Initial treatment of patients with extensive trauma

Article Abstract:

Many hospital patients are treated not for disease, but for the results of accidents. About 15 percent of patients hospitalized for injuries have sustained trauma severe enough to be life-threatening. The author provides a detailed discussion reviewing the tasks that must be accomplished by the clinician who works in a hospital unit dealing with victims of extensive trauma. In general, these patients have sustained multi-system damage. It is important not to let the visible trauma distract from the determination of invisible, but potentially more threatening injuries. Deaths due to trauma are distinct from deaths due to disease. The pattern begins with about half of all injury-related deaths occurring at the scene of the accident. Another 30 percent of these deaths occur within a few hours, and the remaining 20 percent within days or weeks, sometimes of infection and sometimes of multi-system organ failure. The deaths that occur within a few hours are the ones in which prompt effective action on the part of the physician may make the most difference. The deaths that occur within days or weeks, in contrast, are likely to be the ones in which physician error or misdiagnosis may make a significant difference. The author divides the job of the physician into the primary and secondary survey. In the first part of the primary survey, the physician determines if the patient needs ventilation and if the patient's circulation is adequate. Is the patient in shock? Is the heart able to beat without interference from blood in the surrounding tissues? After these important factors are determined, the physician must ascertain the neurological status of the patient. Evaluation of possible brain injury must take place as quickly as possible. Only after the primary survey has taken place should the physician initiate the secondary survey and begin to concern himself/herself with CT scans, chest X-rays, laboratory tests, surgery, and other possibilities. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Current concepts: acute spinal injury

Article Abstract:

Spinal injuries require immobilization before further assessment takes place. The cervical part of the spine around the neck is most commonly injured and most vulnerable to instability and further damage. The anatomy of the injury needs to be clarified, commonly by examining motor functions, sensory functions, head injuries, and the distinction of partial versus complete lack of function. Initial evaluation begins with X-ray films of the injury, progressing to computed tomography and magnetic resonance imaging, if the patient can be moved. Patients with unstable injuries will need traction to prevent further complications. Special care should be taken with removing missiles from gunshot wounds, knives, and other metal objects.

Spinal cord injuries, Spine

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Evaluation and management of traumatic lacerations

Article Abstract:

Current recommendations and procedures used for wound care are highlighted. Patient history, wound location, and wound type all can play a role in how a wound heals and its risk for infection. Wounds should be thoroughly cleaned, exposed, and examined for additional complications. Several techniques can be used to close a wound including staples, adhesives, absorbable sutures, or sutures to be removed at a later date. Each technique has its advantages and can be chosen based on wound location, wound depth, patient age, or doctor preference. Care should be taken to keep the closed wound moist and free of infection.

Methods, Surgery

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