Early total care to early appropriate care - What every anesthesiologist must know!
Orthopedic trauma is one of the commonest injuries necessitating surgical intervention in a trauma patient. The management protocols in such severely injured orthopedic patients have evolved from conservative treatment to 'early total care' (ETC) to 'damage control orthopedics' (...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
| Subjects: | |
| Online Access: | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=1;spage=3;epage=10;aulast=Gupta |
| _version_ | 1797774086789660672 |
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| author | Babita Gupta Kamran Farooque |
| author_facet | Babita Gupta Kamran Farooque |
| author_sort | Babita Gupta |
| collection | DOAJ |
| description | Orthopedic trauma is one of the commonest injuries necessitating surgical intervention in a trauma patient. The management protocols in such severely injured orthopedic patients have evolved from conservative treatment to 'early total care' (ETC) to 'damage control orthopedics' (DCO) and recently to 'early appropriate care' (EAC)/'safe definitive surgery' (SDS). 'DCO' involves emergent, basic minimum life- or limb-saving surgery with continued resuscitation and definitive fixation of fractures being done later, once the patient has been resuscitated and stabilized. An insight into the immunological processes at a molecular level evoked in a poly-traumatized patient led to the evolution of the 'two-hit theory;' 'first hit' being the injury itself while the 'second hit' caused by the surgical trauma. As the 'two-hit theory' gained popularity, it led to a delay of definitive surgery for 2–5 days following trauma, since a higher complication rate was observed following definitive surgery within the first 5 days of the injury. This is a review article on the historical perspectives of DCO, immunological mechanisms involved, and various injuries requiring damage control approach or EAC/ETC and their anesthetic management. |
| first_indexed | 2024-03-12T22:15:56Z |
| format | Article |
| id | doaj.art-6969c4a8e42148bfa722322860cac43c |
| institution | Directory Open Access Journal |
| issn | 0970-9185 |
| language | English |
| last_indexed | 2024-03-12T22:15:56Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj.art-6969c4a8e42148bfa722322860cac43c2023-07-23T11:17:37ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852023-01-0139131010.4103/joacp.joacp_157_21Early total care to early appropriate care - What every anesthesiologist must know!Babita GuptaKamran FarooqueOrthopedic trauma is one of the commonest injuries necessitating surgical intervention in a trauma patient. The management protocols in such severely injured orthopedic patients have evolved from conservative treatment to 'early total care' (ETC) to 'damage control orthopedics' (DCO) and recently to 'early appropriate care' (EAC)/'safe definitive surgery' (SDS). 'DCO' involves emergent, basic minimum life- or limb-saving surgery with continued resuscitation and definitive fixation of fractures being done later, once the patient has been resuscitated and stabilized. An insight into the immunological processes at a molecular level evoked in a poly-traumatized patient led to the evolution of the 'two-hit theory;' 'first hit' being the injury itself while the 'second hit' caused by the surgical trauma. As the 'two-hit theory' gained popularity, it led to a delay of definitive surgery for 2–5 days following trauma, since a higher complication rate was observed following definitive surgery within the first 5 days of the injury. This is a review article on the historical perspectives of DCO, immunological mechanisms involved, and various injuries requiring damage control approach or EAC/ETC and their anesthetic management.http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=1;spage=3;epage=10;aulast=Guptadamage controlearly appropriate careearly total careorthopedic trauma |
| spellingShingle | Babita Gupta Kamran Farooque Early total care to early appropriate care - What every anesthesiologist must know! Journal of Anaesthesiology Clinical Pharmacology damage control early appropriate care early total care orthopedic trauma |
| title | Early total care to early appropriate care - What every anesthesiologist must know! |
| title_full | Early total care to early appropriate care - What every anesthesiologist must know! |
| title_fullStr | Early total care to early appropriate care - What every anesthesiologist must know! |
| title_full_unstemmed | Early total care to early appropriate care - What every anesthesiologist must know! |
| title_short | Early total care to early appropriate care - What every anesthesiologist must know! |
| title_sort | early total care to early appropriate care what every anesthesiologist must know |
| topic | damage control early appropriate care early total care orthopedic trauma |
| url | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=1;spage=3;epage=10;aulast=Gupta |
| work_keys_str_mv | AT babitagupta earlytotalcaretoearlyappropriatecarewhateveryanesthesiologistmustknow AT kamranfarooque earlytotalcaretoearlyappropriatecarewhateveryanesthesiologistmustknow |