A 30-year-old motorcyclist sustains polytrauma. On arrival: GCS 10, BP 70/40 mmHg, HR 140/min, respiratory rate 32/min, SpO2 88% on room air. FAST exam shows free fluid in Morrison's pouch. Temperature is 34.2°C, pH 7.18, INR 2.1. According to the damage control surgery (DCS) concept, which sequence is most appropriate?
- A Immediate definitive repair of all injuries in a single operation to reduce reoperation risk
- B DCS phase 1: abbreviated laparotomy (haemorrhage control + contamination control), ICU resuscitation (DCS2), then definitive repair when physiology normalises (DCS3) ✓
- C Angioembolisation of hepatic injury as first intervention before any laparotomy
- D Massive transfusion alone with damage control resuscitation; surgery deferred until INR < 1.5
Explanation
The damage control surgery (DCS) paradigm is indicated when the 'lethal triad' is present: hypothermia (<35°C), acidosis (pH < 7.2), and coagulopathy (INR > 1.5). DCS Phase 1 is an abbreviated surgery focused exclusively on haemorrhage control (packing, vascular shunting) and contamination control (enteric stapling without anastomosis), completed within 60-90 minutes. DCS Phase 2 is ICU resuscitation with damage control resuscitation (DCR): correction of coagulopathy (1:1:1 pRBC:FFP:platelets per MTP), temperature, and acidosis. DCS Phase 3 is definitive reconstruction when physiology is restored (usually 24-48 hours). Attempting definitive repair in a physiologically exhausted patient dramatically increases mortality ('the lethal triad' is irreversible if not addressed).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.