Reviewed and revised 30 July 2014 OVERVIEW INDICATIONS CONTRA-INDICATIONS ASSESSMENT APPROACH TO PHYSICAL RESTRAINT Exclude other therapeutic options first Ensure safety at all times Prepare physical restraint team Initiate manual restraint During manual restraint Monitoring (according to depth of sedation) may…
Traditional ATLS teaching was that a digital rectal exam (DRE) is mandatory in trauma patients: “a finger or tube in every orifice”. This is no longer the case.
Major Haemorrhage in Trauma
Damage control resuscitation (DCR) is a systematic approach to the management of the trauma patient with severe injuries that starts in the emergency room and continues through the operating room and the intensive care unit (ICU). DCR involves haemostatic resuscitation, permissive hypotension (where appropriate) and damage control surgery
Most genitourinary injuries are not immediately life-threatening. Renal pedicle injury can lead to life-threatening hemorrhage and renal ischemia
Splenic trauma may result from blunt or penetrating abdominal injury. The spleen is the most commonly injured organ in blunt abdominal trauma
Diaphragmatic injury can be a challenging diagnosis and is missed on imaging about 50% of the time. Comprises 0.8 to 8% of all closed blunt trauma and penetrating trauma case combined
Liver trauma may result from blunt or penetrating abdominal injury. The liver is the most commonly injured organ in penetrating abdominal trauma
Pelvic fractures are important in critical care because they are associated with: High energy mechanisms; Major haemorrhage; Other major injuries; and High morbidity and mortality
There are various systems for classification, these are the 2 most often used: Tile classification and the Young-Burgess classification
Pre-peritoneal packing is a method of directly packing the retroperitoneum without the need for a laparotomy
Pelvic Arterial Injury: potentially lethal complication of pelvic trauma; more common that previously reported: >10%