A seriously injured patient with severe metabolic abnormalities may benefit from damage control operations, in which a series of targeted procedures are performed over several days rather than having everything completed in one prolonged operation.


A trauma patient with one or more of the following may be a candidate for a damage control procedure:

(1) hypothermia, with body temperature < 35°C (some use < 34°C or < 33°C)

(2) acidosis with arterial pH < 7.2 (some use < 7.10 or < 7.25)

(3) elevated base deficit (see table below)

(4) lactic acidosis, with serum lactate > 5 mmol/L

(5) coagulopathy (see below)


Additional findings favoring a damage control procedure:

(6) sustained hypotension with systolic blood pressure < 70 mm Hg

(7) excessive hemorrhage

(8) injury severity score > 35

Age of the Patient

Base Deficit

<= 55 years

< -15 mmol/L

> 55 years

< -6 mmol/L



(1) blood loss > 4,000 mL

(2) massive transfusion (15+ units of blood)


Coagulopathy: one or more of the following

(1) PT and/or PTT > 1.5 times the upper limit of normal

(2) incessant microvascular bleeding

(3) non-clotting blood

(4) fibrinogen < 100 mg/dL



• Most of the coagulation findings could be seen with DIC.

• A low fibrinogen may be a manifestation of consumption (DIC) or massive transfusion with dilution. The latter is amenable to cryoprecipitate administration, plus platelet concentrates and fresh frozen plasma if only packed red cells and crystalloid have been given.

• I would imagine that a profound thrombocytopenia might also qualify.


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