Approach To Resuscitation of Trauma Patient

The management of injuries is based based on their life-threatening potential. That means severe and more life threatening injury is dealt first and others later. In resuscitation of trauma patient ABC system of trauma resuscitation is followed.

ABC is airway, breathing, circulation and they are managed in that priority.

How to approach trauma resuscitation?

Airway

The first priority in management of the injured patient is the establishment of a clear airway, followed by ventilation and oxygenation. Removal of oral debris and jaw-thrust maneuvers are performed for this purpose only.

If, however, the adequacy of the airway is in question because of head or facial trauma, shock, or thoracic trauma, definitive airway control must be achieved.

In some conditions, it becomes difficult to put endotracheal tube through mouth. In such case nasotracheal intubation can alternatively be performed.

Tracheotomy( Slitting the wind pipe to let air go into the lung and out) may be required in rare cases where all other means of ventilation are not feasible.

Breathing
After the airway is cleared or established, next thing to loook for is whether the patient has a problem in breathing. Malposition of the endotracheal tube, pneumothorax, and hemothorax can lead to loss of ventilation. The respiratory therapist can be directed to set up mechanically assisted ventilation at the direction of the team captain when the patient has decreased ventilatory drive due to head injury, flail chest wall segment, or chemical paralysis that may have been used to assist in intubation.

Circulation

Fluid replacement and pressure control of obvious external bleeding will have been initiated in the field and should be continued in the emergency department.

Additionally, a large-bore venous catheter may be placed to facilitate fluid and blood replacement, which is performed based on the patient’s blood pressure, pulse, and hematocrit. At a minimum, two large-bore (16-gauge) catheters are necessary for this phase of treatment. They are generally placed in the antecubital fossae or groin; injured extremities should be avoided for line placement.

Management of hemorrhage are equally important as the principles of fluid replacement.

Related posts:

1. Trauma Care- A Team Based Approach
2. Airway Management in Trauma- Special Considerations
3. Management of Shock In Trauma
4. Monitoring of A Polytrauma Patient
5. Polytrauma-Fracture Management In Patient With Head Injury