ISCCM Manual of TRAUMA CARE
ISCCM Manual of TRAUMA CARE
Editors
Simant Kumar Jha
DA DNB PGDHM PDCR ATLS
Faculty FCCS Course, Director and Senior Consultant Department of Critical Care Pushpawati Singhania Hospital and Research Institute New Delhi, India
Associate Editors
Jayant Kumar
MS (Ortho) Fellowship in Arthroscopy and Sports Injury (Coimbatore, Seoul, South Korea) Fellowship in Joint Replacement (New Delhi, Germany) Fellowship in Orthopedic Trauma (Seoul, South Korea) ISKSAA Travelling Fellowship (Liverpool, UK, ATLS Certified) Former Assistant Professor Department of Orthopedics PDU Medical College, Rajkot, Gujarat Al-Falah School of Medical Science Faridabad, Haryana Presently Consultant Orthopedic and Joint Replacement, Tata Main Hospital Jamshedpur, Jharkhand, India
Abhinav Gupta FNB EDIC
Consultant Department of Critical Care Homerton Hospital London, UK
Srinivas Samavedam
MD DNBFRCP FNB EDIC FICCM
Diploma in Health Care Quality Management Diploma in Medical law and Ethics MBA (Hosp Admin) Head, Critical Care Medical Director Virinchi Hospitals Hyderabad, Telangana, India
Arindam Kar
MD DNB FNB EDICM FCCP FICCM FCCM
Director and Head CK Birla Hospitals and CMRI Institute of Critical Care Kolkata, West Bengal, India
Forewords
Subhal Bhalchandra Dixit
Mahesh C Misra
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ISCCM Manual of Trauma Care
First Edition: 2020
9789389776874
Printed at
- Abhinav Gupta FNB EDIC
- Consultant
- Department of Critical Care
- Homerton Hospital
- London, UK
- Alok Panigrahi MD (Anesthesia) DM
- Critical Care Trainee
- All India Institute of
- Medical Sciences
- New Delhi, India
- Amit Goyal DA DNB IDCC
- Consultant
- Department of Critical Care
- Artemis Hospital
- Gurugram, Haryana, India
- Amit Keshri MS
- Assistant Professor
- Department of Surgery
- VCSGGMS and RI
- Srinagar, Uttarakhand, India
- Anand Waman Dongre MBBS DA MD
- Director
- Swastik Critical Care
- Nagpur, Maharashtra, India
- Anirban Hom Choudhuri MD FICCM PGDMLE FIAMLE
- Professor and ICU Incharge
- Department of Anesthesiology and
- Critical Care
- Govind Ballabh Pant Institute of
- Postgraduate Medical Education and
- Research
- New Delhi, India
- Arindam Kar MD DNB FNB EDICM FCCP FICCM FCCM
- Director and Head
- CK Birla Hospitals and CMRI Institute of Critical Care
- Kolkata, West Bengal, India
- Babu K Abraham MD MRCP (UK) FICCM
- Senior Consultant
- Department of Critical Care Medicine
- Apollo Hospitals
- Chennai, Tamil Nadu, India
- Bhavya Jha MS (Obs & Gyne) Fellowship in Reproductive Medicine
- Fellowship in Gyne Endoscopy
- Visiting Consultant
- International Fertility Center
- New Delhi, India
- Bhuvna Ahuja MD
- Senior Resident
- Department of Anesthesiology and Critical Care
- Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
- New Delhi, India
- Chandan Kakkar MD
- Assistant Professor
- Department of Radiodiagnosis
- Dayanand Medical College and Hospital
- Ludhiana, Punjab, India
- Daljit Singh MS MCh (Neurosurgery)
- Professor and Head
- Department of Neurosurgery
- Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
- Govind Ballabh Pant Hospital
- New Delhi, India
- Dhara Tanna MD (Anesthesia)
- Assistant Professor
- Gujarat Medical Education and Research Society Medical College
- Vadodara, Gujarat, India
- Gunchan Paul MD IDCCM
- Associate Professor
- Department of Critical Care Medicine
- Dayanand Medical College and Hospital
- Ludhiana, Punjab, India
- Jayant Kumar MS (Ortho) Fellowship in Arthroscopy and Sports Injury (Coimbatore, Seoul, South Korea)
- Fellowship in Joint Replacement (New Delhi, Germany)
- Fellowship in Orthopedic Trauma (Seoul, South Korea)
- ISKSAA Travelling Fellowship (Liverpool, UK, ATLS Certified)
- Former Assistant Professor
- Department of Orthopedics
- PDU Medical College, Rajkot, Gujarat
- Al-Falah School of Medical Science, Faridabad, Haryana
- Presently Consultant Orthopedic and Joint Replacement
- Tata Main Hospital, Jamshedpur, Jharkhand, India
- Kamal Lashkari MD (Anesthesiology) IDCCM EDIC
- Specialist and Incharge
- Department of Critical Care Medicine
- Thumbay Hospital
- Ajman, UAE
- Kapil Dev Soni MD (Anesthesia)
- Associate Professor
- Department of Critical and Intensive Care
- Jai Prakash Narayan Apex Trauma Center
- All India Institute of Medical Sciences
- New Delhi, India
- Mritunjay Kumar MD DNB MNAMS
- Associate Professor
- Department of Anesthesiology and Critical Care
- All India Institute of Medical Sciences
- Jodhpur, Rajasthan, India
- Neeta Bose MD (Anesthesia)
- BLS ACLS Instructor, ATLS Instructor
- BCLS CCLS Instructor, Associate Professor
- Gujarat Medical Education and Research Society Medical College
- Vadodara, Gujarat, India
- Nidhi Jha MS (Obs & Gyne)
- FIAOG FMAS Fellowship in Reproductive Medicine
- Fellowship in Cosmetic Gynecology (American Aesthetic Association)
- Diploma in Obs and Gyne USG
- Assistant Professor
- Department of Obstetrics and Gynecology
- SGT Medical College
- Gurugram, Haryana, India
- Nipun Bajaj DNB (Ortho) FNB (Spine Surgery) MNAMS
- Consultant
- Department of Spine Surgery
- QRG Health City
- Faridabad, Haryana, India
- Nitesh K Singh DA FCCS FCCCM
- Junior Consultant
- Department of Critical Care
- Pushpawati Singhania Hospital and Research Institute
- New Delhi, India
- Nitin Jain MD EDIC
- Head
- Department of Critical Care
- Paras Hospital
- Gurugram, Haryana, India
- PL Gautam MD DNB FICCM MNAMS
- Professor and Head
- Liver Transplant Anesthesiologist
- Department of Critical Care Medicine
- Dayanand Medical College and Hospital
- Ludhiana, Punjab, India
- Prashant Kumar MD IDCCM FNB (Critical Care) EDIC ADHCA DOA
- Senior Consultant
- Department of Critical Care
- Medanta—The Medicity
- Gurugram, Haryana, India
- Rachna Wadhwa MD (Anesthesia) MNAMS BLS & ACLS Faculty
- Faculty of Airway Management Foundation
- Associate Professor
- Department of Anesthesiology and Critical Care
- Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
- Govind Ballabh Pant Hospital
- New Delhi, India
- Rahul Deb Das MD
- Consultant Cardiac Anesthesiologist
- Narayan Multispecialty Hospital
- Jamshedpur, Jharkhand, India
- Ranajit Chatterjee DA MRCP EDIC
- Consultant Incharge
- Department of Intensive Care Unit
- Swami Dayanand Hospital
- New Delhi, India
- Sandeep K Jha MS (Surg) DNB
- (Surgical Gastroenterology) FMAS DMAS FICRS
- Associate Consultant and Liver Transplant Surgeon
- Department of HPB Surgery and Liver Transplant
- BLK Super Specialty Hospital
- New Delhi, India
- Sandeep Sahu MD DNB PDCC
- Professor
- Department of Anesthesiology and Intensive Care
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Shalini Kumari DO (Ophthalmology) DNB FSCEH (Oculoplasty)
- Assistant Professor
- Al-Falah School of Medical Science
- Faridabad, Haryana, India
- Simant Kumar Jha DA DNB PGDHM PDCR ATLS
- Faculty FCCS Course, Director and Senior Consultant
- Department of Critical Care
- Pushpawati Singhania Hospital and Research Institute
- New Delhi, India
- Srikant Behera MD (General Medicine) PDCC (Critical Care Medicine)
- DM Student
- Department of Critical Care Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Tapas Kumar Singh MD PDCC
- Assistant Professor
- Department of Anesthesiology and Intensive Care
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Yamini Dudeja MD (Anesthesiology)
- Senior Resident
- Department of Anesthesiology, Critical Care and Pain Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Yudhyavir Singh MD (Anesthesiology)
- Assistant Professor
- Department of Anesthesiology, Critical Care and Pain Medicine
- Jai Prakash Narayan Apex Trauma Center
- All India Institute of Medical Sciences
- New Delhi, India
As, President of Indian Society of Critical Care Medicine (ISCCM), it is my proud privilege to introduce the book Manual of Trauma Care to the critical care community.
With the ever-expanding field of critical care, an endeavor to strengthen the academics and ICU practices across the country, the ISCCM has come up with this book to serve as a bedside reference guide.
Trauma the leading cause of death in young adults is trauma. Traumatic injuries may range from small lesions to life-threatening multiorgan injury. In order to achieve the best possible outcomes while decreasing the risk of undetected injuries, the management of trauma patients requires a highly systematic approach. Prehospital trauma care involves first aid and basic life support administered by emergency services personnel. In the hospital setting, the treatment of trauma patients is traditionally divided into primary, secondary, and tertiary survey. Each consists of an algorithm designed to diagnose and manage injuries in order of decreasing morbidity and mortality.
Experts from across the country have come together through the book to share their wide evidence-based literature and knowledge in the field of trauma.
All the contributors are renowned critical care experts from leading institutions across India.
The book represents an invaluable resource for critical care professionals, and covers the full spectrum of critical care ultrasound.
Intensivists and postgraduates across the country will find this book an invaluable reference text.
I would like to congratulate Dr Simant Kumar Jha and team on accomplishing the difficult task successfully.
I hope the book serves the purpose for the critical care community in saving lives!
Best Wishes!!
Subhal Bhalchandra Dixit MD IDCCM FICCM FICP FCCM
Consultant Critical Care and Director ICU
Department of Critical Care
Sanjeevan and MJM Hospitals
Pune, Maharashtra, India
President
Indian Society of Critical Care Medicine (2019–2020)
Foreword
The book Manual of Trauma Care has been compiled by Indian Society of Critical Care Medicine (ISCCM). The Chapter on Trauma has been contributed by multiauthors outlining management protocols on injury to different body regions. There are 12 chapters in the book.
Chapter 1 deals with rapid and accurate assessment and initial management of injured patient.
Subsequent Chapter 2 [Airway (A) and Breathing (B)] emphasizing the importance of airway with cervical spine protection since airway kills injured patient before breathing issue. Next in sequence is the breathing problem, which kills the injured patients (particularly those in shock and/or have sustained significant brain injury. Only after taking care of A and B, hypotension (largely due to blood loss) in Chapter 3 (circulation) has been discussed in detail with algorithmic approach.
Other chapters include Chapter 4 on Thoracic Trauma discussing the life- threatening thoracic injury and potentially life-threatening scenarios.
Abdominal Trauma Emergency Radiological Imaging has been described in Chapter 5, Head Trauma has been dealt with in Chapter 6, Spine and Spinal Cord Trauma in Chapter 7, Musculoskeletal Trauma in Chapter 8, Chapter 9 deals with special situations like Management of Burns, Trauma in Pregnancy, Pediatric Trauma, Trauma in Elderly and Drowning, Chapter 10 deals with Essentials of Managing Trauma in Rural/Remote Areas, Chapter 11 on Trauma Scores and ICU Management of Trauma Patients, and last Chapter 12 deals with Triaging and Principles of Disaster Management.
I am sure that this book will serve as handbook for postgraduate and DNB students across specialties those are involved in the acute care of injured patients.
I take this opportunity to congratulate the authors who have worked hard to prepare the manuscripts for various chapters on the basis of Advanced Trauma Life Support (ATLS) protocol to deal with immediate care of trauma patients. Editors of Trauma Section, viz., Simant Kumar Jha, Jayant Kumar, Abhinav Gupta, Srinivas Samavedam, and Arindam Kar need to be complimented.
I wish the book manual a wide readership and hope that a digital/online version will also be available for the benefit of the current generation of students.
Mahesh C Misra
Emeritus Professor, Jai Prakash Narayan Apex Trauma Center
All India Institute of Medical Sciences, New Delhi
ATLS India Chair, Program and Course Director, ATLS India Program
Former Director, All India Institute of Medical Sciences, New Delhi
Member French Academy of Medicine (Elected 2017)
Invited Member International Endo-Hernia Society (IEHS)
IMA Eminent Medical Teacher Award 2016 (In 2017)
Professor of General and Minimally Invasive Surgery
Director of Surgical Disciplines, The President cum Vice Chancellor
Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
Visiting Consultant, Department of General and Laparoscopic Surgery
Sir Ganga Ram Hospital, New Delhi, India
Preface
In my 22 years of career in medicine and 13 years of it in orthopedics, I have realized the challenges faced by a doctor during implementing his knowledge at the scene of trauma especially in developing countries like India which have a nonuniformity of medical resources. The book intends to guide all medical professionals on how to utilize their skills to manage different trauma scenarios with a special chapter on managing trauma in rural and remote areas. The chapters spread over from the ABCD of trauma management to how to apply them in special scenarios. A chapter on Trauma and ICU scores has been added to help in objective assessment of the trauma patient. The authors of individual chapters are experts in their fields and have enriched the book with their individual experiences as well. I would like to thank each contributor and especially Dr Simant Kumar Jha for coordinating among all the authors and editing the contents to compile it into a compact user-friendly source of knowledge. I hope the book provides an even mix of knowledge and it is application in the Indian perspective.
Jayant Kumar
Acknowledgments
I would like to start by expressing my sincere gratitude to my teacher and mentor, Professor Mahesh C Misra, Former Director, All India Institute of Medical Sciences, New Delhi, India and presently Vice Chancellor and President, Mahatma Gandhi University of Medical Sciences and Technology (MGUMST), Jaipur, Rajasthan who has taught me everything about trauma. I am grateful for his constant encouragement, guidance and support.
I am thankful to all my advanced trauma life support (ATLS) teachers, especially Drs Amit Goyal, Sunil and Sanjay Shah.
A note of special heartfelt thanks to Dr Subhal Bhalchandra Dixit, who constantly guided and supported me throughout this journey.
I am also thankful to Drs Atul Kulkarni, Yatin Mehta, Deepak Govil and Pradeep Bhattacharya for their support.
I would like to thank the Associate Editors, Dr Srinivas Samavedam, Dr Abhinav Gupta, Dr Arindam Kar and my friend Dr Jayant Kumar for their able assistance in completing this book.
Deep regards and gratitude to Dr Khilnani and Dr Anurag Mahajan for their patronage and motivation that inspired me to keep going.
I am thankful to my co-authors Drs Srikant Behera, Sandeep K Jha, Nidhi Jha, Bhavya Jha, Rahul Deb Das, Kamal Lashkari, Sandeep Sahu, Amit Goyal and everyone else.
Love, thanks and appreciation to my parents; my wife, Neha; my sister, Dr Shalini; and my daughter, Ira, for being there as rock support for successful completion of this publication.
Lastly, I would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their untiring support.
Thank you.
Simant Kumar Jha