Early appropriate care (EAC) is a system in

orthopaedic Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

trauma surgery Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in general surgery and often fe ...

aiming to identify serious major trauma patients and treat the most

time-critical A window of opportunity (also called a margin of opportunity or critical window) is a period of time during which some action can be taken that will achieve a desired outcome. Once this period is over, or the "window is closed", the specified ...

injuries without adding to their physiological burden.

Measures

EAC prescribes that definitive management of unstable

axial skeleton The axial skeleton is the part of the skeleton that consists of the bones of the head and trunk of a vertebrate. In the human skeleton, it consists of 80 bones and is composed of six parts; the skull (22 bones), also the ossicles of the middle ...

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 In physiology, base excess and base deficit refer to an excess or deficit, respectively, in the amount of base present in the blood. The value is usually reported as a concentration in units of mEq/L (mmol/L), with positive numbers indicating an ...

> (less negative than) -5.5 mmol/L Other factors such as coagulopathy and

hypothermia Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe ...

(parts of the Trauma triad of death) would also be indications for DCO with

external fixation External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide ...

History

''Early total care'' (ETC) became widespread in the 1980s, when studies showed early definitive fixation of long bone

fractures Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...

lead to better outcomes, with a reduction in incidence of secondary

ARDS Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin color ...

, fat embolism and

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

. 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, aiming to prevent early death in a critically wounded patient via stabilization and not definitive fixation, often with the use of

systems. The term early appropriate care was first proposed in 2013 as an evolution of DCO, with a focus on resuscitation rather than injury severity score.

References

{{Trauma , state=autocollapse Traumatology Trauma surgery

Measures

History

See also

References