubMedCrossRefGoogle Scholar
  37. 37.
    Ivatury RR, Porter JM, Simon RJ, Islam S, John R, Stahl WM: Intraabdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 1998; 44: 1016–1021.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Asher Hirshberg
  • Kenneth L. Mattox

There are no affiliations available

Personalised recommendations