High Bilateral Amputations and Dismounted Complex Blast Injury (DCBI).

High Bilateral Amputations and Dismounted Complex Blast Injury (DCBI). Mil Med. 2018 Sep 01;183(suppl_2):118-122 Authors: Gordon W, Talbot M, Fleming M, Shero J, Potter B, Stockinger ZT Abstract High, combat-related bilateral lower extremity amputations rarely occur in isolation. Dismounted complex blast injury is a devastating and life-threatening constellation of multisystem injuries most commonly due to dismounted contact with improvised explosive devices. Rapid damage control resuscitation and surgery are essential to improve patient survival and minimize both early complications and late sequelae. A coordinated team approach is essential to provide simultaneous airway management, volume resuscitation (ideally with whole blood or ratio transfusion), and immediate control of life-threatening hemorrhage. Temporary aortic or iliac vessel clamping during concurrent exploratory or vascular control laparotomy is frequently required. Stabilization of unstable pelvic fractures is then performed, followed by debridement and irrigation of all wounds, which should be left open, and subsequent provisional stabilization of long bone fractures. The goal of the initial surgical resuscitative endeavor is rapid concurrent control of all sources of hemorrhage to avoid the lethal triad of acidosis, hypothermia and coagulopathy. To this end, multiple surgeons or surgical teams should be utilized whenever feasible. Patients then require ongoing resus...
Source: Military Medicine - Category: International Medicine & Public Health Tags: Mil Med Source Type: research