The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.

HighlightsBRBNS most commonly manifests as bleeding, however complications such as obstruction and infarction may be present.In obstructive complications, with lesions deffusely present, surgical treatment without resection is a viable alternative.DIVC should be promptly detected in such patients during the postoperative course. Although rare, it is a life-threatening condition.

The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among Surge-Man, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.

The final frontier in endoscopy is the peritoneal cavity which was recently reached through natural orifice transluminal endoscopic surgery (NOTES). Endoscopic perforation caused by NOTES has been the major challenge for this procedure because of the risk of peritonitis and consequent complications. We describe in a dog model the use of an overtube system, one of them with a balloon, to access the peritoneal cavity by NOTES. It permits direct access to the peritoneal cavity from the mouth and also allows the performance of a controlled perforation and provides conditions for a safe closure of the gastric wall.

Purpose In a previous work, we presented a protocol for the management of patients with complex pelviperineal injuries (CPI) resulting from blunt trauma. This treatment protocol included: early hemorrhage control, surgical debridement of devitalized tissue, selective loop transverse colostomy according to the location of the perineal wound, distal colonic irrigation with saline solution, pulsatile saline solution irrigation of the perineal wound, maintenance of the perineal wound open, management of bone fractures and visceral injuries, surgical revisions at intervals of 24 to 48 hours, presumptive antibiotic therapy, early nutritional support, and definitive repair of wound defect and visceral injuries after infection control and metabolic recovery. In order to determine whether the evolution of the authors's protocol for the assessment and management of patients with CPI is associated with improved patient outcome we conduct this review. Materials and methods The medical records of 42 patients with CPI resulting from blunt trauma admitted in the level I trauma center at the HC-USPSM, were reviewed. Demographic data, mechanism of trauma, revised trauma score (RTS) and injury severity score (ISS), classification of perineal injuries, associated systemic trauma, infection complications and mortality rates (overall, early and late) were collected. Results The early mortality was 19% and the late mortality was 17%. The overall mortality was 36%. Patients who died had higher average ISS (average ISS = 45) comparing to patients who survived (average ISS = 25) with significant statistical difference (p < 0.05). Damage control principles applied to CPI was the standard of care and a selective approach to perform fecal stream diversion were used. Conclusion The results of this study showed that the use of this protocol was effective and reinforced the importance of the priority in early control of hemorrhage, early fecal diversion in selected cases, multiple surgical perineal revisions, and avoidance of complex visceral injury repair at the first surgical intervention. How to cite this article Teixeira Jr FJR, do Couto Netto SD, Collete e Silva FS, Mori ND, Fontes B, Poggetti RS, Birolini D, Bernini CO, Utiyama EM. Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach. Panam J Trauma Crit Care Emerg Surg 2015;4(2):87-95.