Hemorrhage Control and Damage Control Surgery Flashcards

A patient with a pelvic fracture and refractory hemorrhagic shock after pelvic binder application should next undergo:

Answer: Preperitoneal pelvic packing or angiographic embolization depending on institutional protocol

For pelvic fracture hemorrhage unresponsive to binder, preperitoneal pelvic packing or angioembolization are the next interventions, chosen based on available resources and injury pattern.

The correct sequence of the damage control surgery phases is:

Answer: Abbreviated surgery → ICU resuscitation → planned reoperation for definitive repair

DCS proceeds as: abbreviated operation (hemorrhage/contamination control) → ICU correction of the lethal triad → planned reoperation for definitive repair.

Hypocalcemia is a common complication during massive transfusion because:

Answer: Citrate preservative in stored blood products chelates and lowers ionized calcium

Citrate in stored blood products binds ionized calcium; during massive transfusion, hepatic metabolism cannot clear citrate fast enough, causing clinically significant hypocalcemia.

In penetrating abdominal trauma with evisceration, the appropriate emergency management is:

Answer: Cover the eviscerated bowel with a moist sterile dressing and prepare for urgent surgery

Eviscerated bowel should be covered with a moist sterile dressing to prevent desiccation and contamination; reduction and repair are surgical procedures performed in the OR.

Which clinical scenario most clearly indicates a patient requires damage control surgery rather than definitive repair?

Answer: Severe coagulopathy, metabolic acidosis, and hypothermia with ongoing hemorrhage requiring packing

The presence of the lethal triad (coagulopathy, acidosis, hypothermia) with ongoing hemorrhage is the classic indication for DCS, as prolonged definitive surgery will worsen physiology and increase mortality.

After damage control laparotomy, the primary goals of ICU resuscitation before planned reoperation include:

Answer: Correcting hypothermia, metabolic acidosis, and coagulopathy to prepare for safe reoperation

ICU resuscitation targets correction of the lethal triad — rewarming, buffering acidosis, and restoring coagulation — so the patient can tolerate the planned reoperation.

In damage control vascular surgery, a temporary intravascular shunt is used to:

Answer: Restore distal perfusion to the extremity while deferring definitive vascular repair

Temporary intravascular shunts (e.g., Javid or Argyle shunts) maintain distal perfusion through an injured vessel, preventing ischemia while definitive repair is deferred until physiology is corrected.