ABC of Major Trauma E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: ABC Series
• Sprache: Englisch

Seitenzahl: 637

Veröffentlichungsjahr: 2013

Beschreibung

Prehospital care is a growing area in medicine, and emergency treatments are becoming more sophisticated as the potential to save lives grow.

The fourth edition of this ABC has been thoroughly updated and includes new chapters on nuclear and biological emergencies.

Each chapter gives concise and clear guidance and is accompanied by excellent photographs and diagrams.

Edited and written by leading UK trauma authorities, this is a truly comprehensive and practical book for everyday use by emergency medicine staff, nurses, hospital doctors, paramedics, and ambulance services.

This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.

Leseprobe

Table of Contents

Series Page

Title Page

Copyright

List of Contributors

Foreword

Preface

Acknowledgements

List of Abbreviations

Chapter 1: Initial Assessment and Management: Primary Survey and Resuscitation

The trauma team

Before the patient arrives

Roles of trauma team members

Reception and transfer

Primary survey and resuscitation

Team leader co-ordination

Further reading

Chapter 2: Initial Assessment and Management: Secondary Survey

Objectives

History

Analgesia

Head-to-toe assessment

Further reading

Chapter 3: The Upper Airway

First vital minutes

Indications for oxygenation and ventilation

Hospital management

Anaesthetic considerations

Intubation technique

Summary

Acknowledgement

Further reading

Chapter 4: Thoracic Trauma

Mechanisms and patterns of chest injury

Primary survey and resuscitation

Diagnostic adjuncts to the primary survey

Immediate life-threatening injuries

Procedures associated with the primary survey

Secondary survey

Diagnostic adjuncts to the secondary survey

Analgesia

Summary

Chapter 5: Hypovolaemic Shock

Early symptoms and signs

Factors affecting response to blood loss

Pulmonary oxygenation

Control of haemorrhage and replacement of blood loss

Monitoring progress and treatment

Analgesia

Summary

Further reading

Chapter 6: Head Injuries

Epidemiology and causes of head injury

Pathophysiology of head injury

Initial assessment of head injuries

Radiological assessment in head injuries

Admission or discharge?

Inpatient management

Transfer to a neurosurgical unit

Paediatric head injuries

Delayed effects of head injury

Further reading

Chapter 7: Maxillofacial Trauma

Primary survey

Secondary survey

Imaging: brain and facial trauma

Medication

Further reading

Chapter 8: Spine and Spinal Cord Injury

Management at the scene of the accident

Transfer to hospital

Arrival at hospital

Radiology

Treatment

The future

Further reading

Chapter 9: Abdominal Trauma

Anatomical considerations

Mechanism of injury

Assessment

Abdominal treatment

Treatment

Further reading

Chapter 10: The Urinary Tract

Upper urinary tract

Ureteral injuries

Lower urinary tract

Acknowledgements

Further reading

Chapter 11: Limb Injuries

Prehospital care

Hospital care

Definitive management of fractures

Summary

Further reading

Chapter 12: Eye Injuries

Applied anatomy

Assessment of ophthalmic trauma

Practical approach to ophthalmic trauma

Summary

Further reading

Chapter 13: Medical Problems in Trauma Patients

Why are medical problems important?

Avoidable mortality and morbidity

Medical problems that cause trauma

Medical problems caused by trauma

Medical problems that may complicate trauma

The future

Further reading

Chapter 14: Radiological Assessment

Head

Cervical spine

Chest

Abdomen

Post processing

Ultrasound

Pathways

Further reading

Chapter 15: Role of the Trauma Nurse

Preparation

On arrival

Pain

Investigations

What next?

Transfer

Special circumstances

Summary

Further reading

Chapter 16: Scoring Systems for Trauma

Input measures

Trauma outcome prediction methodology

Comparing systems of care

Trauma Audit and Research Network

References

Chapter 17: Handling Distressed Relatives and Breaking Bad News

Initial contact

Arrival of relatives at the hospital

Breaking the news

Advice for the doctor (or other breaker of news)

Management of relatives

Staff support

Summary

Acknowledgement

Further reading

Chapter 18: Trauma in Pregnancy

Airway and breathing

Circulation

Primary survey

Secondary survey

Fetomaternal haemorrhage

Blunt trauma

Penetrating trauma

Cardiac arrest

Burns

Further reading

Chapter 19: Paediatric Trauma

Which hospital?

Trauma team activation

Primary survey and resuscitation

Secondary survey

Burns

Pain relief in children

Non-accidental injury

Should relatives be present in the resuscitation room?

Summary

Acknowledgements

Further reading

Chapter 20: Trauma in the Elderly

Primary survey and resuscitation

Secondary survey: AMPLE

Head injuries

Chest trauma

Abdominal trauma

Fractures

Summary

Further reading

Chapter 21: Prehospital Trauma Care

Tasking and dispatch

Scene management

Clinical management

Road traffic crash entrapment

Emergency department pre-arrival alert

Mode of transport

Handover

Future developments in prehospital trauma care

Further reading

Chapter 22: Transfer of the Trauma Patient

Primary transfer

Secondary transfer

Summary

Further reading

Chapter 23: Management of Severe Burns

Evacuation from the scene

Reception and resuscitation

Reassessment

Chemical burns

Electrical burns

Summary

Further reading

Chapter 24: Chemical Incidents

Common problems encountered

What is a chemical incident?

How can emergency departments plan for chemical incident response?

What are the local chemical hazards?

Health effects from chemical incidents

What emergency facilities are required?

Actions

How to obtain help following a chemical incident

Summary

References

Chapter 25: Ballistic Injury

Bullets and firearms

Explosive injury

Managing the ballistic incident

Surgical treatment of ballistic injuries

Summary

Online resources

Further reading

Chapter 26: Trauma in Hostile Environments

Threat and levels of care

The ballistic environment: key points

Isolation

External environment

Trauma in a chemical environment

Further reading

Chapter 27: Psychological Trauma

Psychological responses to trauma

Management of psychological responses to trauma

Summary

Further reading

Chapter 28: Major Incidents

The initial response

Preparation for major incidents

Hospital response

Recovery phase

Further reading

Chapter 29: Trauma Systems in Developing Countries

Appropriate

Affordable

Adaptable

Sustainable

The scale of the problem

Advanced Trauma Life Support

Primary Trauma Care

Further reading

Index

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Library of Congress Cataloging-in-Publication Data

ABC of major trauma / edited by David Skinner and Peter Driscoll.—4th ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-7279-1859-8 (pbk. : alk. paper)

I. Skinner, David V. II. Driscoll, P.A. (Peter A.), 1955-

[DNLM: 1. Wounds and Injuries–therapy. 2. Emergencies. 3. Emergency Medical Services–methods. WO 700]

617.1′026–dc23

2011043617

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: iStock (17389284)

Cover design by Meaden Creative

1 2013

List of Contributors

Munawar Al-Mudhaffar

Specialist Registrar in Emergency Medicine

Department of Emergency Medicine

John Radcliffe Hospital

Oxford, UK

Orla Austin

Department of Plastic Surgery

Pinderfields Hospital

Wakefield, UK

Dominic Barron

Consultant Radiologist

Leeds General Infirmary

Leeds, UK

John J.M. Black

Medical Director, South Central Ambulance Service;

Consultant in Emergency Medicine

John Radcliffe Hospital

Oxford, UK

Rebecca S. Black

Department of Obstetrics

John Radcliffe Hospital

Oxford, UK

Lizle Blom

Consultant in Emergency Medicine

Royal Berkshire Hospital

Reading, UK

Andrew Blyth

Royal Berkshire Hospital

Reading, UK

Mark Byers

Ministry of Defence

London, UK

Jon Clasper

Defence Professor, Orthopaedics and Trauma

Royal Centre for Defence Medicine

Birmingham, UK

Andre Cromhout

Emergency Physician

Emergency Department

Welllington Hospital

Wellington, New Zealand

Peter R. Davis

Consultant in Emergency Medicine

Defence Medical Services and Honorary Consultant

Southern General Hospital

Glasgow, UK

Martin P. Deahl

Consultant Psychiatrist

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

Stafford, UK

Anthony Deane

Consultant Urologist

William Harvey Hospital

Ashford;

Buckland Hospital

Dover, UK

Peter A. Driscoll

Consultant in Accident and Emergency Medicine

Department of Emergency Medicine

Hope Hospital

Salford, UK

Karen A. Eley

Research Fellow

University of Oxford

Oxford, UK

John Elston

Consultant Ophthalmologist

Oxford Eye Hospital

Oxford University Hospitals NHS Trust

Oxford, UK

Oliver Fenton

Department of Plastic Surgery

Pinderfields Hospital

Wakefield, UK

Andrew Gibson

Consultant Ophthalmologist

The James Cook University Hospital

Middlesbrough, UK

Carl L. Gwinnutt

Consultant Anaesthetist

Hope Hospital

Salford, UK

Deborah J. Harrington

Department of Obstetrics

John Radcliffe Hospital

Oxford, UK

Jill Hill

Senior Sister

Emergency Department

John Radcliffe Hospital

Oxford, UK

Timothy J. Hodgetts

Chief Medical Officer

NATO Allied Rapid Reaction Corps;

Honorary Professor of Emergency Medicine

University of Birmingham

Birmingham, UK

Michael A. Horan

Hope Hospital

Salford, UK

Philip Hormbrey

Consultant in Emergency Medicine

Department of Emergency Medicine

John Radcliffe Hospital

Oxford, UK

Tom Hughes

Consultant in Emergency Medicine

John Radcliffe Hospital, Oxford;

Consultant in Emergency Medicine and Clinical

Director of Emergency Care

Hinchingbrooke Hospital, Huntingdon;

Hon. Senior Lecturer in Emergency Medicine

University of Oxford

Oxford, UK

Bruce Jenner

Trauma Nurse

Royal Air Force

UK

Rohit Kotnis

Specialist Registrar in Trauma and Orthopaedics

John Radcliffe Hospital

Oxford, UK

Peter F. Mahoney

Defence Professor Anaesthetics and Critical Care

Royal Centre for Defence Medicine

Birmingham, UK

Ajith Malalasekera

Department of Urology

Leicester General Hospital

Leicester, UK

Chris A.J. McLauchlan

Consultant in Emergency Medicine

Emergency Department

Royal Devon and Exeter Hospital

Exeter, UK

Lisa E. Munro-Davies

Consultant in Emergency Medicine

University Hospitals Bristol NHS Foundation Trust

Bristol, UK

Virginia Murray

Consultant Medical Toxicologist and Environmental Public Health

Head of Extreme Events and Health Protection

Health Protection Agency

London, UK

David Nicholson

Consultant Radiologist

Department of Emergency Medicine

Hope Hospital

Salford, UK

Jerry P. Nolan

Consultant Anaesthetist

Department of Anaesthesia and Intensive Care Medicine

Royal United Hospital

Bath, UK

Rachael Pery-Johnston

Department of Emergency Medicine

Princess Alexandra Hospital

Brisbane, QLD, Australia

Catherine Peters

Consultant in Critical Care Medicine and Anaesthesia

Department of Intensive Care

Homerton University Hospital

London, UK

Rick Pullinger

Consultant in Emergency Medicine

Department of Emergency Medicine

John Radcliffe Hospital

Oxford, UK

Jaskarn Rai

Department of Urology

Leicester General Hospital

Leicester, UK

James Rankine

Consultant Radiologist

Leeds General Infirmary

Leeds, UK

Colin Robertson

Consultant in Accident and Emergency Medicine

Department of Emergency Medicine

Royal Infirmary of Edinburgh

Edinburgh, UK

Nigel Rossiter

Consultant Trauma and Orthopaedic Surgeon

Basingstoke General Hospital;

Royal Defence Medical College

Basingstoke, UK

Rob Russell

Royal Army Medical Corps Consultant

Emergency Medicine

Royal Centre for Defence Medicine

Birmingham, UK

David V. Skinner

Consultant in Emergency Medicine

John Radcliffe Hospital

Oxford, UK

Andrew Swain

Senior Lecturer and Consultant in Emergency Medicine

University of Otago

Wellington, New Zealand

Timothy Terry

Consultant Urologist

Department of Urology

Leicester General Hospital

Leicester, UK

David Watson

Honorary Professor of Intensive Care Education

Department of Medical Education

Homerton University Hospital

London, UK

Steve R. Watt-Smith

Consultant Maxillofacial Surgeon

Honorary Clinical Senior Lecturer

Oxford University Hospitals NHS Trust

University of Oxford

Oxford, UK

Douglas Wilkinson

Consultant Anaesthetist in Intensive Care

Oxford University Hospitals NHS Trust

Oxford, UK

Keith Willett

Foreword

As a contributor and user of this book, I am delighted to see a fourth edition published. It represents a most useful core text for those seeking a contemporary practical guide to assess and deliver the best trauma care for those patients who are “candidate major traumas”. All counties and healthcare systems are different and some changing, but the core principles of management are common. This text, through its breadth of expert contributors, succinctly describes these. Reading each chapter feels like you've just had a really good tutorial on the subject and represents a very efficient method of acquiring knowledge. I would certainly recommend you keep a copy of this publication close by whether preparing for your on-call day or a teaching session.

Keith WillettProfessor of Trauma SurgeryJohn Radcliffe HospitalOxford, UK

Preface

This edition of the ABC of Major Trauma has had a long gestation, being 12 years since the third edition.

Trauma care continues to evolve and improve both in the ‘front line’ and nationally with the development of Trauma Centres and supporting networks. Prevention is also playing its part, with deaths on the roads continuing to fall.

There is, however, no room for complacency and we hope this fourth edition will remind our readership of the crucial importance of a thorough, stepwise assessment of the trauma patient and that attention to detail, not least in spinal care, can avoid the devastating consequences of the ‘second’ injury.

This edition sees extensive revision of all its chapters and the addition of further material. At the time of publishing all information is current.

The book is aimed at all clinicians involved in front line trauma care, paramedics, hospital doctors and nurses as well as those members of the ‘team’, crucial to optimal management, including radiographers, radiologists and laboratory staff.

Chapter 29 reminds us of the excellent facilities available to us in UK practice. However, this chapter also shows us that simple manoeuvres can be life saving in the Third World environment.

The continuing conflicts around the world involving UK armed forces has resulted in improved trauma management in these conflict zones. Lessons learnt and techniques developed have been shared with civilian clinicians to the benefit of patients. Many authors in this edition have put themselves in ‘harms way’ to manage victims of conflict. This edition is dedicated to them.

David V. Skinner

Acknowledgements

I would like to acknowledge the help and guidance afforded to me by all at Wiley-Blackwell during the course of the production of this fourth edition of the ABC of Major Trauma.

I would like in particular to thank Adam Gilbert, Vicki Donald, Ilaria Meliconi, Laura Quigley, Kate Newell, Cathryn Gates and Helen Harvey whose support, encouragement, good humour and pure professionalism have seen this task to completion.

David V. Skinner

List of Abbreviations

5-HT

5-hydroxytryptamine

ABC

airway, breathing, circulation

ACE

angiotensin-converting enzyme inhibitor

AIC

ambulance incident commander

AIS

Abbreviated Injury Scale

AP

anteroposterior

APLS

Advanced Paediatric Life Support

ARDS

acute respiratory distress syndrome

ASD

acute stress disorders

ATLS

Advanced Trauma Life Support

ATP

adenosine triphosphate

BATLS

Battlefield Advanced Trauma Life Support

BP

blood pressure

BVM

bag-valve-mask

CAT

computed axial tomography

CBF

cerebral blood flow

CBT

cognitive-behavioural therapy

CCS

casualty clearing station

CHaPD

Chemical Hazards and Poisons Division

COPD

chronic obstructive pulmonary disease

CPB

cardiopulmonary bypass

CPP

cerebral perfusion pressure

CPR

cardiopulmonary resuscitation

CRT

capillary refill time

CSF

cerebrospinal fluid

CT

computed tomography

CXR

chest X-ray

DCLHb

diaspirin cross-linked haemoglobin solution

DIC

disseminated intravascular coagulation

DPL

diagnostic peritoneal lavage

DVT

deep venous thrombosis

ECG

electrocardiogram

ECMO

extracorporeal membranous oxygenation

ED

emergency department

EEG

electroencephalogram

ET

endotracheal

ETA

expected time of arrival

ETCO

2

end-tidal carbon dioxide concentration

FAST

focused assessment with sonography in trauma

FBC

full blood count

FFP

fresh frozen plasma

FiO

2

fraction of inspired oxygen

FRC

functional residual capacity

GCS

Glasgow Coma Scale

GDP

Gross Domestic Product

GP

general practitioner

HART

hazardous area response team

HBOC

haemoglobin-based oxygen carrier

HCT

hospital co-ordination team

HCVR

hypercapnic ventilatory response

HPA

Health Protection Agency/hypothalamo-pituitary-adrenal

HR

heart rate

HVR

hypoxic ventilatory response

ICP

intracranial pressure

ICU

intensive care unit

I/E

inspiratory/expiratory

IED

improvised explosive device

IO

intraosseous

IPE

individual protective equipment

ISS

Injury Severity Score

ITU

intensive therapy unit

IV

intravenous

MAP

mean arterial pressure

MERIT

medical emergency incident response team

MIC

medical incident commander

MODS

multiorgan dysfunction syndrome

MRI

magnetic resonance imaging

NAI

non-accidental injury

NGT

nasogastric tube

NICE

National Institute for Health and Clinical Excellence

NPIS

National Poisons Information Service

NSAID

non-steroidal anti-inflammatory drug

PEEP

positive end-expiratory pressure

PPE

personal protective equipment

PPH

postpartum haemorrhage

PTA

post-traumatic amnesia

PTC

Primary Trauma Care

PTSD

post-traumatic stress disorder

RSI

rapid-sequence induction

RTA

road traffic accident

RTC

road traffic crash

RTS

Revised Trauma Score

SaO

2

oxygen saturation

SCIWORA

spinal cord injury without radiological abnormality

SHO

senior house officer

SIGN

Scottish Intercollegiate Guidelines Network

SIRS

systemic inflammatory response syndrome

SXR

plain radiograph of the skull

TARN

Trauma Audit and Research Network

TNF

tumour necrosis factor

US

ultrasound

USAR

urban search and rescue

WHO

World Health Organization

ZPP

zone of partial preservation

Chapter 1

Initial Assessment and Management: Primary Survey and Resuscitation

David V. Skinner1 and Peter A. Driscoll2

1John Radcliffe Hospital, Oxford, UK

2Hope Hospital, Salford, UK

OVERVIEW

Initial management of trauma victims requires a team approach in which each member carries out a specific task. Collectively, the team should aim to treat all the immediately life-threatening conditions and identify the need for surgery early.The ABC (airway, breathing, circulation) approach provides an optimal system whereby urgent, potentially life-threatening conditions are dealt with first.The critically injured patient requires a calm rapid response to his/her injuries, in the field, resuscitation room and operating theatre. If prehospital personnel, the resuscitation room team and its leader, as well as the appropriate surgeons can deliver this, then lives will be saved and unnecessary deaths avoided. Any deaths that do occur will have been unavoidable. The team should also be aware of this and suitably debriefed.

Morbidity and mortality in seriously injured patients, managed in UK hospitals, remain higher than necessary. Recognition of this problem over the last 25 years has seen a variety of initiatives designed to improve the situation, including the introduction of Advanced Trauma Life Support (ATLS) to clinical practice, the widespread use of the auditing tool TARN (Trauma Audit and Research Network), and the deployment of multidisciplinary trauma teams to manage trauma victims in emergency department (ED) resuscitation rooms. Increasingly, consultant-delivered services, where available, will further enhance care.

For each individual patient, however, survival and reduction of long-term disability depend on the rapid deployment of skilled prehospital clinicians (paramedics and/or doctors), the skills and experience of the receiving clinicians (trauma team) and the human and other resources available round the clock to deal with patient injuries in a timely and effective fashion.