SurgeryAnaesthesia & ICU
Damage Control Laparotomy
Concept of staged surgery for severely unstable trauma / surgical patient — control bleeding + contamination, defer definitive repair, ICU resuscitation, planned re-look.
Source: EAST 2017; NCEPOD
Step 1 of ~4
info
Indications
Damage control surgery (DCS) — abbreviated initial surgery + ICU resuscitation + planned re-look.
Indications: severe trauma OR critically ill emergency surgical patient with the lethal triad:
• Hypothermia (<35°C).
• Acidosis (pH <7.2, base excess <−6).
• Coagulopathy (INR >1.5, fibrinogen <1, platelets <100).
Other: ongoing massive haemorrhage, persistent hypotension despite resuscitation, refractory metabolic disturbance, incomplete contamination control, swollen bowel preventing closure, anticipated need for further surgery.
Vascular DCS for non-trauma: e.g. mesenteric ischaemia, ruptured AAA — similar principles.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Tranexamic Acid (Surgical / Trauma Haemorrhage) · Antifibrinolytic (Haemostatic)
- Lipid Emulsion 20% (Intralipid) · Antidote / Resuscitation
- Insulin (IV Infusion — ICU Glucose Control) · Insulin — ICU Glucose Management
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Lipid Emulsion 20% (Intralipid) · Antidote / Resuscitation
Pathways
- Major Trauma — Primary Survey (ATLS) · ATLS 10th Edition; JRCALC; NICE NG39
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Burns — TBSA Estimation & Fluid Resuscitation · British Burn Association; EMSB; RCEM 2024
- Lower Gastrointestinal Bleed · NICE; BSG; ACPGBI — Commissioning Guide
- Acute Pancreatitis · NICE; IAP/APA; ACPGBI — CG104
- Hypertrophic Pyloric Stenosis · BAPS / RCPCH
Decision support only. Always apply local guidelines and clinical judgement.