Principles of Initial Trauma Management and Evaluation

2018 ◽  
Author(s):  
Shelby Resnick ◽  
Brian Smith ◽  
Patrick Reilly
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Injured Patient ◽  
The United States ◽  
Rapid Sequence Intubation ◽  
Multidisciplinary Teams ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Secondary Survey

Trauma accounts for almost 10% of deaths worldwide and is the fourth most common cause of death in the United States. Treatment of the injured patient requires multiple unique resources, including multidisciplinary teams, surgical subspecialties, and dedicated resuscitation areas. Evaluation and initial management of the trauma patient is performed systematically to quickly identify and treat life-threatening injuries. This review serves as an introduction to care for the critically injured patient. It covers the initial steps for evaluation, resuscitation, diagnosis and treatment of the trauma patient and provides a brief overview of various injury patterns resulting from both blunt and penetrating trauma. This review contains 6 figures, 6 tables and 49 references Key Words: blunt trauma, damage control resuscitation, FAST exam, lateral canthotomy, penetrating trauma, primary survey, rapid sequence intubation, secondary survey, trauma systems

Principles of Initial Trauma Management and Evaluation

2018 ◽  
Author(s):  
Shelby Resnick ◽  
Brian Smith ◽  
Patrick Reilly
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Injured Patient ◽  
The United States ◽  
Rapid Sequence Intubation ◽  
Multidisciplinary Teams ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Secondary Survey

Trauma accounts for almost 10% of deaths worldwide and is the fourth most common cause of death in the United States. Treatment of the injured patient requires multiple unique resources, including multidisciplinary teams, surgical subspecialties, and dedicated resuscitation areas. Evaluation and initial management of the trauma patient is performed systematically to quickly identify and treat life-threatening injuries. This review serves as an introduction to care for the critically injured patient. It covers the initial steps for evaluation, resuscitation, diagnosis and treatment of the trauma patient and provides a brief overview of various injury patterns resulting from both blunt and penetrating trauma. This review contains 6 figures, 6 tables and 49 references Key Words: blunt trauma, damage control resuscitation, FAST exam, lateral canthotomy, penetrating trauma, primary survey, rapid sequence intubation, secondary survey, trauma systems

scholarly journals DAMAGE CONTROL SURGERY

2009 ◽  
Vol 16 (01) ◽  
pp. 12-16
Author(s):  
MUHAMMAD ATEEQ ◽  
SHAZIA JAHAN ◽  
M. HANIF
Keyword(s):  
Teaching Hospital ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Pelvic Trauma ◽  
Biliary Fistula ◽  
Phase Iii ◽  
Severely Injured ◽  
Life Threatening ◽  
Abdominal Packing

Objective: To analyze the role of damage control in surgery in severely injured and polytrauma patients. D e s i g n:Descriptive study. S e t t i n g : Surgical unit of District Headquarter (teaching) Hospital, Rawalpindi. P e r i o d : January 2000 to December 2007.Patients a n d m e t h o d s : This study included 28 severely injured patients who presented in the accident and emergency department ofDistrict Headquarters (teaching) Hospital, Rawalpindi. These patients were unstable because of life threatening hemorrhage following someblunt or penetrating trauma. After immediate shifting to operation theater, resuscitation and operative intervention was done simultaneously.Different procedures of damage control surgery like abdominal packing for hepatic and pelvic trauma, major vascular ligation for vascularinjuries of neck and extremities were adopted in phase I. In phase II patients were managed in ITC for coagulopathy and hypothermia.Definitive treatment was done in Phase III after 24-72 hours once patients got stable. R e s u l t s : Total 28 patients included in the study. In18 patients abdominal packing for hepatic injury (n=11) and pelvic fractures (n=7) was done. Major vascular ligations in n=11 and temporaryintestinal clamping in n=1 patient. Planned re-exploration after 24-72 hours in n=16 and unplanned re-exploration within 24 hours in n=5patients was done. Complications included ongoing hemorrhage (n=5), coagulopathy (n=2), controlled biliary fistula (n=1), abdominalcompartment syndrome (n=1), cerebral ischemia (n=1) and gangrene of abdominal wall (n=1). Two patients died.

A systematic approach to the injured patient

2016 ◽  
Author(s):  
Clay Cothren Burlew ◽  
Ernest E. Moore
Keyword(s):  
Cause Of Death ◽  
Injured Patient ◽  
Trauma Team ◽  
Detailed Examination ◽  
Simultaneous Treatment ◽  
Common Cause ◽  
Primary Survey ◽  
Life Threatening ◽  
Secondary Survey ◽  
Injured Patients

Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years, and is the third most common cause of death regardless of age. It is also the leading cause of years of productive life lost. However, death rate underestimates the magnitude of the societal toll. Organized trauma systems have improved mortality by providing timely and expert care to severely-injured patients. Patient management consists of rapid primary survey, which should focus on the identification and simultaneous treatment of immediately life-threatening injuries. A classical ABC (airway, breathing, circulation) approach is recommended and is best carried out by a trained and practiced trauma team. The primary survey is followed by a more detailed examination, the secondary survey, which consists of a head-to-toe examination to identify all specific injuries. The secondary survey should be followed by investigation and definitive care.

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

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.

Initial Management of Life-Threatening Trauma

2018 ◽  
Author(s):  
Emily Cantrell ◽  
Jay Doucet
Keyword(s):  
Life Support ◽  
Rapid Assessment ◽  
Trauma System ◽  
Injured Patient ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Primary Survey ◽  
Field Triage ◽  
Life Threatening ◽  
Secondary Survey

Management of the critically injured patient is optimized by a coordinated team effort in an organized trauma system that allows for rapid assessment and initiation of life-preserving therapies. This initial assessment must proceed systematically and be prioritized according to physiologic necessity for survival. Beginning in the prehospital setting, coordination, preparation, and appropriate triage of the injured are crucial to facilitating rapid resuscitation of the trauma patient. Next, active efforts to support airway, breathing, circulation, and disability are performed with simultaneous intervention to treat life-threatening injuries and restore hemodynamic stability in the primary survey. With ongoing evaluation and continued resuscitation, a secondary survey provides a head-to-toe assessment of the patient allowing for further diagnosis of injuries and triage to more definitive care. This review contains 12 figures, 8 tables and 63 references Key Words: advanced trauma life support, definitive airway, FAST/eFAST, field triage, Glasgow coma scale, primary survey, 1:1:1 resuscitation, secondary survey

Intraosseous Infusion as a Bridge to Definitive Access

2016 ◽  
Vol 82 (10) ◽  
pp. 876-880 ◽  
Author(s):  
Megan Johnson ◽  
Kenji Inaba ◽  
Saskya Byerly ◽  
Erika Falsgraf ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Life Support ◽  
Unit Length ◽  
Penetrating Trauma ◽  
Venous Access ◽  
Rapid Sequence Intubation ◽  
Inhospital Mortality ◽  
Rapid Sequence ◽  
Data Points ◽  
Level 1 Trauma Center ◽  
Difficult Venous Access

Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008–May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7.4% medical), 56 per cent were hypotensive on arrival and 38.2 per cent asystolic. The most common indications for IO infusion were difficult IV access (69%) and rapid sequence intubation (20.6%). The median time to IO access was three minutes. IV access was gained after IO in 72.1 per cent of patients. Through IO access, 30.9 per cent patients received crystalloid, 29.4 per cent received Advanced Care Life Support (ACLS) medications, 25 per cent rapid sequence intubation medications, 20.6 per cent blood products, and 2.9 per cent seizure medications. Overall, 80.9 per cent were intubated in the Emergency Department (ED), 26.5 per cent had ED thoracotomy, and 20.6 per cent had a laparotomy. Median crystalloid infused through IO was 180 cc in pediatric patients and 1 L in adults, respectively. Extravasation, the most common complication, was experienced by 7.4 per cent of patients. Inhospital mortality was 72.9 per cent. IO access should be considered when there is a need for rapid intervention requiring vascular access.

scholarly journals Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation

2021 ◽  
Vol 6 (1) ◽  
pp. e000588
Author(s):  
Jason Randall West ◽  
Brandon P O'Keefe ◽  
James T Russell
Keyword(s):  
Injury Severity ◽  
Penetrating Trauma ◽  
Rapid Sequence Intubation ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Rapid Sequence ◽  
Severity Scores ◽  
First Pass ◽  
Gcs Score

ObjectiveThe predictors of first pass success (FPS) without hypoxemia among trauma patients requiring rapid sequence intubation (RSI) in the emergent setting are unknown.MethodsRetrospective study of adult trauma patients requiring RSI during a 5-year period comparing the trauma patients achieving FPS without hypoxemia to those who did not. The primary outcome was FPS without hypoxemia evaluated by multivariate logistic regression adjusting for the neuromuscular blocking agent used (succinylcholine or rocuronium), hypoxemia prior to RSI, Glasgow Coma Scale (GCS) scores, the presence of head or facial trauma, and intubating operator level of training.Results246 patients met our inclusion criteria. The overall FPS rate was 89%, and there was no statistical difference between those receiving either paralytic agent. 167 (69%) patients achieved FPS without hypoxemia. The two groups (those achieving FPS without hypoxemia and those who did not) had similar mean GCS, mean Injury Severity Scores, presence of head or facial trauma, the presence of penetrating trauma, intubating operator-level training, use of direct laryngoscopy, hypoxemia prior to RSI, heart rate per minute, mean systolic blood pressure, and respiratory rate. In the multivariate regression analysis, the use of succinylcholine and GCS score of 13–15 were found to have adjusted ORs of 2.1 (95% CI 1.2 to 3.8) and 2.0 (95% CI 1.0 to 3.3) for FPS without hypoxemia, respectively.ConclusionTrauma patients requiring emergency department RSI with high GCS score and those who received succinylcholine had higher odds of achieving FPS without hypoxemia, a patient safety goal requiring more study.Level of evidenceIV.Study typePrognostic.

scholarly journals REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Fernando Rodriguez ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
New Technology ◽  
Management Strategies ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Hemostatic Resuscitation ◽  
The Right ◽  
Trauma Surgeons

Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.

scholarly journals Hybrid trauma service: on the leading edge of damage control

2021 ◽  
Vol 52 (2) ◽  
pp. e4014686
Author(s):  
Helmer Emilio Palacios-Rodríguez ◽  
Nao Hiroe ◽  
Mónica Guzmán-Rodríguez ◽  
Yaset Caicedo ◽  
Luis Saldarriaga ◽  
...  
Keyword(s):  
Damage Control ◽  
Injured Patient ◽  
Leading Edge ◽  
Advanced Technology ◽  
Therapeutic Approaches ◽  
Current Standard ◽  
Trauma Service ◽  
Life Threatening ◽  
Therapeutic Tools ◽  
Severely Injured Patient

Trauma damage control seeks to limit life-threatening bleeding. Sequential diagnostic and therapeutic approaches are the current standard. Hybrid Room have reduced hemostasis time by integrating different specialties and technologies. Hybrid Rooms seek to control bleeding in an operating room equipped with specialized personnel and advanced technology including angiography, tomography, eFAST, radiography, endoscopy, infusers, cell retrievers, REBOA, etc. Trauma Hybrid Service is a concept that describes a vertical work scheme that begins with the activation of Trauma Code when admitting a severely injured patient, initiating a continuous resuscitation process led by the trauma surgeon who guides transfer to imaging, angiography and surgery rooms according to the patient's condition and the need for specific interventions. Hybrid rooms integrate different diagnostic and therapeutic tools in one same room, reducing the attention time and increasing all interventions effectiveness.

Initial Management of Life-Threatening Trauma

2018 ◽  
Author(s):  
Emily Cantrell ◽  
Jay Doucet
Keyword(s):  
Life Support ◽  
Rapid Assessment ◽  
Trauma System ◽  
Injured Patient ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Primary Survey ◽  
Field Triage ◽  
Life Threatening ◽  
Secondary Survey

Management of the critically injured patient is optimized by a coordinated team effort in an organized trauma system that allows for rapid assessment and initiation of life-preserving therapies. This initial assessment must proceed systematically and be prioritized according to physiologic necessity for survival. Beginning in the prehospital setting, coordination, preparation, and appropriate triage of the injured are crucial to facilitating rapid resuscitation of the trauma patient. Next, active efforts to support airway, breathing, circulation, and disability are performed with simultaneous intervention to treat life-threatening injuries and restore hemodynamic stability in the primary survey. With ongoing evaluation and continued resuscitation, a secondary survey provides a head-to-toe assessment of the patient allowing for further diagnosis of injuries and triage to more definitive care. This review contains 12 figures, 8 tables and 63 references Key Words: advanced trauma life support, definitive airway, FAST/eFAST, field triage, Glasgow coma scale, primary survey, 1:1:1 resuscitation, secondary survey

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