Trauma Workup

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- ATLS Assessment:  (General Approach to Trauma)
    - airway protection:
            - virtual anesthesia textbook / intubation menu 
            - anesthesia consideration for spine patients:
            - Emergency Airway Management
   - breathing and ventilation:
            - pneumothorax
            - pulmonary contussion: 
            - management of respiratory failure
    - circulation:
            - cardiac contussion:
            - ACLS
            - fluid resusitation, pRBC transfusion: 
            - subclavian vein approach / internal jugular approach for central line placement
    - disability (head trauma / glasgow) 
    - exposure / environmental control:

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- Adjunctive Studies:
     - portable lateral cervical spine, chest radiograph, and AP pelvis;
     - baseline labs: CBC, UA, electrolytes, blood gases, clotting studies, and type & crossmatch;
     - foley for urinary output: (caution with urinary and rectal injuries from pelvic frx)

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- General Survey Exam
         - cranio-maxillo-facial 
         - cardiovascular:
         - vascular trauma

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    - Orthopaedic Assessment: 
         - spine; 
                - management of the spine injured patient 
                - cervical radiographic clearance: 
                          - high index of suspcion for cervical spine injury with multitrauma, altered mentation, and/or blunt injury above the clavicle;

                - pediatric cervical spine 
                - cervical spine immobilization:
                          - patients should be transported to the ER with the neck immobilized in C-collar and head taped between two sandbags (or equivalent); 
                          - without exception, trauma patients need to be taken off the trauma board ASAP to prevent decubiti;
                          - while moving one assistant controls the head while others help turn, check the scalp and back for lacerations and deformities, and then help to
                                     transfer to a padded mattress; 
                          - children are immobilized so that shoulders are raised on a folded sheet (which counteracts tendency for the C-spine to be flexed on the trauma board,
                                    due to the child's larger head size; 
                          - Pediatric cervical spine immobilization: achieving neutral position? C Curran et al. J. Trauma. Vol 39(4). 1995. p 729-732.     
                  - references:
                             - Lumbartransverse process fractures: A sentinel marker of abdominal organ injuries.
                             - Skeletal fracture demographics in spinal cord-injured patients 
                             - ER transport and positioning of young children who have an injury of the C spine. The standard backboard may be haazardous. 
                             - Falls from height: spine, spine, spine!
         - pelvic fractures 
                  - radiographs:  AP view will help diagnose open book pelvic injuries, femoral neck frx, or verticle shear injuries;
         - extremities: 
                  - fractures
                  - dislocations
                  - compartment syndromes
                  - vascular injury note: it is difficult to assess for vascular injuries when the SBP is less than 90 mm Hg;
                  - mangled extremity severity score generalized assessment: 

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- Outside links:

 

    - Iowa
    - Family Practice Handbook
    - A History of Resusitation
    - ACLS
    - Iowa Family Practice Handbook
    - AHCPR Guidelines
    - eMedicine Online Text