Clinical management of a trauma patient

This prediction has received support in a case studies and open trials with a variety of diagnoses.

Clinical management of a trauma patient

Airway Management of the Trauma Victim The potential for cervical spine injury makes airway management more complex in the trauma patient.

A cervical spine injury should be suspected in all injury mechanisms involving blunt trauma. Cervical spine injury is often occult, and secondary injury to the spinal cord must be avoided. Immobilization of the cervical spine must be instituted until a complete clinical and radiological evaluation has excluded injury.

Assessment The fully conscious, talking patient is able to maintain his own airway and needs no further airway manipulation. However patients' status may deteriorate at any time, and ABC's must constantly be reassessed. The following categories of patients require a definitively secured airway: Large flail segment or respiratory failure.

Inability to otherwise maintain an airway or oxygenation. The urgency of airway intubation is the most important factor in planning which technique of securing the airway is the safest and most appropriate. One must evaluate and assess the risk of further cord injury given head and neck movement, the degree of cooperation from the patient, anatomy and trauma to the airway and one's own expertise in each technique.

Airway Management Initially the airway should be cleared of debris, blood and secretions. It should be opened using the 'chin lift' or 'jaw thrust' manoeuvres.

The 'sniffing the morning air' position for standard tracheal intubation flexes the lower cervical spine and extends the occiput on the atlas. This movement was unaffected by use of a rigid collar.

Manual stabilization did however reduce movement. An oral Guedel or nasopharyngeal airway may be necessary to maintain patency until a definitive airway is secured.

Insertion of an airway produces minimal disturbance to the cervical spine.

Clinical management of a trauma patient

Bag and mask ventilation also produces a significant degree of movement at zones of instability. Tracheal Tube The safest method of securing a tracheal tube remains debatable. In general, the technique used should be the one the operator is most familiar with.

The method is generally unimportant as long as the potential cervical spine injury is recognised and reasonable care taken 4. The ATLS recommends a nasotracheal tube in the spontaneously breathing patient, and orotracheal intubation in the apnoeic patient.

The hard collar may interfere with intubation efforts and the front part may be removed to facilitate intubation as long as manual stabilisation is in effect.

Nasotracheal intubation is relatively contraindicated in patients with potential base of skull fracture or unstable mid-face injuries.A concise yet comprehensive guide to trauma evaluation and management covering the full scope of injuries "This is a worthy update to the previous edition published 10 years ago.

Airway Management of the Trauma Victim. The potential for cervical spine injury makes airway management more complex in the trauma patient.

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Clinical approach to the trauma patient. Interventional radiology (IR) plays a strong role in the management of patients with solid organ injuries, and an understanding of the presentation, imaging features, and management of patients is vital to administer appropriate care by both interventional physicians and nursing staff.

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Clinical Approach to the Trauma Patient - ScienceDirect