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The response to patient factors Injuries presenting with increased frequency in an individual patient require special attention. Older patients, perhaps with multiple medical problems, can represent such a vulnerable group. The reduced bone mineral density mak...

The response to the mechanism of injury (injury prevention) Not infrequently , two or more patients are seen who have been injured in the same geographical area by the same mecha - nism. A possible scenario is that, over a period of a few weeks, several pati...

The response to the mechanism of injury (injury prevention) Not infrequently , two or more patients are seen who have been injured in the same geographical area by the same mecha - nism. A possible scenario is that, over a period of a few weeks, several pati...

The significance of time in the outcome Injuries can happen at lightning speed. Time point 0 (time 0) is defined as literally the seconds prior to the event, when the patient is at their normal baseline. All subsequent events, including the acute physiological r...

A: Airway with cervical spine control All trauma patients should have their cervical spine immobil ised and protected throughout. An immediate assessment of the patient’s airway is made. A compromised airway requires a stepwise progression, first clearing the a...

B: Breathing and ventilation All patients should receive high-flow oxygen. Life-threatening chest pathology such as tension pneumothorax, massive haemothorax and flail segment should be diagnosed and managed immediately . Equipment and expertise for rapid insert...

C: Circulation and haemorrhage control All patients require adequate intravenous (IV) access with at least two large-bore IV cannulae. Equipment and expertise for insertion of central or intraosseous venous access should be - - - available where peripheral ac...

D: Disability and E: Exposure On admission, the GCS score should be calculated ( Table 27.1 ), the pupils assessed for size and reaction to light and the patient observed to determine whether they are moving all four limbs. The core temperature must be recorde...

DAMAGE CONTROL SURGERY VERSUS EARL Y TOTAL CARE As discussed in Chapter 26 , the concept of damage control surgery (DCS) was developed because severely traumatised patients with impaired physiology have poor outcomes after lengthy and complex surgical reconst...

FURTHER READING Sierink HJC, Treskes K, Edwards MJR et al ., for the REACT-2 Study Group. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet 201...

IDENTIFICATION OF SEVERE TRAUMA The severely injured patient, with multiple injuries to di ff er ent body systems, poses unique diagnostic and treatment challenges. The early assessment and management of severe trauma begins in the prehospital environment. Man...

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Learning objectives How to identify and assess the severely injured patient • Early treatment goals for multiply injured patients • Understand the role of permissive hypotension, • tranexamic acid and massive transfusion protocols Learning objectives How to id...

ROLE OF THE TRAUMA TEAM All hospitals managing severe trauma should have a dedicated trauma team that is available immediately to attend and manage patients presenting with severe trauma. The composition of the team will depend on local policies but it will i...

SECONDARY SURVEY All severely injured patients require a detailed top-to-toe exam ination after life-threatening injuries have been identified and managed during the primary survey . Patients may be intubated and unresponsiv e at this point, limiting the accura...

Venous lactate V enous lactate is a useful marker of resuscitation and phys - - iological state. A normal lactate (<2 /uni00A0 mmol/L) is a sign that the patient is probably resuscitated and suitable for ETC. An elevated lactate (>3 /uni00A0 mmol/L) suggests ...

c: Exsanguinating external haemorrhage Experience from war zones over the past 20 years has shown that exsanguinating external haemorrhage from massive arte rial bleeding needs to be controlled even before the airway is managed (see Chapter 34 ). Most of thes...

A: Airway with cervical spine control All trauma patients should have their cervical spine immobil ised and protected throughout. An immediate assessment of the patient’s airway is made. A compromised airway requires a stepwise progression, first clearing the a...