Where is the second step of damage control resuscitation carried out?
In emergency
In ICU
In OT
Prehospital resuscitation
Phases of Damage control Surgery Phase (Initial exploration) Phase II (Secondary Resuscitation) Phase III (Definitive Operation) Consists of an initial operative exploration to attain rapid control of active hemorrhage & contamination. Abdomen is entered a middle incision and if exsanguinating hemorrhage is encountered four quadrant packing should be performed Any violation of GI tract should be treated with suture closure or segmental stapled resection External drains are placed to control any major pancreatic or biliary injuries. Following completion of the initial exploration the critically ill patients is transferred to the ICU Invasive monitoring & complete ventilator suppo are often needed. This phase focusses on secondary resuscitation to correct hypothermia, coagulopathy & acidosis It consists of planned re-exploration & definitive repair of injuries. This phase typically occurs 48 & 72 hours following initial and after successful secondary resuscitation Abdomen should be closed primarily if possible Risky GI anastomoses or complex reconstruction should be avoided STAGES OF DCS Stage I Patient selection Stage II Operative control of haemorrhage & Contamination Stage III ICU resuscitation Stage IV Definitive surgery Stage V Abdominal closure