Damage Control

The fundamental objective of staged laparotomy is to accomplish definitive operative management in a calculated, stepwise fashion based on the patient’s physiologic tolerance. This important concept has emerged from collective experience with massive acute abdominal injuries but clearly extends to elective operative procedures and surgical challenges in other torso compartments. Whereas the inability to achieve hemostasis is due most frequently to a recalcitrant coagulopathy following trauma, other scenarios include inaccessible venous injuries, coexisting extraperitoneal life-threatening injuries, uncertain viability of abdominal contents, and the inability to reapproximate abdominal fascia due to reperfusion-induced visceral edema. There are five critical decision-making phases of staged laparotomy: I, patient selection; II, intraoperative reassessment; III, physiologic restoration in the surgical intensive care unit; IV, return to the operating room for definitive procedures; and V, abdominal wall reconstruction. The abdominal compartment syndrome (ACS) is a common, often insidious complication of staged laparotomy. In fact, during phases II and III there is often a delicate balance between effective pressure tamponade of capillary bleeding and the untoward effects of the ACS. During phases IV and V a frequent dilemma is how to enclose the abdominal contents to reduce protein loss and facilitate patient mobilization.

Laparoscopy is one of the most commonly performed procedures in the United States. Injury to a major retroperitoneal vessel occurs in 0.3% to 1.0% of procedures, most commonly during laparoscopic entry while placing the Veress needle or primary trocar. Fatal outcome can be related to massive gas embolism or exsanguination. Recommended treatment for gas embolism can range from supportive measures to external chest compression and insertion of a central line to withdraw gas from the right side of the heart. Recommended treatment of major vessel injury with massive hemorrhage consists of rapid laparotomy and control of hemorrhage using direct pressure until a surgeon experienced in vascular procedures arrives. When a major vessel injury occurs in a surgical facility distant from a medical center and without an available surgeon with vascular experience, based on the trauma literature, we recommend temporary control of blood loss using abdominal packing and closure (i.e., "damage control surgery") and judicious resuscitation (i.e., "damage control resuscitation") before transportation to a medical center.

This paper provides an overview of the US Army Corps of Engineers' guidance for seismic design and evaluation of concrete dams, as presented in the Engineer Manual EM1110-2-6053. The re- quirements to design and evaluate concrete dams to have a predictable performance for specified levels of seismic hazard are discussed. The seismic input and performance levels associated with serviceability, damage control, and collapse prevention are defined. The analysis and evaluation procedures and acceptance criteria for each performance level are described. They consist of linear and nonlinear procedures for estimation of seismic response and acceptance criteria that use demand-capacity ratios, damage control thresholds, and irrecoverable level of movements and post-earthquake stability condition to assess dam safety. Finally, an example is provided to demonstrate the application of the manual to seismic evaluation of a concrete gravity dam.

The small fruit tortrix, Grapholita lobarzewskii (Nowicki) (Lepidoptera Tortricidae), is a serious problem in the organic apple or-chards of the Friuli Venezia Giulia region (northeastern Italy), particularly in hilly areas. Three trials on mating disruption of G. lobarzewskii were ...

This is a case on what happens to companies when they do not take steps to mitigate current and future problems regarding there IT security.  This paper that I have written walks one through the steps on what they should consider doing after an online hacker attack.

An earlier version of this paper was presented at the Annual Meeting of the Society for the Scientific Study of Religion and Religious Research Association October 29-31, 1993, Raleigh, NC ... The Sociology of Damage Control: The Seventh-day Adventist Church and the Branch ...

Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spi...

Enterocutaneous fistulas (ECFs) remain a feared complication of surgery, particularly in acute care and trauma patients. Despite advances in medical and surgical therapies, ECFs are associated with significant morbidity and mortality; in addition, significant health care resources are consumed in their treatment. Because of the frequency nowadays of open-abdomen and damage-control surgery, of aggressive treatment for abdominal compartment syndrome, and

A genome-wide microarray analysis of gene expression was carried out on human microvascular endothelial cells (HMEC-1) exposed to hyperbaric oxygen treatment (HBOT) under conditions that approximated clinical settings. Highly up-regulated genes included immediate early transcription factors (FOS, FOSB, and JUNB) and metallothioneins. Six molecular chaperones were also up-regulated immediately following HBOT, and all of these have been implicated in protein damage control. Pathway analysis programs identified the Nrf-2-mediated oxidative stress response as one of the primary responders to HBOT. Several of the microarray changes in the Nrf2 pathway and a molecular chaperone were validated using quantitative PCR. For all of the genes tested (Nrf2, HMOX1, HSPA1A, M1A, ACTC1, and FOS), HBOT elicited large responses, whereas changes were minimal following treatment with 100% O2 in the absence of elevated pressure. The increased expression of immediate early and cytoprotective genes corresponded with an HBOT-induced increase in cell proliferation and oxidative stress resistance. In addition, HBOT treatment enhanced endothelial tube formation on Matrigel plates, with particularly dramatic effects observed following two daily HBO treatments. Understanding how HBOT influences gene expression changes in endothelial cells may be beneficial for improving current HBOT-based wound-healing protocols. These data also point to other potential HBOT applications where stimulating protection and repair of the endothelium would be beneficial, such as patient preconditioning prior to major surgery.

What a pity that Hamlet couldn't get help from a psychotherapist and that King Lear was not able to gain admittance to a home for senior citizens. Such speculations open the way to those philosophical and theological issues that have captivated the minds of thinkers great and small from time immemorial. This clip may be seen as a trivial contribution to the issues of debate just mentioned or just as a fun tangent to divert minds from the contentions and buffeting of our troubled times. https://www.youtube.com/watch?v=fyAok2cp8Aw

Researchers have examined the efficacy of crisis response strategies, which are intended to maintain or gain legitimacy after a serious incident. However, the video allegedly showing Toronto Mayor Rob Ford smoking crack provides an interesting case that reveals a
blind spot in political crisis response theory: the factor of partisan community. This article suggests that crises should be seen not as types but as breaks in the discourses of communities. Ford’s response was not an example of poor crisis communication response because he acted in ways that were acceptable within his partisan community. The article suggests that crisis communication researchers and practitioners must first understand the norms and values of
the political community in question before selecting crisis response strategies.

This paper examines the processes and outcomes of the negotiation of public discourse between the police and the media when police organisations are called to account in public scandals. Using the 1992 television documentary Cop It Sweet as a case study, the paper describes the problems of police/Aborigines relations exposed in the film, the reaction within the police hierarchy, the attempt at damage control and the subsequent repair work carried out in tenns of improving police/minority relations. The role of the media as an agent of criminal justice reform and a mechanism for demanding police accountability is discussed in this context. It will be argued that scandals force police organisations to provide a credible account that deviance is under control. The consequences of scandals depend on the nature of the police organisation and its commitment to reform. Public discourse in relation to police deviance may provide an opportunity for police reformers to further their reform ag...

Massive trauma and abdominal catastrophes carry high morbidity and mortality. In addition to the primary pathologic process, a secondary systemic injury, characterized by inflammatory mediator release, contributes to subsequent cellular, end-organ, and systemic dysfunction. These processes, in conjunction with large-volume resuscitations and tissue hypoperfusion, lead to acidosis, coagulopathy, and hypothermia. This "lethal triad" synergistically contributes to further physiologic derangements and, if uncorrected, may result in patient death. One manifestation of the associated clinical syndrome is the development of intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS). The development of ACS is insidious. If not recognized and treated promptly, ACS leads to multi-system organ failure (MSOF) and mortality. Improved understanding of IAH and ACS led to the development of damage control (DC)/open abdomen (OA) as surgical decompressive strategy. The ...