Damage Control! The Acutely Hemorrhaging Patient

By: Andrew Linklater, DVM, DACVECC

Description: Damage Control is a set of techniques which have developed over a few decades to help minimize mortality associated with hemorrhage, the leading cause of death in patients suffering trauma, accounting for 75% of mortality in human patients. Hemorrhage leads to the common triad of physiological changes which exacerbate patient stability and contribute to both morbidity and mortality: acidosis, hypothermia and hypotension. This lecture will review many aspects of Damage Control including medical (Damage Control Resuscitation, DCR) and surgical (Damage Control Surgery, DCS) techniques to help avoid ongoing blood loss and death in patients suffering from significant hemorrhage from trauma. DCR involves all attempts to avoid the lethal triad, including permissive hypotension, early administration of blood products, reduced crystalloid infusion, immediate hemorrhage control and correction hypothermia, acidosis and coagulopathy which all occur with hemorrhage and shock. Each of these will be reviewed in detail. The techniques to successfully perform DCS will also be reviewed. These involve a rapid, but short lived anesthetic and surgical event to arrest hemorrhage and minimize contamination, followed by a period of resuscitative efforts (medical management) to return the patient to a normal physiological state, and a second surgical procedure for definitive care is pushed at a later time. Alternative (conservative) methods for managing traumatic hemoabdomen patients will also be discussed.

By the end of the session, attendees will be able to:

1. Know how to rapidly assess a patient for life-threatening hemorrhage
2. Learn the concepts of damage control resuscitation for the hemorrhaging patient
3. Learn the concepts of damage control surgery
4. Know of alternative non-surgical techniques for patients with cavitary hemorrhage

Speaker Info: Dr. Linklater grew up in Canada and graduated from the Western College of Veterinary Medicine in Saskatoon, Saskatchewan. He completed a rotating internship in Los Angeles before moving on to residency at the Animal Emergency Center in Milwaukee. He became board certified by the American College of Veterinary Emergency and Critical Care in 2009. He worked at and was part owner of Lakeshore Veterinary Specialists in Wisconsin prior to acquisition by BluePearl. During his 20 year tenure in Wisconsin, he has served as Medical Director, Emergency Service head, Director of a certified Veterinary Trauma Center and Director of an Internship and Residency Program, where he has mentored more than 100 individuals. He has authored more than 50 peer-reviewed journal and textbook chapter publications, been the senior editor of two veterinary emergency textbooks, and has hundreds of lecture and lab instruction at a multitude of national and international conferences. In his hospitals, he instituted IPASS rounding, lead the Patient Safety Initiative, developed and instituted COVID, ER Service Pause, Antibiotic Stewardship, Critical anesthesia, Blood Banking, and Sustainability guidelines. He was a top-awarded veterinarian of the Veterinary Involvement Program at his previous hospital for three years. Recently, he has embarked on a new chapter, moving with his family to Colorado, and is excited to be the lead criticalist at Veterinary Specialists of the Rockies. Dr. Linklater’s professional interests include trauma, surgical emergencies, coagulpathies, respiratory intervention, and transfusion medicine; he is also a certified RECOVER instructor. On a personal note, he has run several marathons and half marathons, enjoys curling, outdoor activities such as hiking, and camping, traveling, and spending quality time with his wife and their pets. He is excited to participate in all the outdoor adventure that Colorado has to offer.