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.
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:[citation needed]
- 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.[citation needed]
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.
EAC was developed by Heather Vallier while at MetroHealth in Cleveland.[3] The term early appropriate care was first proposed in her Journal of Orthopaedic Trauma article in 2013[3] as an evolution of DCO, with a focus on resuscitation rather than injury severity score.
See also
[edit]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 (3): 336–340. doi:10.2106/00004623-198971030-00004. PMID 2925704.
- ^ 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 (4): 613–21. doi:10.1097/00005373-200004000-00006. PMID 10780592. S2CID 44429710.
- ^ a b 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 (10): 543–551. doi:10.1097/bot.0b013e31829efda1. PMID 23760182. S2CID 32252098.