Early appropriate care
Early appropriate care (EAC) is a system in orthopaedic trauma surgery aiming to identify serious major trauma patients and treat the most time-critical injuries without adding to their physiological burden.
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Measures[edit]
EAC prescribes that definitive management of unstable axial skeleton and long bone fractures should only be undertaken within 36 hours if an adequate response to resuscitation has been demonstrated by:
- pH ≥7.25
- Lactate ≤4 mmol/L
- Base excess > (less negative than) -5.5 mmol/L
Other factors such as coagulopathy and hypothermia (parts of the Trauma triad of death) would also be indications for DCO with external fixation.
History[edit]
Early total care (ETC) became widespread in the 1980s, when studies showed early definitive fixation of long bone fractures lead to better outcomes, with a reduction in incidence of secondary ARDS, fat embolism and sepsis.[1] Subsequent studies showed that in the unstable patient, long operations lead to a 'second hit' which actually worsened mortality outcomes.
A philosophy of damage control orthopaedics (DCO) was proposed in 2000,[2] aiming to prevent early death in a critically wounded patient via stabilization and not definitive fixation, often with the use of external fixation systems.
The term early appropriate care was first proposed in 2013[3] as an evolution of DCO, with a focus on resuscitation rather than injury severity score.
References[edit]
- ^ Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989). "Early versus delayed stabilization of femoral fractures. A prospective randomized study". J Bone Joint Surg Am 71: 336–340.
- ^ Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN (2000). "External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics". J Trauma 48: 613–21. doi:10.1097/00005373-200004000-00006.
- ^ Vallier HA, Wang X, Moore TA, Wilber JH, Como JJ (2013). "Timing of orthopaedic surgery in multiple trauma patients; development of a protocol for early appropriate care". J Orthop Trauma 27: 543–551. doi:10.1097/bot.0b013e31829efda1.
See also[edit]
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Points of interest related to trauma and orthopedics on Wikipedia: Outline – Index – History – Portal – Category:Traumatology, Category:Orthopedics – Stubs |
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