Chapter 73 Evaluation and Acute Resuscitation of the Trauma Patient
INTRODUCTION
Although not all trauma patients need surgical intervention, they do require immediate evaluation and resuscitation. Therefore, trauma continues to be a surgical disease. Early intervention in critically injured patients can significantly influence mortality, morbidity, and disability after major trauma. Patients have improved outcomes when treated at these specialized centers1–3 and when additional resources and commitment are dedicated to trauma care.4–6
The Advanced Trauma Life Support (ATLS) course sponsored by the American College of Surgeons Committee on Trauma is the “gold standard” for teaching trauma management and heavily emphasizes the importance of the initial trauma resuscitation.7 This chapter utilizes the ATLS framework to highlight the essentials and potential pitfalls in the evaluation and resuscitation of the injured patient.
PRIMARY SURVEY
Airway
Loss of Airway
• Consequence
• Prevention
Conversion of a Metastable Airway to an Unstable Airway
• Consequence
• Prevention
Causing Worse Neurologic Injury with Spine Manipulation
• Consequence
• Prevention
Breathing
Missed Tension Pneumothorax on Physical Examination
• Consequence
• Prevention
Placing an Unnecessary Chest Tube
• Consequence
• Prevention
Conversion of Simple Pneumothorax to Tension Pneumothorax with Positive-Pressure Ventilation
• Consequence
• Prevention
Main Stem Intubation Leading to Unnecessary Chest Tube
• Consequence
• Prevention
Air Embolism
• Consequence
• Prevention
Circulation
Uncontrolled External Hemorrhage
• Prevention
Exacerbating a Vascular Injury by Blind Clamping
• Consequence
• Prevention
Assuming that a Normal Heart Rate or Blood Pressure Ensures that a Patient Is Not in Shock
• Consequence
• Prevention
Elderly patients also may not exhibit typical signs and symptoms of hemorrhage and shock (e.g., tachycardia, hypotension) after major trauma. These patients may not have the physiologic reserve that their younger counterparts do. Extra vigilance must be used in elderly trauma patients to ensure timely diagnosis and treatment because elderly patient may not be able to recover if the therapy is delayed. Trauma team activation and early intensive monitoring may improve outcomes in trauma patients older than 70 years.10,11
Assuming Hemodynamic “Stability” Excludes Significant Hemorrhage after Penetrating Abdominal Trauma
• Consequence
• Prevention
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