Key Clinical Topics in Trauma Keith Porter, Ian Greaves, Derek Burke
INDEX
ABCDEFGHIJKLMNOPQRSTUVW
Note: Page numbers in bold or italic refer to tables or figures, respectively.
A
ABCDE resuscitation 63–64
advanced trauma life support (ATLS) system 63
haemorrhage control, techniques of 64
haemostatic resuscitation 64
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report 63
Abdominal injury, selective nonoperative management of 254–255
Abdominal tourniquets 315
Abdominal trauma 1–5
blunt trauma 1, 2, 3
complications 4, 5
CT scan 2
damage control laparotomy 4
diagnostic laparoscopy 4
diaphragmatic injuries 1
examination in 1–2
focus abdominal sonography for trauma (FAST) scan 2
hollow viscus injury 1
management 3, 3–4, 4
penetrating 1, 3, 4
plain radiographs 2
solid organ injury 1
Abnormal fracture healing 6–8
Achilles tendon rupture 78
Acinetobacter baumannii 27
Acute radiation syndrome (ARS) 71, 73
Acute respiratory distress syndrome (ARDS) 9–11
alveolar damage and 9
Berlin criteria 9
nonpulmonary risk factors 10
nonventilatory strategies 11
pathological phases 9–10
pulmonary infiltrates in 9
pulmonary risk factors 10
rescue therapies 11
sepsis-related 9
trauma-related 9
ventilatory strategies 10
Aeromedical evacuation and retrieval 12–15
advantages 12
air ambulances 12–13, 13
communications 14
equipment 14–15
medical personnel 14
organisations 13–14
patient preparation 14
standard approach 14
Aeromonas hydrophila 26
Aldosterone 183
Amitriptyline 240
Amplatzer plugs 139–140
Amputation, traumatic 308–310
Anaesthesia 16
environmental factors 16
induction 17
maintenance 18
neuromuscular blockade 17–18
patient factors 16
preparation 16–17
rapid sequence induction (RSI) of 16
Analgesia 19–21
antidepressants, anxiolytics and anticonvulsants 19–20
spinal and epidural anaesthesia 20
Animal bites 132–133
Ankle fractures 22–24
ankle joint anatomy 22
classification 22–23
Danis–Weber classification 23, 23
eponymous fracture types 24
Lange–Hansen classification 22–23
nonoperative management 24
operative management 24
Salter–Harris classification 22
Ankle sprains 25
anterior talofibular ligament (ATFL) and 25
calcaneofibular ligament (CFL) and 25
Ottawa rules 25
Anterior cruciate ligament (ACL), injury to 271–272
Anterior cruciate ligament rupture 78
Antibiotics
bite wounds 133
infection control 27–28, 28
Anticoagulation, after trauma 29–30
Antimicrobial prophylaxis 186
Antiplatelet agents, after trauma 29–30
Arthroplasty 266–267
Asphyxiation 32–34
causes 32, 32
complications 33, 34
hypoxia 32
hypercarbia 32
treatments for specific causes of 33, 33
Aspirin 30
Avulsed teeth 181
B
Ballistic injuries 1 see also Abdominal trauma
Bariatric trauma 35–36
injury pattern of obese patients 35
insulin resistance in obese patients 35
negative nitrogen balance 35, 36
practicalities of management 36
surgical considerations 36
thromboelastography/rotation thromboelastometry (TEG/ROTEM) 35
Barton's fracture 324, 324–325
Beck's triad 261
Benzodiazepines 20, 184
β-haemolytic streptococci 26
Birth-related bony injuries 202
Bisphosphonates 112
Bite wounds 132–133
Bladder and urethra injury see Genitourinary trauma
Blast trauma 38–41
blast wave 38, 38
blast wind 38, 38
explosive injuries 38, 38
fixation of fractures 41
haemorrhage control 40–41
infection, prevention of 41
lung protective ventilation 41
pneumothorax 39, 40
primary blast injuries 38–39
pulmonary contusion and pneumothorax 39, 40
secondary blast injuries 39
tertiary blast injuries 39
tympanic membrane rupture 39
Blood product (1:1:1) resuscitation 42–44
pharmacological adjuncts to 43–44
whole blood and 43
Blood product resuscitation, prehospital 236–238
Bony injuries 75
Bosworth fracture 24
Boxer's fracture 123
Brachial plexus injuries 49–52
anatomy of brachial plexus 49, 49
axonal cell death 50
chest radiograph 51
CT scan 51
lower brachial plexus (infraclavicular) 50
MRI of cervical spine and brachial plexus 51
nerve compression 50
nerve exploration and decompression 52
nerve grafting 52
nerve laceration 50
nerve transfer surgery 52
neurological examination 51
neurophysiological tests 51
traction injury 50
upper brachial plexus (supraclavicular) 50
Brain stem death and organ donation 53–57
confirmation of brain stem death 54–56
contraindications to organ donation 56
defining end of life 54
demand for solid organ transplantation 53, 53
international organ donor rates 54, 55
loss of potential donors, reasons for 53–54, 54
tests 56–57
total potential donor rate 53
Bucket handle fractures 203, 203
Bupivacaine 20
Burns 58–62
assessment of burn size 59–60, 60
burn depth, assessment of 60
burn networks and referral criteria 61–62
burn shock 58
burn wound and systemic effects 58
chemical burns 61
deep partial-thickness burns 60
dressings 61
electrical burns 61
fluid requirements 60
full-thickness burns 60
inhalation injury 58–59
Lund and Browder chart 60
monitoring 61
nutrition in 209–210
primary survey 59
superficial partial-thickness burns 60
total body surface area (TBSA) 58
C
Calcaneal fractures 78, 100, 100–101, 101
Bohler's angle 100, 101
complications 101
CT scanning 100–101
extra-articular fractures 101
intra-articular fractures 101
percutaneous fixation with screws 101
Sanders classification 101, 101
X-ray 100
Calcium 110, 112
Caloric reflex test 56
Carbapenemase-producing Enterobacteriaceae 27
Cardiac trauma 45–47
blunt 45, 46
haemorrhagic shock 45
operative repair 47
penetrating 45, 46
pericardial tamponade 45
pericardial window 46–47
portable chest radiograph (CXR) 46
postpericardiotomy syndrome 47
sudden cardiovascular collapse 46
ultrasound and CT scanning 46
Carpal dislocation 325, 326
Cat bites 132–133
Catecholamines 183
Celox 64, 293
Central cord syndrome 274
Central slip injury 123
Cerebral perfusion pressure (CPP) 17, 18, 192, 193
Cervical spine injuries 66–70, 76
autonomic function, loss of 67
Canadian C-spine rules 68–69
complete and incomplete lesions 67
computerised tomography 69
conscious patient 66
Glasgow coma score (GCS) and 66
motor function, assessment of 67, 67
MRI 69
neurogenic shock 67
neurological damage 66
NEXUS (National Emergency X-ray Utilization Study) 68
paediatric considerations 69
plain radiographs 69
proprioception 67
respiratory compromise 67–68
sensation, assessment of 67, 68
spinal immobilisation 66
spinal shock 67
unconscious patient 66
Chemical, biological, radiological or nuclear (CRBN) environment and trauma 71–73
biological agents 71
casualty management, principles of 72
CBRN incident, implications of 71–72
chemical agents 71
clean (cold) zone 73
combined injuries, management of 73
exclusion zone 72
hot zone 72
nuclear weapons 71
priorities for casualty care 72–73
radiological agents 71
triage categories 73
warm zone 72
Chen test 77
Ciprofloxacin 26, 27, 28, 186
Circumferential binders 315
Classic metaphyseal lesions (CMLs) 203, 203
Clavicular fractures 202
Clindamycin 28
Clonidine 184
Clopidogrel 30
Clostridium tetani 26
Co-amoxiclav 26, 28, 133
Codeine 19
Colles’ fracture 323, 323
Colloids 157–159
crystalloids and 157
current position of 157
glycocalyx model 158–159
Starling equation 158–159, 159
ideal resuscitation fluid 158
natural 157
semisynthetic 157
Combat application tourniquet (CAT) 64, 308
Compartment syndrome 80–82
delta-P and 81
endogenous causes 80
exogenous causes 80
fasciotomy in 81–82
irreversible changes in muscle 80
measurements of compartment pressure 81
muscle ischaemia in 80
pain in 80–81
split skin grafting 81
Computed tomography (CT) 135–137
intracranial haemorrhage 136
liver and kidney trauma 136
pelvic trauma 135
scanning and contrast protocols 136–137
soft tissue trauma 136
vascular trauma 136
whole-body CT (WBCT) 136
Contusions 191
Coronoid fractures 89
management 89
Regan and Morrey classification 90
Cortisol 183
Crystalloids 161–163
balanced solutions 161
hypertonic saline 162–163
isotonic 161–162
lethal triad of trauma and 162, 162
unbalanced solutions 161
Crystalloid use, in trauma patients 42–43
Cushing's reflex 193
Cytokines 58
D
Damage-associated molecular patterns (DMAPs) 279
Damage control laparotomy (DCL) 4
Damage control resuscitation (DCR) 83–85, 161, 236
indications for surgery 84
intensive care management 84
return to theatre 85
stages of damage control 83
Damage control surgery (DCS) 170
Deep vein thrombosis (DVT) 30
Delphi Medical Tourniquet 308
Dental injuries 181
avulsion 181
intrusion 181
luxation 181
Desmopressin acetate (DDAVP) 56
Diabetes insipidus (DI) 55
Diffuse axonal injury 191
Direct oral anticoagulants (DOACS) 29
Dislocations
elbow 88–89
hip 130–131
Distal humerus, fractures of 88
Distal interphalangeal joint (DIPJ) 123
Distal radius fractures 322, 322
Dog bites 132–133
Donation after cardiac death (DCD) 54
Donation after circulatory determination of death (DCDD) 54
Doxycycline 27, 28
Dressings, haemorrhage control 64
Dual energy X-ray absorptiometry (DEXA) scan 112
E
Elbow dislocations 88–89
reduction in 88, 88
stabilisers of elbow 89
terrible triad 88–89
Elbow injuries 86–92
adults 88–89
in children 86, 86–87, 87, 88
coronoid fractures 89, 90
Monteggia fracture–dislocations 90–92, 91
olecranon fractures 90, 90, 91
radial head fractures 89, 89
ellaOne 258
Emergency Medical Tourniquet 308
Entonox 20–21
Epidemiology of trauma 93–95
children and adolescents 94
European Union (EU) countries 94
geographical considerations 93–94
global mortality statistics 93, 93
Epidural anaesthesia 184
Epiphyseal injuries 325, 326
Erb's palsy 202
Escherichia coli 27
Etomidate 17
Extensor tendons 123
External genitalia, injuries to see Genitourinary trauma
Extracorporeal gas exchange devices 11
Extradural haemorrhage 191
F
Fat embolism syndrome (FES) 96–97
arterial blood gas analysis 97
bronchoalveolar lavage 97
chest radiograph 97
CT of chest 97
mechanical theory 96
metabolic theory 96
minor features 97
MRI of brain 97
neurological features 97
petechial rash 97
prevention 97
respiratory features 96–97
ventilation/perfusion scans 97
Femoral diaphyseal fractures 203
Fentanyl 19
Fibrinogen 237
Flexor digitorum profundus (FDP) tendons 122
Flexor digitorum superficialis (FDS) tendons 122
Flexor pollicis longus (FPL) tendon 123
Flexor tendons 122–123
Flucloxacillin 26, 28
Focus abdominal sonography for trauma (FAST) 2, 144–145, 289
Forearm fractures 77, 173, 173
Fracture classifications 107–109
AO/Orthopaedic Trauma Association (OTA) system 108–109
Gustilo classification of open fractures 107–108, 108
Neer classification 109
Salter–Harris growth plate injuries 109
Weber classification 109
Fracture healing, abnormal 6–8
biochemical markers 7
classification system 7
clinical examination 6
CT scan 7
delayed union 6
dietary insufficiency and 8
dual-energy X-ray absorptiometry scan 7
fracture nonunion 6
nailing for nonunion 8
plain radiographs 6–7
risk factors for fracture nonunion 7, 7–8
smoking and 8
Fragility fractures 110–112, 219
distal radius fracture 111–112, 112
hip fractures 111, 111
nutrition and bone loss 110
osteoporosis and 110–111, 111
postmenopausal bone loss 110
prevention 112
risk assessment tool 112
vertebral fractures 112
Freeze dried plasma (FDP) 237 see also Lyophilised plasma
Fresh frozen plasma (FFP) 176–177
Fungal infections 26–27
G
Gas gangrene 26
Gelfoam 140
Genitourinary trauma 114–117
bladder and urethra 114, 115, 115
external genitalia 114, 115
grading of ureteric injury 115, 116
intraperitoneal rupture of bladder 115–116, 116
kidney 114, 115, 115
renal trauma severity scale 115, 116
ureters 114, 115
Gentamicin 28
Glucagon 183
Glutamine 209
Growth hormone 183
Gunshot injuries 118–121
damage to tissues 118–119, 119
extremity injuries 120
gun crime in United Kingdom 118, 118
haemorrhagic shock 119
high-and low-energy gunshot wounds 120
neurovascular injury 120
penetrating abdominal injuries 120
surgical management 120
Gut organisms 26
H
Haemostatic packing-gauzes 64
Haemostatic resuscitation (HR) 64
Hand injuries 122–125
cutaneous nerves in hand 124
dislocations 123
fight-bites 124
fractures 123–124
lacerations 122
nail bed injuries 123
nerve injuries 124, 124–125
replantation of digits 125
tendon injuries 122–123
ultrasonography 122
volar plate injuries 123
Harris-Benedict equation 209
Hartmann's solution 42, 60, 161
HemCon 64
High-pressure injection injuries 126–128
clinical course after injury 127
digital amputation 128
injected substances 126
tissue dispersal 126
Hill–Sachs lesion 76
Hindfoot fractures 99–101
calcaneal fractures 100, 100–101, 101
talar fractures 99, 99, 99–100, 100
Hip dislocations 130–131
acetabular fractures and 130, 131
anterior 130
femoral head fractures and 130, 131
posterior 130
reduction and fixation 130–131
Thompson and Epstein classification 130, 131
Hip fractures 129–130
extracapsular fractures 129
Garden's classification 129, 129
intracapsular fractures 129, 129
proximal femoral fractures 129
surgical treatment 130
X-ray 129–130
Hoffmann–Tinel sign 50–52
Horner's sign 51
Horner's syndrome 202
Human and animal bites 132–133
Humeral diaphyseal (shaft) fractures 202–203, 203
Hydroxyethyl starch (HES) 164–166
animal models of trauma and haemorrhagic shock 165
chemical structure 164, 165
human studies on use of 165–166
preparation for clinical use 164
Hyperchloraemic acidosis 161
Hyperglycaemia 183
Hypertonic saline 162–163
Hyphaema 212
I
Imaging, in trauma
computed tomography 135–137
interventional radiology 138–140
magnetic resonance imaging 141–142
ultrasound 144–145
Infections 26
antibiotic treatment 27–28, 28
endogenous organisms 26
environmental organisms 26–27
health care-associated organisms 27
traumatic injuries and 26
Inferior vena cava (IVC) filters 30
International normalised ratio (INR) 29
Interventional radiology (IR) 138–140
embolisation 139, 139–140
haemorrhage control 138
stent grafts 140
visceral trauma 138
Intracerebral haemorrhage 191
Intracranial pressure (ICP) 17, 18, 192, 193
Intraosseous access 154–156
complications 156
drugs, fluids and blood products 155
EZ-IO 154, 156
First Access in Shock and Trauma (FAST) system 154, 155
insertion procedure 155, 155–156, 156
insertion sites 155
laboratory investigations 155
J
Jones fracture 105
K
Kaolin 293
Ketamine 17, 20
Kirschner (K) wire fixation, Colles’ fracture 323
Klebsiella spp. 27
Klumpke's paralysis 202
Knee injuries, soft tissue 270–272
L
Lachman's test 78
Lactated Ringer's solution 161
Lateral condyle fractures 87, 88
Lethal triad 168–170, 285
clinical assessment and patient identification 169
damage control (DC) approach 170
hypothermia, acidosis and coagulopathy 168
pathophysiology 168–169
treatment 169–170
Levonelle 258
Ligament of Treitz 1
Lignocaine 20
Limbal ischaemia 213
Liposomal amphotericin B 27
Lisfranc injuries 103, 103–104
classification 104
CT scan and MRI 104
mechanisms of injury 103
post-traumatic arthrosis 104
presentation 103–104
radiological findings 104
Locking plates, use of 265, 266
Long-bone fractures 171–175
aetiological classification 171
in children 174–175
closed 171
configurations and directions of fracture fragments 171
displaced 171
femoral shaft fracture 173–174, 174
fracture healing 172
humeral shaft fractures 172–173, 173
initial management 171–172
maintenance of reduction 172
open 171
reduction of fracture 172
rehabilitation 172
tibial fractures 174, 174
undisplaced 171
Low-molecular weight heparin (LMWH) 30
Lunate dislocates 77, 77
Lung recruitment manoeuvres 56
Lyophilised/freeze-dried plasma 44
Lyophilised plasma 176–177
clotting factor concentrations 177
disease transmission 177
and hypocalcaemia 177
M
Magnetic resonance imaging (MRI) 141–142
central nervous system, imaging of 142
image production 141
musculoskeletal imaging 142
safety during 141
sequences 141–142
severely injured patient, use in 142
Maisonneuve fracture 24, 77
Mallet deformity 123
Maxillofacial injuries 179–181
cervical spine injury 180
frontal bone and base of skull 180
mandible and maxilla, fracture of 179–180
primary survey and 179
secondary survey and 179
soft tissue injuries 180–181
zygoma and orbits, fracture of 180
Mean arterial pressure (MAP) 17, 18
Medial epicondylar fractures 87
Median nerve, hand 124, 125
Metabolic response to trauma 182–184
cellular metabolism and systemic inflammatory response syndrome 183
ebb phase 182, 182
flow phase 182, 182
fluid and electrolytes 183
hormones and glucose 182–183
lipolysis 183
proteolysis 183
response modification 184
Metacarpophalangeal joint (MCPJ) 123
Metatarsal fractures 105
Methicillin-resistant Staphylococcus aureus (MRSA) 27
Methyl prednisolone 57
Metronidazole 28
Microbiological considerations 185–186
initial risk assessment 185–186
management principles 186
trauma and infection 185
Midfoot and forefoot fractures 103–105
fractures of cuboid 105, 105
Lisfranc fracture 103, 103–104
metatarsal fractures 105
midtarsal joint 105
navicular fracture 104
phalangeal fractures 105
Midtarsal joint (Chopart's joint) 105
Mirtazapine 240
Moderate-to-severe traumatic brain injury 191–194
CT head scan 193
extradural haematoma, craniotomy and evacuation for 193
Glasgow Coma Scale (GCS) score 191, 193
goal-directed approach for 194
intra-axial primary brain injuries 191
intracranial haemorrhages 191
intracranial pressure and 192, 193
primary brain injury 191
secondary brain injury 191–192
subdural haematoma, craniotomy and evacuation for 193
tonsillar herniation 193
Trauma Audit and Research Network (TARN) data 191
uncal herniation 192–193
Monroe-Kellie doctrine 192
Monteggia fractures 90
Bado classification 91
Morphine 19
Mortality patterns 195–197
bimodal distribution of death 196–197
trimodal distribution of trauma deaths 195–196, 196
N
Navicular stress fractures 104
Near infrared spectroscopy (NIRS) 198–200
in compartment syndrome 200
and reflectance technique 198, 198
in trauma resuscitation 199–200
Neonatal trauma 202–204
birth trauma 202
brachial plexus injuries 202–203
bruises 203–204
facial and intraoral trauma 204
fractures 202–203, 203
head injuries 204
nonaccidental injury (NAI) 203–204
subdural haematoma 203
Nitric oxide, inhaled 11
Nitrous oxide, for pain relief 20–21
Nonaccidental injury (NAI) 205–207
information sharing and confidentiality 206–207
multidisciplinary team for 205
patterns of injury 206
physical examination signs 206
processes for raising concern 206
risk factors 206
Noncompressible torso haemorrhage (NCTH) 248
Nonunion of fracture see Fracture healing, abnormal
Normal saline (NS) 161
Nutcracker injuries 105, 105
Nutrition 208–210
in burns 209–210
calorie requirements 208–209
delivery route 208
enteral nutrition (EN) 208
European Society of Enteral and Parenteral nutrition (ESPEN) recommendations 208
monitoring of 210
nutritional guidelines 209
parenteral nutrition (PN) 208
protein and immunonutrients 209
stress ulcer prophylaxis 210
O
Oestrogen replacement therapy 110
Olecranon fractures 90
fixation methods 91
Mayo classification 90, 90
Ophthalmic injury 211–214
acute visual loss 213
anterior chamber 212
bulging eye 212
chemical burns 213
conjunctiva 212
cornea, assessment of 212
examination 211–212
eyelids 211
face examination 211
globe 212
lens 212
ocular blast injury 214
ocular burns 212
ocular/periocular foreign bodies 213
orbital blow-out fractures 213
penetrating injuries/globe rupture 213–214
pupils 212
retina 212
retrobulbar haemorrhage 214
sunken eye 212
symptoms 211
ultraviolet burns 212–213
vitreous 212
Opiates, for pain relief 19
Osteogenesis imperfecta 221
Osteomyelitis, post-traumatic 26
Osteopenia of prematurity 203
P
Paediatric trauma 215–218
airway 216
AVPU (alert, voice, pain, unresponsive) scale 217, 217
breathing 216
circulation 216–217, 217
disability 217, 217
early deaths 215
exposure 217
late deaths 215
nonaccidental injury 217–218
resuscitation 215–217
spinal cord injury 216
Paget's disease 221
Pain control 19 see also Analgesia
nonpharmacological methods 21
pharmacological methods 19–21
protocols for 21
Panton-Valentine leukocidin MRSA 27
Paracetamol 19
Parkland Formula 209
Paroxetine 240
Pasteurella multocida 27
Pathological fractures 219–221
bisphosphonate medication and 219–220
impending or incomplete 220–221, 221
malignancy and 219, 219
Mirel's scoring system 220, 221
nuclear bone scan 220, 220
processes causing 219, 219–220
sites 219
Pelvic trauma 222–226
acetabular fractures 224
emergency assessment and management 224
external fixation 225
injury type, management by 224–225
lateral pelvic compression injury 222, 223
open book fracture 222, 222
open reduction and internal fixation 226
pelvic anatomy and pathology 222
pelvic ring injuries 222, 222–224, 223
percutaneous fixation 225
plain radiographs 225
trauma CT 225
vertical shear injury 222, 223
Young–Burgess classification 223, 224
Penetrating neck injury 227–229
initial management 228
neurologic examination 227–228
signs of damage 227
surgical management 228–229
Peripheral nerve injuries 230–232
classification 230, 231
conduction block 230
demyelination 230
electromyography 232
initial assessment 231
Medical Research Council (MRC) grading of muscle power 231
nerve conduction studies 231
nerve degeneration 230
pathological mechanisms 230
prognosis 232
related anatomy 230
repair and nerve grafting 232
Seddon and Sunderland classification 231
surgical exploration 232
Personal protective equipment (PPE) 72
Phalangeal fractures 105
Phenelzine 240
Pilon fracture 24
Plasma-Lyte solution (PL) 161
Pneumatic prehospital tourniquets 308, 309
Posaconazole 27
Posterior cruciate ligament (PCL), injury to 271–272
Posterior shoulder dislocations 76, 76
Post-traumatic stress disorder (PTSD) 239–240
Prasugrel 30
Pregnancy and trauma 233–235
airway 233
breathing 233–234
chest/pelvic X-rays 234
circulation 234
external inspection 234
fetal assessment 234
fetal death 235
fetomaternal haemorrhage 235
Kleihauer test 234
obstetric complications 234–235
penetrating injury to uterus 235
placental abruption 234
premature labour 235
related anatomy 233, 233
resuscitative hysterectomy 234
uterine rupture 234–235
Prehospital blood product resuscitation 236–237
cold whole blood (CWB) 237
dried blood products 237
fresh frozen plasma (FFP) 236–237
packed red blood cells (PRBC) 236–237
provision for 236–237
remote damage control resuscitation (RDCR) 236
whole blood 237
Prilocaine 20
Propofol 17
Prothrombin complex concentrates (PCC) 29, 237
Prothrombin time ratios (PTr) 318
Proximal humeral nails 266
Proximal interphalangeal joints (PIPJs) 122
Psychological aspects, of trauma 239–240
Psychological first aid (PFA) 240
Pulmonary embolism (PE) 30
Pupillary red reflex 212
Q
QuikClot 64, 293
R
Radial head fractures 89
Essex–Lopresti type lesion 89
Mason classification 89, 89
Radial neck fracture 76–77
Radial nerve, hand 124, 125
Radiological hazards 71
Raloxifene 112
Recombinant factor VIIa (rFVIIa) 242–243
clinical use 242
CONTROL trail 243
effect of abnormal physiology 243
mechanisms of action 242
Rehabilitation 244–247
community rehabilitation 246–247
core rehabilitation team 246
early trauma rehabilitation 246
goal planning 245–246, 246
outcome measurement 247
recovery, re-enablement and 245
rehabilitation medicine 244
specialised rehabilitation 244, 245
in trauma care 244–245
Remifentanil 19
Renal injury see Genitourinary trauma
Resuscitative endovascular balloon occlusion of aorta (REBOA) 248–250
adverse consequences 249
aorta functional zones 249
to control haemorrhage 248
placement of REBOA device 249
plain X-ray 249
Resuscitative thoracotomy (RT) 248
Ringer lactate 60
Road traffic collisions (RTCs) 251–252
in-hospital care 252
injury patterns 251–252
mortality rate 251
pre-hospital care 252
Ropivacaine 20
S
Salter–Harris fractures 76
Scaphoid fractures 77, 325
Scapular fractures 268–269
Seatbelt-induced abdominal injuries 1
Selective nonoperative management (SNOM), of penetrating abdominal injury 254–255
CT scanning 255
Eastern Association for the Surgery of Trauma (EAST) guidelines 254, 255
history and clinical examination 255
stab wounds, selective management of 254
Sexual violence 257–259
assault by penetration 258
consent 258
documentation of account of events 257–258
follow-up care 258, 258–259
genitourinary medicine (GUM) clinic 259
initial management 257
physical injuries after sexual assault 257
postexposure prophylaxis after sexual exposure (PEPSE) 258, 258
rape 258
sexual assault 258
Shock 260–263
arterial blood gas chemistry 261
cardiac tamponade and 261, 262
cellular pathway in 260
CT scan 262
general findings 260
haemorrhage and 261, 262
hypoxia, treatment of 262
myocardial contusions and 261, 262
neurogenic shock 261, 263
physiological observations 261
primary survey 262
tension pneumothorax and 260–261, 262
ultrasound and radiological imaging 261–262
Shoulder, clavicle and humerus fractures 264–269
clavicle fractures 266, 267
proximal humerus fractures 264–267, 265, 266
Slipped capital femoral epiphysis 78
Smith's fracture 323–324, 324
0.9% Sodium chloride 42
Soft tissue injuries 78
Soft tissue knee injuries 270–272
approach to knee pain by location 270
ligamentous injuries 271, 271–272
meniscal injuries 270–271
Spinal cord injury without radiological abnormality (SCIWORA) 273–274
American Spinal Injuries Association (ASIA) assessment tool 273
MRI in 274
neurological examination 273
spinal immobilisation 274
Spinal injuries 150–153
conservative therapy 152
CT and MRI 151
immobilisation of spinal column 150
neurological examination 151
signs of 151
spinal function and biomechanics 150–151
surgical approaches 152–153
thoracolumbar injury classification system (TLICS) 152, 152
Trauma Audit and Research Network (TARN) data 150
X-ray 151
Splintage 276–278
box splints 276, 277
lower limb and pelvis 278
manual splintage plus adjuncts 276
pelvic splints 276, 277
plaster of Paris 277–278
traction splints 276–277, 277
types 276–278, 277
upper limb 278
vacuum splints 276, 277
Sports-related trauma injuries 147–149
airway maintenance with C-spine protection 147
ATMIST (mnemonic) 149
breathing with adequate ventilation 147–148
catastrophic haemorrhage control 147
circulation with haemorrhage control 148
definitive care 148–149
emergency action planning 147
exposure and environment control 148
initial assessment and management 147–148
medical equipment 149
musculoskeletal trauma 149
neurological status, assessment of 148
resuscitation 148
secondary survey 148
spinal injuries 149
Stab wound 1 see also Abdominal trauma
Staphylococcus aureus 26
Stent grafting 140
Subconjunctival foreign bodies 213
Subdural haemorrhage 191
Super-obesity 36
Supracondylar fractures of humerus 86–87
anterior interosseous nerve function, assessment of 87, 87
Gartland classification 86, 86
Kirschner wire fixation 86, 86
pink pulseless hand, management of 87
Suxamethonium 17
Systemic inflammatory response syndrome (SIRS) 279–281
clinical course 280
damage control strategies 280
exacerbators of, in severely injured 279
haemodynamic response 279–280
immunological response 279
metabolic response 279
multiorgan distress syndrome 280
novel hybrid resuscitation 281
persistent inflammation, immunosuppression and catabolism syndrome 281, 281
T
Talar fractures 99–100, 100
anatomy of talus 99, 99
avascular necrosis 100
Hawkins’ classification 99
Hawkins’ sign 100, 100
malunion 100
talar dome fractures 100
talar head fractures 99
Tarsometatarsal joint injuries see Lisfranc injuries
Teicoplanin 28
Teriparatide 112
Tertiary survey 282–283
airway 283
breathing 283
circulation 283
controversies 282
disability 283
exposure 283
National Peer Review Programme for Trauma standard 282
psychological aspects 283
radiological 282
Tetanus prophylaxis, for bite wounds 132
Tetanus vaccine 26
Therapeutic hypothermia 285–287
degrees of cooling 285–286
major haemorrhage and 286
traumatic brain injury and 286–287
Thiopentone 17
Thompson calf squeeze test 78
Thoracic trauma 288–291
alveoli rupture 288
and atelectasis 291
blunt aortic injury 288–289
and bronchopleural fistula 291
chest X ray 289
and chylothorax 291
diaphragmatic injuries 288, 290
and empyema 291
Focused abdominal sonography for trauma (FAST) 289
nonoperative treatment 290
operative management 290
and pneumonia 291
pulmonary contusions 288
rib fractures 288, 289
tracheobronchial injuries 288, 289
Thoracotomy 301–302
Tillaux fracture 22, 23 see also Ankle fractures
Topical haemostatic dressings 292–293
Chitosan-based dressings 293
clotting factor-based dressings 293
ideal haemostatic dressing 292
mineral-based agents 292–293
in surgery 293
types 292–293
Tourniquets 64, 295–297
clinical issues 295
Combat Application Tourniquet 295, 296
Tramadol 19
Tranexamic acid (TXA) 29, 43–44, 84, 234, 298–299
strategies for administration 298
Transfusion-related acute lung injury (TRALI) 177
Trauma-induced coagulopathy (TIC) 42–43, 168–169, 176, 236, 318
Trauma Risk Management (TRiM) 240
Trauma scoring 304–307
Abbreviated Injury Scale (AIS) 305, 305
anatomical systems 305, 305–306, 306
combined systems 306–307
injury severity score (ISS) 305, 306
M statistic 306
New ISS (NISS) 305–306, 306
physiological systems 304, 304–305, 305
relationship between RTS and survival 304
revised trauma score (RTS) 304
trauma score ISS (TRISS) methodology 306
triage RTS (TRTS) 304
weighting coefficient 304
W statistic 307
Z statistic 306
Traumatic amputation 308–310
ABCDE approach 308
first aid 308–310, 309
outcomes 310
postoperative care 310
reimplantation 310
surgery 310
Traumatic brain injury (TBI) 188
CT head scanning 189
educational support 189
mild 188–189
moderate-to-severe 191–194 (see also Moderate-to-severe traumatic brain injury)
MRI 189
neuropsychological assessment 189
pathophysiology 188
physical and cognitive rest 189
sequelae following 189
Traumatic cardiac arrest (TCA) 300–303
blood product resuscitation 302
cessation of resuscitation 302–303
emergency ultrasonography 302
horizontal resuscitation 301
irreversible causes 302
management principles 300–301
markers of low cardiac output state 302
postresuscitation care 302
prehospital management 301
resuscitative thoracotomy, role of 301–302
reversible causes 302
Traumatic subarachnoid haemorrhage 191
Triage 312–314
British Association for Immediate Care (BASIC) card 314
categories 312, 312–313
Medical Emergency Triage Tag (METTAG) card 314
triage labelling 314
triage sieve 313, 313
triage sort (triage revised trauma score (TRTS)) 313, 313–314, 314
Triplane fracture 24
U
Ulnar collateral ligament rupture 78
Ulnar nerve, hand 124, 125
Ultrasound 144–145
extended FAST 145
focussed abdominal/assessment sonography 144–145
vascular access 145
Ureteric injury see Genitourinary trauma
V
Vascular injuries 315–317
chest and abdomen 315
compressible haemorrhage (CH) 316–317
junctional injuries 316
noncompressible haemorrhage (NCH) 315–316
repairing vessels 316
retroperitoneum 316
Vasopressin 55–56
Venous thromboembolism (VTE), after trauma 30
Ventilator-induced lung injury (VILI) 10
Video-assisted thorascopic surgery (VATS) 290
Viscoelastic assessment, of coagulation in trauma 318–321
EXTEM and FIBTEM 320, 320–321
rotational thromboelastometry (ROTEM) 318
systematic evaluations of 320–321
thromboelastography (TEG) 318
viscoelastic assay terminology 319, 319–320
Vitamin D supplements 110, 112
Vitamin K 29
W
Wallerian degeneration 230
Warfarin 29
Whiplash-associated disorders (WAD) 70
Wrist and carpal injuries 322–326
carpal injuries 325, 326
children's fractures 325, 326
distal radius fractures 322, 322
extra-articular dorsally displaced fractures 323, 323
intra-articular fractures 324, 324–325
ulna injuries 325
volar displaced fractures 323–324, 324
×
Chapter Notes

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Key Clinical Topics in Trauma
Key Clinical Topics in Trauma
Keith Porter MB BS FRCS(Ed) FRCS(Eng) FIMC RCS(Ed) FFSEM (UK) FCEM Consultant and Professor of Clinical Traumatology Queen Elizabeth Hospital Birmingham, UK Ian Greaves MBChB FRCP FCOM RCSEd DTMeH DipMedEd Consultant and Professor of Emergency Medicine James Cook University Hospital, Middlesbrough, UK Derek Burke MBChB FRCS(Ed) FRCS(Glas) FRCPCH FFAEM Consultant and Professor of Paediatric Emergency Medicine Sheffield Children's NHS Foundation Trust Sheffield, UK
© 2016 JP Medical Ltd.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the editors assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
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Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
9781909836082
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A catalog record for this book is available from the Library of Congress
Commissioning Editor:
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Editorial Assistant:
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Design:
Designers Collective Ltd
Preface
There has been a significant transformation in the organisation of trauma services and the clinical management of patients in the last decade. Trauma care has a higher profile than ever before, and more patients are surviving than would have been expected only a few years ago. Trauma networks have been developed, with effective transport platforms connecting trauma units and major trauma centres. Organisational change has occurred in parallel with clinical advances, and classic questions regarding fluids, imaging and operative intervention have been answered at least in part.
A significant number of these advances arose from the provision of medical care by the Defence Medical Services in Iraq and Afghanistan and from the efforts of those in the UK responsible for the further management of these challenging injuries. We make no apologies, therefore, for the over representation of such individuals amongst the authors of topics in Key Clinical Topics in Trauma. Having said this, our contributors represent a wide range of centres of excellence in trauma management both in the UK and abroad.
We hope that this book provides readers with access to the most up-to-date thinking and practice in clinical traumatology. We have tried to ensure that all the important areas of trauma care are covered, and we have also included an admittedly personal selection of more unusual topics which are either establishing themselves in clinical practice or are likely to do so in the future (for example REBOA and lyophilised plasma).
We would like to thank all those who have helped us identify topic contributors, and most importantly the contributors themselves for devoting their time and effort to Key Clinical Topics in Trauma.
The editors’ royalties from the sales of this book are donated in their entirety to the organisation Trauma Care UK (www.traumacare.org.uk), an organisation dedicated to promoting excellence in trauma management. We urge you to consider joining it.
Keith Porter
Ian Greaves
Derek Burke
March 2016
Contributors