Damage Control in Penetrating Liver Trauma: Fear of the Unknown
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| Format: | Artículo científico |
| Language: | en |
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Universidad del Valle
2020
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| _version_ | 1876482824199995392 |
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| author | Carlos A. Ordoñez |
| author_facet | Carlos A. Ordoñez |
| contents | Damage Control in Penetrating Liver Trauma: Fear of the Unknown Carlos A. Ordoñez Michael W. Parra Mauricio Millán Yaset Caicedo Mónica Guzmán-Rodríguez Natalia Padilla Juan Carlos Salamea-Molina Alberto García Adolfo González-Hadad Luis Fernando Pino Mario Alain Herrera Fernando Rodríguez-Holguín José Julián Serna Alexander Salcedo Gonzalo Aristizábal Claudia Orlas Ricardo Ferrada Thomas Scalea Rao Ivatury Medicina REBOA liver REBOVC laparotomy algorithms The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver. 2020 artículo científico 0120-8322 https://www.redalyc.org/articulo.oa?id=28366176009 https://www.redalyc.org/journal/283/28366176009/ https://www.redalyc.org/journal/283/28366176009/html/ https://www.redalyc.org/journal/283/28366176009/28366176009.epub https://www.redalyc.org/journal/283/28366176009/movil 10.25100/cm.v51i4.4422.4365 en http://www.redalyc.org/revista.oa?id=283 Colombia Médica application/pdf Universidad del Valle Colombia Médica (Colombia) Num.4 Vol.51 |
| format | Artículo científico |
| id | redalyc_28366176009 |
| institution | Redalyc |
| language | en |
| publishDate | 2020 |
| publisher | Universidad del Valle |
| spellingShingle | Damage Control in Penetrating Liver Trauma: Fear of the Unknown Carlos A. Ordoñez Medicina REBOA liver REBOVC laparotomy algorithms Damage Control in Penetrating Liver Trauma: Fear of the Unknown Carlos A. Ordoñez Michael W. Parra Mauricio Millán Yaset Caicedo Mónica Guzmán-Rodríguez Natalia Padilla Juan Carlos Salamea-Molina Alberto García Adolfo González-Hadad Luis Fernando Pino Mario Alain Herrera Fernando Rodríguez-Holguín José Julián Serna Alexander Salcedo Gonzalo Aristizábal Claudia Orlas Ricardo Ferrada Thomas Scalea Rao Ivatury Medicina REBOA liver REBOVC laparotomy algorithms The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver. 2020 artículo científico 0120-8322 https://www.redalyc.org/articulo.oa?id=28366176009 https://www.redalyc.org/journal/283/28366176009/ https://www.redalyc.org/journal/283/28366176009/html/ https://www.redalyc.org/journal/283/28366176009/28366176009.epub https://www.redalyc.org/journal/283/28366176009/movil 10.25100/cm.v51i4.4422.4365 en http://www.redalyc.org/revista.oa?id=283 Colombia Médica application/pdf Universidad del Valle Colombia Médica (Colombia) Num.4 Vol.51 |
| title | Damage Control in Penetrating Liver Trauma: Fear of the Unknown |
| topic | Medicina REBOA liver REBOVC laparotomy algorithms |
| url | https://www.redalyc.org/articulo.oa?id=28366176009 https://www.redalyc.org/journal/283/28366176009/ https://www.redalyc.org/journal/283/28366176009/html/ https://www.redalyc.org/journal/283/28366176009/28366176009.epub https://www.redalyc.org/journal/283/28366176009/movil |