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Improving outcome in severe trauma: what's new in ABC? Imaging, bleeding and brain injury
  1. Tim Harris1,
  2. Ross Davenport2,
  3. Tom Hurst3,
  4. Paul Hunt4,
  5. Tim Fotheringham5,
  6. Jonathan Jones6
  1. 1Department of Emergency Medicine, Pre-Hospital Care, Royal London Hospital, London, UK
  2. 2Centre for Trauma Sciences, Queen Mary University of London, Royal London Hospital, London, UK
  3. 3Department of Critical Care, King's College Hospital, London, UK
  4. 4Emergency Medicine and Critical Care, The James Cook University Hospital, Middlesbrough, UK
  5. 5Department of Radiology, The Royal London Hospital, London, UK
  6. 6Department of Emergency Medicine, Leeds General Infirmary, Leeds, UK
  1. Correspondence to Dr Tim Harris, Consultant in Emergency Medicine, Pre-Hospital Care and Emergency Preparedness, Royal London Hospital, London E11BB, UK; tim.harris{at}bartsandthelondon.nhs.uk

Abstract

Appropriate imaging is critical in the initial assessment of patients with severe trauma. Plain radiographs remain integral to the primary survey. Focused ultrasonography is useful for identifying intraperitoneal fluid likely to represent haemorrhage in patients who are shocked and also has a role in identifying intrathoracic pathology. Modern scanners permit a greater role for CT, being more rapid and exposing the patient to less ionising radiation. ‘Whole body’ (head to pelvis) CT scanning has been shown to identify injuries missed by ‘traditional’ focused assessment and may be associated with an improved outcome. CT identifies more spinal injuries than plain radiographs, is the gold standard for diagnosing blunt aortic injury and facilitates non-operative management of solid organ injury and other bleeding. Coagulopathy occurs early in trauma as a direct result of injury and hypoperfusion. Damage control resuscitation with blood components is associated with an improved outcome in patients with trauma with massive haemorrhage. Packed cells and fresh frozen plasma should be used in a 1:1 to 1:2 ratio. Bedside measures of coagulopathy may prove useful. Adjuvant early treatment with tranexamic acid is of benefit in reducing blood loss and reducing mortality. Limited ‘damage control surgery’ with early optimisation of physiology augmented by interventional radiology to control haemorrhage is preferable to early definitive care. Limiting haemorrhage by correction of anticoagulation and minimising secondary brain injury through optimal supportive care is critical to improving outcome in neurotrauma.

  • Trauma
  • injuries and wounds
  • trauma centre
  • resuscitation
  • aviation medicine
  • accident and emergency medicine
  • intensive and critical care
  • adult intensive and critical care
  • ultrasonography
  • adult intensive and critical care
  • law (see medical law)
  • medical law
  • trauma management

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Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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