Trauma: damage control surgery: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Trauma: damage control surgery

Sample item

During laparotomy for multiple gunshot injuries, a 28-year-old man has received 12 units of packed red cells. His core temperature is 33 degrees Celsius, arterial pH 7.10 and there is diffuse non-surgical oozing. Bowel injuries are not yet repaired. What is the most appropriate strategy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Pack, control contamination, close temporarily and resuscitate in ICU before a planned re-look

Hypothermia, acidosis and coagulopathy form the lethal triad of trauma. In a physiologically exhausted patient, damage control surgery limits operating time to controlling bleeding and contamination, using packing and temporary abdominal closure, followed by ICU resuscitation to restore temperature, pH and clotting, and then planned definitive repair at re-look.

Option by option

  • A. Continue prolonged exploration to find all bleeding points

    Prolonged exploration deepens hypothermia and coagulopathy and increases mortality.

  • B. Pack, control contamination, close temporarily and resuscitate in ICU before a planned re-look (correct)

    Correct. Abbreviated surgery followed by ICU resuscitation breaks the lethal triad.

  • C. Complete all definitive bowel anastomoses now

    Definitive anastomoses in a cold acidotic coagulopathic patient leak and prolong the triad.

  • D. Close the abdomen fascia and discharge to ward

    Primary fascial closure under these conditions risks abdominal compartment syndrome and leaves injuries untreated.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Pack, control contamination, close temporarily and resuscitate in ICU before a planned re-look. Hypothermia, acidosis and coagulopathy form the lethal triad of trauma.

Why is "Continue prolonged exploration to find all bleeding points" not the answer?

Prolonged exploration deepens hypothermia and coagulopathy and increases mortality.

Why is "Complete all definitive bowel anastomoses now" not the answer?

Definitive anastomoses in a cold acidotic coagulopathic patient leak and prolong the triad.

Why is "Close the abdomen fascia and discharge to ward" not the answer?

Primary fascial closure under these conditions risks abdominal compartment syndrome and leaves injuries untreated.

What concept does this question test?

It tests Trauma: damage control surgery in General Surgery. In a physiologically exhausted patient, damage control surgery limits operating time to controlling bleeding and contamination, using packing and temporary abdominal closure, followed by ICU resuscitation to restore temperature, pH and clotting, and then planned definitive repair at re-look.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Trauma: damage control surgery?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.