Ortho Oracle - orthopaedic operative atlas
Home » Bones » Spine » Trauma Workup

Trauma Workup

I. Combat/Disaster Injuries
II. Battlefield/Austere Environment Trauma Systems
III. Extremity Soft Tissue Care and Amputation in an Austere Environment

- ATLS Assessment:  (General Approach to Trauma)
- ref: Evolution and Development of the Advanced Trauma Life Support (ATLS) Protocol: A Historical Perspective
- airway protection:
anesthesia menu:  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:
- fluid resusitation, pRBC transfusion:
- subclavian vein approach / internal jugular approach for central line placement
damage control orthopaedics:
- disability (head trauma / glasgow)
- exposure / environmental control:
- Heating pad for the bleeding: external warming during hemorrhage improves survival

- 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)

- General Survey Exam
         - cranio-maxillo-facial
- cardiovascular:
- vascular trauma
- Orthopaedic Assessment:
         - assessment of perfusion: damage control orthopaedics:
- surgical timing for femoral neck fracture
- surgical timing in patients with head injury
- like compartment syndrome, hypotension may exacerbate process (decreases cerebral perfusion leading to cerebral edema);
- surgical timing and prevention of pulmonary complications in patients with femur frx
- T & L spine;
                - management of the spine injured patient
                - references:
                             - Lumbartransverse process fractures--A sentinel marker of abdominal organ injuries.
- Skeletal fracture demographics in spinal cord-injured patients
- Falls from height: spine, spine, spine!
                             - Clinical Examination Is Insufficient to Rule Out Thoracolumbar Spine Injuries.
          - Cervical Spine:
- cervical radiographic clearance:
- high index of suspcion for C spine injury with multitrauma, altered mentation, and/or blunt injury above clavicle;
- pediatric cervical spine
- children are immobilized so that shoulders are raised on a folded sheet (which counteracts tendency for the C-spine
to be flexed on trauma board, due to the child's larger head size;
- Pediatric cervical-spine immobilization: achieving neutral position?
                            - Emergency transport and positioning of young children who have an injury of the cervical spine.
- cervical spine immobilization - adults:

- patients should be transported to the ER with the neck immobilized in C-collar and head taped between two sandbags
- 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;
- references:
- Removing a patient from the spine board: is the lift and slide safer than the log roll?
- Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study.

pelvic fractures
- radiographsAP view will help diagnose open book pelvic injuries, femoral neck frx, or verticle shear injuries;
- ref: Pelvic X-ray misses out on detecting sacral fractures in the elderly - Importance of CT imaging in blunt pelvic trauma.

- extremities:
- fractures (femur fracture)
- with high energy distal femur / proximal tibia fractures, consider spanning external fixation;
- references:
- Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation.
- Tertiary survey in polytrauma patients should be an ongoing process

- dislocations - knee
- compartment syndromes (reperfusion injury)
- Fasciotomy rates in operations enduring freedom and iraqi freedom: association with injury severity and tourniquet use.
- 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
gun shot wounds
- soft tissue coverage for the leg

- Misc: don't miss fractures:
- Analysis of NHSLA Claims in Orthopedic Surgery