Trauma Resuscitation: The Team Approach

Book Cover......Page 1
Title......Page 2
Copyright......Page 3
Contents......Page 4
Contributors......Page 10
Abbreviations......Page 14
Preface......Page 17
Trauma websites......Page 19
Introduction......Page 21
1.2 Pre-hospital information and communication......Page 26
1.3.1 Team members......Page 27
1.3.3 The roles of the team members......Page 28
1.4 Preparation......Page 30
1.6.1 Primary survey and resuscitation......Page 31
1.6.1.4 Dysfunction......Page 35
Exposure and environment......Page 36
1.6.2 Secondary survey......Page 37
1.6.3 Assimilation of information......Page 45
1.6.4 Definitive care......Page 46
1.8 Summary......Page 49
Further reading......Page 50
2.3 Standby preparation and transfer......Page 51
2.4 Assessing and securing the airway......Page 52
2.4.1 Simple airway devices......Page 54
2.5.1 Spontaneous ventilation......Page 55
2.6 Advanced airway control......Page 56
2.6.1 Endotracheal intubation......Page 57
2.6.2 Laryngeal mask airway......Page 62
2.6.3 The Combitube......Page 64
2.6.4 Drugs used to facilitate advance airway management......Page 66
2.6.5 Rapid sequence induction of anaesthesia and tracheal intubation (RSI)......Page 70
2.6.7 Surgical airway......Page 71
Further reading......Page 76
3.2.1 Chest wall......Page 77
3.2.4 Lungs and pleurae......Page 78
3.2.5 Mediastinum......Page 79
3.3.1 Ventilation......Page 80
3.3.3 Diffusion......Page 81
3.4 Assessment and management......Page 82
3.4.1 Primary survey and resuscitation......Page 83
3.4.2 Secondary survey......Page 91
3.5.1 Chest radiograph......Page 96
3.5.2  Computerized tomography (CT)......Page 97
3.5.4 Endoscopy......Page 98
3.5.7  Other investigations......Page 99
3.6.2 Simple pneumothorax......Page 100
3.6.6 Thoracic duct injury......Page 101
Further reading......Page 102
4.2 Classification......Page 103
4.3.1 Cardiac output......Page 104
4.3.2 Systemic arterial blood pressure......Page 108
4.3.4 Oxygen delivery......Page 109
4.4 Cellular effects of shock......Page 111
4.5.2 Cardiogenic shock......Page 112
4.6 Estimating volume loss and grading shock......Page 113
4.6.1 Limitations to estimations of hypovolaemia......Page 114
4.7.1 Primary survey and resuscitation......Page 116
4.7.2 Venous access......Page 118
4.7.3 Secondary survey......Page 123
Appendix 4.1: Invasive monitoring......Page 125
Oxygen content of arterial blood......Page 126
Appendix 4.2 Colloids versus crystalloids......Page 127
Crystalloids......Page 128
Further reading......Page 129
5.1 Introduction......Page 131
5.2.1 The abdomen......Page 132
5.3 Mechanism of injury......Page 140
5.3.2 Penetrating abdominal trauma (PAT)......Page 141
5.4.1 Primary survey......Page 142
5.4.2 Secondary survey......Page 143
5.4.4 Investigations......Page 144
5.4.5 Definitive care......Page 148
Further reading......Page 149
6.2 Anatomy......Page 150
6.2.1 Anatomical changes following head injury......Page 152
6.3.2 Cerebral perfusion......Page 156
6.3.3 Consciousness......Page 157
6.4 Signs of a head injury......Page 158
6.5.2 Primary survey and resuscitation......Page 159
6.5.3 Secondary survey......Page 162
6.5.4 Other relevant conditions......Page 165
6.6 Terminology applied to head injuries......Page 166
6.6.1 Minor head injuries......Page 167
6.7.1 Communication with a neurosurgeon......Page 168
6.7.2 Treatment to discuss with a neurosurgeon......Page 169
Further reading......Page 170
7.1 Epidemiology of spinal injury......Page 172
7.2.1 The vertebral column......Page 173
7.2.2 The spinal cord......Page 177
7.3.1 The vertebrae......Page 179
7.3.2 The spinal cord......Page 180
7.4.1 Initial reception......Page 182
7.4.2 Primary survey and resuscitation......Page 183
7.4.3 Secondary survey......Page 185
7.4.4 Investigations......Page 189
7.4.5 Definitive care......Page 192
Further reading......Page 193
8.2 Applied anatomy......Page 194
8.3 Assessment and management......Page 197
8.3.1 Primary survey and resuscitation......Page 198
8.3.2 Secondary survey......Page 205
Fractures of the maxilla......Page 208
Further reading......Page 209
9.1 Introduction......Page 211
9.2.2 Secondary intention......Page 212
9.2.4 Vascular injuries......Page 213
9.2.6 Fracture healing (Box 9.1)......Page 214
9.3.1 History......Page 217
9.3.2 Examination......Page 218
9.3.3 Exploration and repair......Page 221
9.4.1 Materials used for wound closure......Page 222
9.4.2 Suturing a wound......Page 223
9.5 Extensive wounds......Page 224
9.6.1 Gunshot wounds......Page 226
9.7.1 Assessment......Page 227
9.7.2 Interpretation of x rays......Page 230
9.7.3 Early complications after a fracture......Page 231
9.7.4 Management of fractures......Page 232
9.7.5 Assessing the severity of the fracture......Page 233
9.7.6 Treatment of skeletal injuries......Page 234
9.8.2 Treatment of other dislocations......Page 237
9.9 Ligament injuries......Page 238
Minor trauma ‘checklist’......Page 239
Further reading......Page 240
10.2 Normal reactions to highly stressful and traumatic events......Page 242
10.3 Psychological first aid......Page 243
10.4.2 Delirium......Page 244
10.4.5 Alcohol-related problems......Page 245
10.6 Grief reactions......Page 247
10.7 Dealing with the bereaved......Page 249
10.8 Breaking bad news......Page 250
10.9.1 Impact on staff......Page 251
10.9.2 Violence against staff......Page 252
10.9.3 Psychological debriefing......Page 254
Further reading......Page 255
11.2 Epidemiology of injury......Page 257
11.3 Anatomical and physiological changes......Page 258
11.3.3 Thermoregulation......Page 259
11.3.7 Locomotor system and cutaneous disorders......Page 260
11.4 Assessment and management......Page 261
11.4.1 Primary survey and resuscitation......Page 262
11.4.2 Secondary survey......Page 263
Further reading......Page 264
12.2.1 Head injuries......Page 266
12.2.2 Cervical spine injury......Page 267
12.2.3 Thoracic injury......Page 268
12.2.5 Musculoskeletal injury......Page 269
12.4.1 Primary survey......Page 270
12.4.2 Secondary survey......Page 277
Further reading......Page 279
13.2.1 Airway and ventilation......Page 281
13.2.2 Circulation......Page 282
13.2.7 Uterus and placenta......Page 283
13.3.1 Primary survey and resuscitation......Page 284
13.3.2 Secondary survey......Page 286
13.4.2 Placental abruption......Page 288
Further reading......Page 289
14.1 Introduction......Page 291
14.2.1 Thermal burns......Page 292
14.2.3 Electrical burns......Page 295
14.2.4 Chemical burns......Page 296
14.3.1 First aid measures......Page 298
14.3.2 Communication......Page 299
14.3.3 Transport......Page 300
14.4.1 Introduction......Page 301
14.4.2 Primary survey......Page 302
14.4.3 Management of the thermal burn......Page 303
14.4.5 Other initial interventions......Page 306
14.4.7 Management of the electrical burn......Page 307
14.4.8 Management of cold injury......Page 308
14.5.1 National Burn Injury Referral Guidelines......Page 309
14.5.2 Preparations for transfer......Page 310
Further reading......Page 311
15.2 Pathophysiology......Page 313
15.3 Diagnosis......Page 314
15.4 Initial management of the hypothermic patient......Page 316
15.4.1 Primary survey and resuscitation......Page 317
15.4.2 Secondary survey......Page 318
► Drowning......Page 319
15.8 Pathophysiology of immersion and submersion......Page 320
15.9 Rescue......Page 321
15.10.2 Secondary survey......Page 322
Further reading......Page 324
16.2 Physiology of the experience of pain......Page 325
16.2.1 Peripheral nervous system......Page 326
16.3.1 Psychological......Page 327
16.3.2 Pharmacological......Page 331
16.3.3 Physical treatments......Page 338
16.5 Progression to chronic pain......Page 339
16.5.1 Examples of chronic pain syndromes......Page 340
Further reading......Page 341
17.2 Indications for secondary transfer......Page 343
17.3 Transfer team composition......Page 345
17.4 Equipment and drugs......Page 346
17.5 The five phases of inter-hospital transfer......Page 347
17.5.2 Phase two: consultation and referral......Page 348
17.5.3 Phase three: preparation for transfer......Page 350
17.5.4 Phase four: transportation......Page 352
17.5.5 Phase five: handover and return......Page 354
17.6 Summary......Page 355
Further reading......Page 356
Index......Page 357