The early management of patients with multiple injuries

Abstract

There have been many advances in the resuscitation and early management of patients with severe injuries during the last decade. These have come about as a result of the reorganisation of civilian trauma services in countries such as Germany, Australia and the United States, where the development of trauma systems has allowed a concentration of expertise and research. The continuing conflicts in the Middle East have also generated a significant increase in expertise in the management of severe injuries, and soldiers now survive injuries that would have been fatal in previous wars. This military experience is being translated into civilian practice. The aim of this paper is to give orthopaedic surgeons a practical, evidence-based guide to the current management of patients with severe, multiple injuries. It must be emphasised that this depends upon the expertise, experience and facilities available within the local health-care system, and that the proposed guidelines will inevitably have to be adapted to suit the local resources.

CT scanning reduces the risk of missing a fracture of the thoracolumbar spine

“…Initial CT scans to assess gross injury to the viscera may be ordered during the course of the primary survey provided that the condition of the patient permits safe transportation to the scanner. 28 Many patients will, therefore, have a scan without undergoing a complete secondary survey or detailed examination of the spine/axial skeleton. In this series, each patient underwent physical examination before imaging: many unanticipated thoracolumbar spine injuries were found on the CT scans ordered by the trauma team who were primarily looking for chest and/or abdominal injuries.…”