ICU Cases · Trauma & burns
Polytrauma — the integrated primary survey to damage-control resuscitation
A long case on the polytrauma patient — the parallel ATLS primary survey (ABCDE) and the damage-control resuscitation, the pelvic binder, the FAST and the CT, the early tranexamic acid (CRASH-2), the intubation for the head injury, and the avoidance of the secondary brain injury (the CRASH corticosteroid harm).
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A 24-year-old unrestrained driver is brought in 20 minutes after a high-speed crash into a tree. He is unconscious (GCS 7, E1 V2 M4), hypotensive at 78/50, tachycardic at 124, with a deformed, unstable pelvis, a swollen painful right thigh (a femoral fracture), and a lactate of 5.5 mmol/L. He has facial injuries and is snoring. He is in polytrauma with the haemorrhagic and the brain injuries that will kill him first.
[1]References5ShowHide
- [1]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2). Lancet, 2010.PMID 20554319
- [2]Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care (TRICC). New England Journal of Medicine, 1999.PMID 9971864
- [3]Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet, 2004.PMID 15474134
- [4]American College of Surgeons Committee on Trauma Advanced Trauma Life Support (ATLS) Student Course Manual. 10th edition, ACS, 2018.
- [5]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.