Involves staging and defininitive management to avoid adding trauma to patient during vulnerable period.
The decision to operate and surgical timing on multiple injured trauma patients remains controversial
Intra-operative hypotension increases mortality rate in patients with head injury
Parameters that help decide who should be treated with DCO
ISS >40 (without thoracic trauma)
ISS >20 with thoracic trauma
Multiple injuries with severe pelvic/abdominal trauma and hemorrhagic shock
Bilateral femoral fractures
Pulmonary contusion noted on radiographs
Hypothermia <35 degrees C
Head injury with AIS of 3 or greater
Optimal time of surgery
Patients are at increased risk of ARDS and multisystem failure during acute inflammatory window (period from 2 to 5 days characterized by a surge in inflammatory markers)
Therefore only potentially life-threatening injuries should be treated in this period including :
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sir i am really a fan of ur teaching. i m amazed how u make every thing so simple and interesting. u r like a god of orthopaedics. all teachers should be like u.