Improving outcome in severe trauma: trauma systems and initial management—intubation, ventilation and resuscitation

Abstract

Severe trauma is an increasing global problem mainly affecting fit and healthy younger adults. Improvements in the entire pathway of trauma care have led to improvements in outcome. Development of a regional trauma system based around a trauma centre is associated with a 15-50% reduction in mortality. Trauma teams led by senior doctors provide better care. Although intuitively advantageous, the involvement of doctors in the pre-hospital care of trauma patients currently lacks clear evidence of benefit. Poor airway management is consistently identified as a cause of avoidable morbidity and mortality. Rapid sequence induction/intubation is frequently indicated but the ideal drugs have yet to be identified. The benefits of cricoid pressure are not clear cut. Dogmas in the management of pneumothoraces have been challenged: chest x-ray has a role in the diagnosis of tension pneumothoraces, needle aspiration may be ineffective, and small pneumothoraces can be managed conservatively. Identification of significant haemorrhage can be difficult and specific early resuscitation goals are not easily definable. A hypotensive approach may limit further bleeding but could worsen significant brain injury. The ideal initial resuscitation fluid remains controversial. In appropriately selected patients early aggressive blood product resuscitation is beneficial. Hypothermia can exacerbate bleeding and the benefit in traumatic brain injury is not adequately studied for firm recommendations.

The use of antioxidants in the treatment of traumatic brain injury

“…It has been shown that more aggressive initial TBI management has led to improved patient outcomes (Harris et al . , Prabhakar et al . ).…”

“…One of the most important nursing roles when caring for TBI patients is to ensure that accurate neurological assessments are conducted and communicated in a timely manner so treatments can be initiated promptly. It has been shown that more aggressive initial TBI management has led to improved patient outcomes (Harris et al 2012, Prabhakar et al 2014. Patients with TBIs may have sudden increased intracranial pressure, instability or changes in balance or vision that require immediate therapy lest lifelong Table 1 Literature inclusion and exclusion criteria.…”

Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial

“…39,40 Despite the fact that trauma center personnel routinely record demographic, treatment, and outcome data of their patients, surprisingly few studies have published airway management and fluid and blood resuscitation data. 39,40 Despite the fact that trauma center personnel routinely record demographic, treatment, and outcome data of their patients, surprisingly few studies have published airway management and fluid and blood resuscitation data.…”

Improving outcome in severe trauma: what's new in ABC? Imaging, bleeding and brain injury

“…Clear leadership and coordination must exist across regions and within hospitals 118. When managing individual patients the evidence base remains poor119 and large high quality trials remain the exception.…”