Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemicreperfusion injury and acute kidney injury. We present a case involving a 20-yearold man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed.
An incorporation of waste tyre particles in concrete has been established to produce a green concrete.
However, despite its advantages, strength reduction is an obvious handicap. To improve the strength,
pre-treatments of the waste tyre particles and addition of Oil Palm Fruit Fibre (OPFF) were chosen and
reported in this study. The addition of OPFF was to influence the internal structure in order to improve
shrinkage and other strength properties. Performance of the composites in compressive, split tensile and
flexural strengths, as well as shrinkage and microstructure were observed. Results showed better behaviour
of the treated tyre crumb mortar rather compared to the untreated tyre, with the replacement of up to 40%
by volume of the treated tyre crumb particles and 0.5- 1.0% OPFF addition by mass of cement content.