CRITICAL PHYSIOLOGY

CRITICAL PHYSIOLOGY

Resuscitation of all injuries to the chest and abdomen should follow the latest Advanced Trauma Life Support (ATLS) prin ciples ( Table 29.1 ; see Chapters 26 and 27 ). Haemorrhage is the major problem. This may be obvi - ous at the time of evaluation; however, in the young physi - cally fit individual, bleeding may produce no or only minimal changes in vital measures and, therefore, be di ffi cult to assess ( Table 29.2 ). Although obvious injury may be present, tradi - tional indicators (such as pulse rate), in isola tion, are unreliable. Bleeding occurs from five major sites – ‘ one on the floor and four more ’: /uni25CF external – ‘floor’; /uni25CF chest; /uni25CF abdomen (including the retroperitoneum); /uni25CF pelvis; /uni25CF extremities.

TABLE 29.1 Advanced Trauma Life Support principles of resuscitation. C Catastrophic haemorrhage A Airway B Breathing C Circulation D Disability (neurology) E Environment and exposure Liver Spleen Kidney bleeding in torso trauma. Physiological Increasing respiratory rate Increasing pulse rate Falling blood pressure Rising serum lactate Anatomical Visible bleeding Injury in close proximity to major vessels Penetrating injury with a retained missile

CRITICAL PHYSIOLOGY

Resuscitation of all injuries to the chest and abdomen should follow the latest Advanced Trauma Life Support (ATLS) prin ciples ( Table 29.1 ; see Chapters 26 and 27 ). Haemorrhage is the major problem. This may be obvi - ous at the time of evaluation; however, in the young physi - cally fit individual, bleeding may produce no or only minimal changes in vital measures and, therefore, be di ffi cult to assess ( Table 29.2 ). Although obvious injury may be present, tradi - tional indicators (such as pulse rate), in isola tion, are unreliable. Bleeding occurs from five major sites – ‘ one on the floor and four more ’: /uni25CF external – ‘floor’; /uni25CF chest; /uni25CF abdomen (including the retroperitoneum); /uni25CF pelvis; /uni25CF extremities.

TABLE 29.1 Advanced Trauma Life Support principles of resuscitation. C Catastrophic haemorrhage A Airway B Breathing C Circulation D Disability (neurology) E Environment and exposure Liver Spleen Kidney bleeding in torso trauma. Physiological Increasing respiratory rate Increasing pulse rate Falling blood pressure Rising serum lactate Anatomical Visible bleeding Injury in close proximity to major vessels Penetrating injury with a retained missile

CRITICAL PHYSIOLOGY

Resuscitation of all injuries to the chest and abdomen should follow the latest Advanced Trauma Life Support (ATLS) prin ciples ( Table 29.1 ; see Chapters 26 and 27 ). Haemorrhage is the major problem. This may be obvi - ous at the time of evaluation; however, in the young physi - cally fit individual, bleeding may produce no or only minimal changes in vital measures and, therefore, be di ffi cult to assess ( Table 29.2 ). Although obvious injury may be present, tradi - tional indicators (such as pulse rate), in isola tion, are unreliable. Bleeding occurs from five major sites – ‘ one on the floor and four more ’: /uni25CF external – ‘floor’; /uni25CF chest; /uni25CF abdomen (including the retroperitoneum); /uni25CF pelvis; /uni25CF extremities.

TABLE 29.1 Advanced Trauma Life Support principles of resuscitation. C Catastrophic haemorrhage A Airway B Breathing C Circulation D Disability (neurology) E Environment and exposure Liver Spleen Kidney bleeding in torso trauma. Physiological Increasing respiratory rate Increasing pulse rate Falling blood pressure Rising serum lactate Anatomical Visible bleeding Injury in close proximity to major vessels Penetrating injury with a retained missile