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2013 Templeton Pediatric Trauma Symposium Of BIG HOLES in little vessels

2013 Templeton Pediatric Trauma Symposium Of BIG HOLES in little vessels. Jeremy W. Cannon, MD, SM, FACS San Antonio Military Medical Center Trauma & Acute Care Surgery jeremy.w.cannon@us.army.mil. Vascular Injury. Blast event 8 yo child—Cold R leg. Damage Control Resuscitation

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2013 Templeton Pediatric Trauma Symposium Of BIG HOLES in little vessels

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  1. 2013 Templeton Pediatric Trauma SymposiumOf BIG HOLES in little vessels Jeremy W. Cannon, MD, SM, FACS San Antonio Military Medical Center Trauma & Acute Care Surgery jeremy.w.cannon@us.army.mil Vascular Injury

  2. Blast event8 yo child—Cold R leg • Damage Control Resuscitation • Tourniquets • CT Angiogram • Damage Control Surgery • Shunt • Fasciotomy • Technique

  3. Demographics 1-3 4 1Klinkner, et al. J Pediatr Surg 42:178, 2007 2Shah, et al. Jsurg Res 153:162, 2009 3Corneille, et al. JTrauma 70(4): 823, 2011 4Villamaria, et al. JTTR, 2011

  4. Head/Neck/Face 9% Upper Ext 29% Thoracic 7% Lower Ext 37% Abd/Pelvis 17%

  5. Damage Control • Damage Control Resuscitation1 Permissive hypotension Replace shed blood Limit crystalloid Massive transfusion Avoid hypothermia DAMAGE CONTROL SURGERY 1Duchesne, et al. J Trauma 69(4):976, 2010

  6. Hemorrhage Control • Tourniquets1 Save Lives No Increase in Amputations 1Kragh, et al. Ann Surg 249(1):1, 2009

  7. Imaging3 yo child—R Hemothorax • CT Angiogram1 Fragmentation Torso Cerebrovascular Occult Injuries 1Cannon, Peck. Perspect Vasc Surg Endovasc Ther 23(2):100, 2010

  8. Operative Management (Adjuncts) • Damage Control Surgery1 Argyle Zone of injury Shunt technique Stabilize bone Debride wound VAC dressing Shunt-Stabilize-DC Dressing-Resuscitate Angiocath 1Rasmussen, et al. J Trauma 61(1):8, 2006

  9. Operative Management (Adjuncts) • Damage Control Surgery1 Liberal Fasciotomy Medial/Lateral Incisions All 4 Compartments VAC dressing Generous 4-compartment Fasciotomy 1Rasmussen, et al. J Trauma 61(1):8, 2006

  10. Operative Management(Technique) • Damage Control Surgery1 Reversed saphenous v. Thrombectomy Regional heparin Papaverine Interrupted prolene Debride Injured Vessel 1Rasmussen, et al. J Trauma 61(1):8, 2006

  11. Outcomes

  12. Summary8 yo child—Cold R leg • Damage Control Resuscitation • Tourniquets • CT Angiogram • Damage Control Surgery • Shunt • Fasciotomy • Technique

  13. The Future? • Training—ASSET-Peds? • Clinical Research—National Vascular Trauma Registry • Basic Research –Vascular Biology in the developing vessel • New Frontiers—Non-compressible torso hemorrhage • Torso injuries: Blunt or penetrating solid organ • Junctional Injuries • Pelvis

  14. 2013 Templeton Pediatric Trauma SymposiumOf BIG HOLES in little vessels Jeremy W. Cannon, MD, SM, FACS San Antonio Military Medical Center Trauma & Acute Care Surgery jeremy.w.cannon@us.army.mil Vascular Injury

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