الفهرس 
Acknowledgement
PathophysiologyOnly 14 pages are availabe for public view
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Abstract
Multiple trauma patients are more likely to die from their intra-operative metabolic failure than from a failure to complete operative repairs. The decision to switch from definitive treatment to damage control should be made early, as this has been associated with improved mortality rate. Damage control management is indicated when there is coagulopathy, when pH is less than 7.2, when temperature is less than 34, when there are multi compartment injuries, when abdominal compartment syndrome is predicted, and when further evaluation before repair is required. The Damage Control Surgery is a staged approach to severe abdominal injury that might best be described “Staged Trauma Injury Repair” (STIR). Operative intervention is focused on full exposure and rapid hemorrhage and contamination control, with rapid temporary abdominal closure. The entire operative intervention should take no longer than 90 minutes. attention is then turned to full resuscitation in the intensive care unit, including clotting factors replacement, rewarming, and correction of anemia and oxygen saturation. The aim of the ICU stay is the correction of physiological and biochemical deficits. This state usually takes 24–36 h to achieve, and during this time, a complete tertiary survey of potential missed injuries is performed Following resuscitation, the patient is returned to operative room with the aim of definitive organ repair and fascial closure. Once all the repairs are completed, formal abdominal closure without tension is the final step. Primary fascial closure is the most preferable closure technique but persistent edema within the retroperitoneum, bowel wall, and abdominal wall often renders primary fascial closure impossible at this time risking the formation of entero-cutaneous fistula or recurrent wound problems.
Damage control surgery and resuscitation have been associated with improvements in survival rates for the severely injured trauma patients, while prolonged morbidity and ICU stay were the possible disadvantages.