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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...

Introduction No content extracted automatically.

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

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...

CLASSIFICATION OF HEAD INJURY The severity of head injury is classified according to the post- resuscitation Glasgow Coma Scale (GCS) score ( Table 28.1 ), as it is the GCS score – and in particular the motor score – that is the best predictor of neurological...

Concussion, second impact syndrome and postconcussive syndrome Concussion is defined as the alteration of consciousness as a result of closed head injury but is generally used to describe consciousness at the time of injury is not a prerequisite. Key feature...

Concussion, second impact syndrome and postconcussive syndrome Concussion is defined as the alteration of consciousness as a result of closed head injury but is generally used to describe consciousness at the time of injury is not a prerequisite. Key feature...

Examination: primary survey ATLS guidelines address a fundamental priority: ensuring uninterrupted perfusion of the brain with oxygenated blood. This is especially important after a head injury , given the disturbance to intracranial autoregulation and the se...

Examination: secondary survey A full secondary survey will be required. Particular attention must be paid to the head, neck and spine. Head Examination of the head should include inspection and palpa tion of the scalp for evidence of subgaleal haematoma and s...

History Mechanism In moderate and severe TBI, a history must be obtained from witnesses and paramedics. High-energy mechanisms of injury , including a fall from a height or a high-speed road accident, will require careful clinical and radiological exclusion of...