Chapter 37
Algorithmic Bedside Approach to the Major Trauma Patient in Extremis
Robert Arntfield,
Andrew W. Kirkpatrick,
Robert Arntfield
Search for more papers by this authorAndrew W. Kirkpatrick
Search for more papers by this authorRobert Arntfield,
Andrew W. Kirkpatrick,
Robert Arntfield
Search for more papers by this authorAndrew W. Kirkpatrick
Search for more papers by this authorBook Editor(s):James A. Connolly,
Anthony J. Dean,
Beatrice Hoffmann,
Robert D. Jarman,
James A. Connolly
Search for more papers by this authorAnthony J. Dean
Search for more papers by this authorBeatrice Hoffmann
Search for more papers by this authorRobert D. Jarman
Search for more papers by this authorFirst published: 14 July 2017
Summary
The Advanced Trauma Life Support (ATLS) course remains the standard and tried approach to resuscitating the trauma patient in a hierarchal manner, serving to both prioritise and address the greatest threats to life rapidly. The initial approach to all serious trauma utilises the ABCDE concept. Thus, the airway is first addressed and either determined to be patent or secured with any number of airway maintenance devices, although a cuffed endotracheal tube remains standard. Once the airway has been secured, breathing is next assessed. This has traditionally consisted of assessing the anterior chest for the hyper-resonance associated with a tension pneumothorax (PTX), and the lateral chest for the dullness of a massive haemothorax (HTX). Penetrating mechanisms remains a common cause of traumatic injury, for which operative intervention is frequently required. When using ultrasound to assess the unstable patient after penetrating torso injury, the sequence of scanning is important.
Further Reading
- Ball, C.G., Kirkpatrick, A.W., D'Amours, S.K. (2011) The RAPTOR: Resuscitation with angiography, percutaneous techniques and operative repair. Transforming the discipline of trauma surgery. Can. J. Surg., 54 (5), E3–E4.
- Ball, C.G., Williams, B.H., Wyrzykowski, A.D., Nicholas, J.M., Rozycki, G.S., Feliciano, D.V. (2009) A caveat to the performance of pericardial ultrasound in patients with penetrating cardiac wounds. J. Trauma: Injury Infect. Crit. Care, 67 (5), 1123–1124.
- Blaivas, M., Lyon, M., Duggal, S. (2005) A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad. Emerg. Med., 12 (9), 844–849.
- Boulanger, B.R., Brenneman, F.D., Kirkpatrick, A.W., McLellan, B.A., Nathens, A.B. (1998) The indeterminate abdominal sonogram in multisystem blunt trauma. J. Trauma, 48, 52–56.
- Boulanger, B.R., Kearney, P.A., Tsuei, B., Ochoa, J.B. (2001) The routine use of sonography in penetrating torso injury is beneficial. J. Trauma, 51, 320–325.
- Burlew, C.C., Moore, E.E., Smith, W.R., Johnson, J.L., Biffl, W.L., Barnett, C.C., et al. (2011) Preperitoneal pelvic packing/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures. J. Am. Coll. Surg., 212 (4), 628–635; discussion 635–637.
- Chun, R., Kirkpatrick, A.W., Sirois, M., Sargsyan, A.E., Melton, S., Hamilton, D.R., et al. (2004) Where's the tube? Evaluation of hand-held ultrasound in confirming endotracheal tube placement. Prehospital Disast. Med., 19, 366–369.
- Cullinane, D.C., Schiller, H.J., Zielinski, M.D., Bilaniuk, J.W., Collier, B.R., Como, J., et al. (2011) Eastern Association for the Surgery of Trauma Practice Management Guidelines for Hemorrhage in Pelvic Fracture – Update and systematic review. J. Trauma, 71 (6), 1850–1868.
- Demetriades, D., Murray, J., Sinz, B., Myles, D., Chan, L., Sathyaragiswaran, L., Noguchi, T., Bongard, F.S., Cryer, G.H., Gaspard, D.J. (1998) Epidemiology of major trauma and trauma deaths in Los Angeles County. J. Am. Coll. Surg., 187 (4), 373–383.
- Heetveld, M.J., Harris, I., Schlaphoff, G., Balogh, Z., D'Amours, S.K., Sugrue, M. (2004) Hemodynamically unstable pelvic fractures: Recent care and new guidelines. World J. Surg., 28, 904–909.
- Hsieh, K.S., Lee, C.L., Lin, C.C., Huang, T.C., Weng, K.P., Lu, W.H. (2004) Secondary confirmation of endotracheal tube position by ultrasound image. Crit. Care Med., 32, S374–S377.
- Hyacinthe, A.C., Broux, C., Francony, G., Genty, C., Bouzat, P., Jacquot, C., et al. (2011) Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest, 141 (5), 1177–1183.
- Kirkpatrick, A.W. (2007) Clinician-performed focused sonography for the resuscitation of trauma. Crit. Care Med., 35, S162–S172.
- Kirkpatrick, A.W., Ball, C.G., D'Amours, S.K., Zygun, D. (2008) Acute resuscitation of the unstable adult trauma patient: Bedside diagnosis and therapy. Can. J. Surg., 51, 57–69.
- Kirkpatrick, A.W., Ball, C.G., Rodriguez-Galvez, M., Chun, R. (2009) Sonographic depiction of the needle decompression of a tension hemo/pneumothorax. J. Trauma, 66 (3), 961.
- Kirkpatrick, A.W., Sirois, M., Ball, C.G., Laupland, K.B., Goldstein, L., Hameed, M., et al. (2004) The hand-held FAST exam for penetrating abdominal trauma. Am. J. Surg., 187, 660–665.
- Kortbeek, J.B., Al Turki, S.A., Ali, J., Antoine, J.A., Bouillon, B., Brasel, K., et al. (2008) Advanced trauma life support, 8th edition, the evidence for change. J. Trauma, 64 (6), 1638–1650.
- Kristensen, M.S. (2011) Ultrasonography in the management of the airway. Acta Anaesthesiol. Scand., 55 (10), 1155–1173.
- Ma, O.J., Mateer, J.R., Ogata, M., Kefer, M.P., Wittman, D., Aprahamian, C. (1995) Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J. Trauma, 38, 879–885.
- Mohanty, K., Musso, D., Powell, J.N., Kortbeek, J.B., Kirkpatrick, A.W. (2005) Emergent management of pelvic ring fractures: an update. Can. J. Surg., 48, 49–56.
- Plummer, D., Brunette, D., Asinger, R., Ruiz, E. (1992) Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann. Emerg. Med., 21 (6), 709–712.
- Ract, C., Moigno, S., Bruder, N., Vigué, B. (2007) Transcranial Doppler ultrasound goal-directed therapy for the early management of severe traumatic brain injury. Intensive Care Med., 33 (4), 645–651.
- Rozycki, G.S., Feliciano, D.V., Ochsner, M.V., Knudson, M.M., Hoyt, D.B., Davis, F., Hammerman, D., Figueredo, V., Harviel, J.D., Han, D.C. (1999) The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J. Trauma, 46 (4), 543–551.
- Rozycki, G.S., Feliciano, D.V., Oschner, G., Knudson, M.M., Hoyt, D.B., Davis, F., et al. (1999) The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J. Trauma, 46, 543–552.
- Rozycki, G.S., Ochsner, M.G., Feliciano, D.V., Thomas, B., Boulanger, B.R., Davis, F.E., et al. (1998) Early detection of hemoperitoneum by ultrasound examination of the right upper quadrant: A multicenter study. J. Trauma, 45, 878–883.
- Weaver, B., Lyon, M., Blaivas, M. (2006) Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign. Acad. Emerg. Med., 13, 239–244.
