The major trauma patient

This chapter describes the anaesthetic management of the major trauma patient. It begins with immediate trauma care, the patient journey, primary survey and resuscitation. The management of head and traumatic brain injury, thoracic injury, abdominal and pelvic injuries, spinal injury, limb and extremity injury, blast injury and gunshot wounds and traumatic cardiac arrest are discussed. The specific management of burns, paediatric trauma and silver trauma are covered. Anaesthesia for major trauma, including damage control resuscitation and damage control surgery are discussed.

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Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making

Canadian Association of Radiologists Journal ◽

10.1177/0846537120914247 ◽

2020 ◽

pp. 084653712091424

Author(s):

Sadia Raheez Qamar ◽

David Evans ◽

Brian Gibney ◽

Ciaran Redmond ◽

Muhammed Umer Nasir ◽

...

Keyword(s):

Computed Tomography ◽

Decision Making ◽

Trauma Patient ◽

Major Trauma ◽

Clinical Decision Making ◽

Damage Control Surgery ◽

Clinical Decision ◽

Whole Body ◽

Initial Assessment ◽

Major Trauma Patient

Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient’s best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.

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Resuscitation and coagulation in the severely injured trauma patient

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2010.0220 ◽

2011 ◽

Vol 366 (1562) ◽

pp. 192-203 ◽

Cited By ~ 39

Author(s):

Mark J. Midwinter ◽

Tom Woolley

Keyword(s):

Trauma Patient ◽

Damage Control ◽

Damage Control Surgery ◽

Physiological Status ◽

Trauma Patients ◽

Severely Injured ◽

Mortality And Morbidity ◽

Tissue Hypoperfusion ◽

Coagulation Status ◽

Haemostatic Resuscitation

Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

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Damage control in the emergency department, a bridge to life

Colombia Medica ◽

10.25100/cm.v52i2.4801 ◽

2021 ◽

Vol 52 (2) ◽

pp. e4004801

Author(s):

Laureano Quintero ◽

Juan Jose Melendez-Lugo ◽

Helmer Emilio Palacios-Rodríguez ◽

Natalia Padilla ◽

Luis Fernando Pino ◽

...

Keyword(s):

Emergency Department ◽

Trauma Patient ◽

Damage Control ◽

Damage Control Surgery ◽

Hemodynamic Instability ◽

Massive Hemorrhage ◽

Severely Injured ◽

Airway Injury ◽

Hemostatic Resuscitation ◽

Altered State Of Consciousness

Patients with hemodynamic instability have a sustained systolic blood pressure less or equal to 90 mmHg, a heart rate greater or equal to 120 beats per minute and an acute compromise of the ventilation/oxygenation ratio and/or an altered state of consciousness upon admission. These patients have higher mortality rates due to massive hemorrhage, airway injury and/or impaired ventilation. Damage control resuscitation is a systematic approach that aims to limit physiologic deterioration through a group of strategies that address the physiologic debt of trauma. This article aims to describe the experience earned by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia in the management of the severely injured trauma patient in the emergency department following the basic principles of damage control surgery. Since bleeding is the main cause of death, the management of the severely injured trauma patient in the emergency department requires a multidisciplinary team, which should perform damage control maneuvers aimed at rapidly control bleeding, hemostatic resuscitation and/or prompt transfer to the operating room, if required.

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The Practice of Venous Thromboembolism Prophylaxis in the Major Trauma Patient

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318031b5f5 ◽

2007 ◽

Vol 62 (3) ◽

pp. 557-563 ◽

Cited By ~ 74

Author(s):

Avery B. Nathens ◽

Megan K. McMurray ◽

Joseph Cuschieri ◽

Emily A. Durr ◽

Ernest E. Moore ◽

...

Keyword(s):

Venous Thromboembolism ◽

Trauma Patient ◽

Major Trauma ◽

Thromboembolism Prophylaxis ◽

Major Trauma Patient ◽

Venous Thromboembolism Prophylaxis

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Early management of the severely injured major trauma patient

British Journal of Anaesthesia ◽

10.1093/bja/aeu235 ◽

2014 ◽

Vol 113 (2) ◽

pp. 234-241 ◽

Cited By ~ 16

Author(s):

A.L. McCullough ◽

J.C. Haycock ◽

D.P. Forward ◽

C.G. Moran

Keyword(s):

Trauma Patient ◽

Major Trauma ◽

Severely Injured ◽

Early Management ◽

Major Trauma Patient

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Defining the Major Trauma Patient and Trauma Severity

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199108000-00013 ◽

1991 ◽

Vol 31 (8) ◽

pp. 1125-1141 ◽

Cited By ~ 17

Author(s):

WANDA W. YOUNG ◽

JOSEPH C. YOUNG ◽

STANLEY J. SMITH ◽

MICHAEL RHODES

Keyword(s):

Trauma Patient ◽

Major Trauma ◽

Major Trauma Patient ◽

Trauma Severity

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High-dose fibrinogen concentrate for haemostatic therapy of a major trauma patient with recent clopidogrel and aspirin intake

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.3109/00365513.2010.500396 ◽

2010 ◽

Vol 70 (6) ◽

pp. 453-457 ◽

Cited By ~ 25

Author(s):

Herbert Schöchl ◽

Alexander Posch ◽

Alexander Hanke ◽

Wolfgang Voelckel ◽

Cristina Solomon

Keyword(s):

Trauma Patient ◽

Major Trauma ◽

High Dose ◽

Fibrinogen Concentrate ◽

Major Trauma Patient

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707 Principles of Damage Control Surgery in Trauma and Beyond: Experience at A Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab259.315 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Y L Quake ◽

C Strong ◽

A Okpala ◽

M Shaaban

Keyword(s):

Septic Shock ◽

Trauma Patient ◽

Road Traffic ◽

Damage Control ◽

Damage Control Surgery ◽

Colonic Injury ◽

Tertiary Centre ◽

Life Threatening ◽

Abdominal Packing ◽

Polytrauma Patient

Abstract Damage control surgery (DCS) is an abbreviated laparotomy used as a temporising measure in critically unwell patients who have limited physiological reserves to tolerate complex definitive surgeries. The aim of DCS is to address life-threatening haemorrhage and manage abdominal contamination. Following an abbreviated laparotomy, patients are continuously resuscitated in intensive care unit until physiological stability can be maintained for definitive surgeries. The role of DCS in the trauma setting is well-described; however, its principles can also be applied in General Surgery for a variety of indications such as mesenteric ischaemia, uncontrolled haemorrhage, and secondary peritonitis. Judicious selection of the non-trauma patient who will benefit from this strategy is paramount. We present two cases of a polytrauma patient (Patient A), and non-trauma patient with abdominal septic shock (Patient B) who underwent DCS at our tertiary centre. Patient A is a 49-year-old male involved in a road traffic accident who sustained multiple injuries including liver laceration, splenic laceration, and colonic injury. Intra-abdominal packing and repair of serosal tears were performed, with a re-look laparotomy 48 hours later -- no further bleeding or visceral injuries were identified. Patient B is a 51-year-old gentleman who re-presented in septic shock due to infected retroperitoneal collection following a bleeding duodenal ulcer, initially managed radiologically. A T tube was inserted into the duodenum with two abdominal drains at initial DCS. After thorough washout, a feeding jejunostomy was sited at the re-look laparotomy. 30-days mortality is 0% and both patients are under follow-up.

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