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.

The term early appropriate care was first proposed in 2013^[3] as an evolution of DCO, with a focus on resuscitation rather than injury severity score.

See also[edit]

• Damage control surgery

References[edit]