Search Results

Clinical examination Pelvic fractures should be easily identified if ATLS guidelines are followed. There is no role of ‘springing’ the pelvis. If a binder has not been applied and an ‘open book’ fracture is suspected, a binder must be immediately applied as ...

Colon Blunt injuries to the colon are relatively infrequent; penetrating injuries occur more often. If relatively little contamination is present and the viability is satisfactory , such wounds can be repaired primarily . If, however, there is extensive conta...

Computed tomography scan CT has become the ‘gold standard’ for the intra-abdominal diagnosis of injury in the stable patient. The scan can be performed using intravenous contrast. CT is sensitive for blood and individual organ injury as well as for retroperito...

DAMAGE CONTROL Following major injury , protracted surgery in the physio logically unstable patient can in itself prove fatal. Patients with the ‘deadly triad’ (hypothermia, acidosis and coagulopathy) are those at highest risk. Damage control or damage limita...

Damage control resuscitation The concept of damage control has been broadened to include the techniques used in resuscitation as well as in surgery . The time in the emergency department is minimised and the majority of resuscitation of the patient is carri...

Diagnosis Radiograph Examination of a plain radiograph of the pelvis requires an understanding of the mechanism of injury and a decision on the stability of the pelvic rim. It is important to note that the vast majority of patients with suspected pelvic ...

Diagnostic peritoneal lavage Diagnostic peritoneal lavage (DPL) is a test rarely used in modern-day practice but can be of value in resource-limited settings. It is a test used to assess the presence of blood or contaminants in the abdomen. A nasogastric tub...

Duodenum Duodenal injury is frequently associated with injuries to the adjoining pancreas. Like the pancreas, the duodenum lies retroperitoneally and so injuries are hidden, discovered late or at laparotomy performed for other reasons. CT is the diagnostic mod...

EMERGENCY THORACIC SURGERY Emergency thoracic surgery is an essential part of the arma - mentarium of any surgeon dealing with major trauma. A - timely surgical intervention for the correct indications can be the key step in saving an injured patient’s life....

Emergency department thoracotomy or sternotomy Emergency department thoracotomy (EDT) should be reserved - for those patients with penetrating injury in whom signs of life are still present. Patients who have received cardiopulmonary resuscitation (CPR) in th...

INDIVIDUAL ORGAN INJURY Liver Blunt liver trauma occurs as a result of direct injury . The liver is a solid organ and compressive forces can easily burst the liver substance ( Figure 29.8 ). The liver is usually compressed between the impacting object and the...

INJURY MECHANISMS ASSOCIATED WITH TORSO TRAUMA Injury consistently traverses di ff erent anatomical zones of the body , a ff ecting structures on both sides of traditional anatomi - cal zones. These zones are known as junctional zones. INJURY MECHANISMS ASSO...

INTERVENTIONAL RADIOLOGY Interventional radiology can be useful in the management of torso trauma as both an investigative and a therapeutic tool for patients with vascular injury . Angioembolisation following demonstration of ongoing bleeding in splenic and ...

Immediate life-threatening injuries Airway obstruction Early intubation is very important, particularly in cases of neck haematoma or possible airway oedema. Airway distortion can be insidious and progressive and can make delayed intubation more di ffi cult if ...

INTRODUCTION Injury seldom respects anatomical boundaries, hence the divi sion of the body into the abdomen and the thorax is artificial. Therefore, injury to the torso with its associated physiological consequences is more appropriate. The torso is generally ...

Investigation Routine investigation in the emergency department of injury to the chest is based on clinical examination, supplemented by appropriate imaging. Figure 29.2 The anatomical extent of the abdomen. with sonography for trauma (eFAST) Ultrasound can b...

Junctional zones The key junctional zones are: ). /uni25CF between the neck and the thorax; /uni25CF between the thorax and the upper limbs; /uni25CF between the thorax and the abdomen; /uni25CF between the abdominopelvic structures and the groin. These zones ...

Laparoscopy Laparoscopy or thoracoscopy may be a valuable screening investigation in physiologically non-compromised patients with penetrating trauma to detect or exclude peritoneal penetration and/or diaphragmatic injury . Laparoscopy may be divided into: /un...