The Emergency Medicine Trauma Handbook 1st Edition by Alex Koyfman, Brit Long ISBN 9781108597654 1108597653

Chapter 1 General Approach to Traumatic Injuries

Introduction

The Trauma Team

Emergency Medical Services (EMS)

Primary Survey

A – Airway (Key Question: Do We Need to Take Control of the Airway Right Now?)

B – Breathing (Key Questions: Are Chest Tubes Required? Is There Bleeding in the Chest?)

C – Circulation (Key Question: Where Are They Bleeding and Do They Need Blood?)

Hypotension/Shock

D – Disability (Key Question: Is There a Major Neurologic Deficit?)

E – Expose (Key Question: What Injuries Haven’t Been Found Yet?)

Secondary Survey

Imaging

Trauma Bay Imaging

CT Scans

Disposition and Ongoing Care

References

Chapter 2 Trauma Airway

Important Considerations for Airway Management in Trauma Patients

Consider Pre-existing Difficult Airway

Trauma Immobilization

Mechanical Distortion of the Airway and Contiguous Structures

Indications for Airway Intervention

Traumatic Injuries with Associated Difficult Airways

Closed Head Injury

Maxillofacial Trauma

Direct Airway Trauma

Cervical Spine Injury

Thoracic Trauma

Burns

Rapid-Sequence Intubation (RSI)

Rapid Sequence Intubation (RSI): The Technique

P – Plan B

P – Predict a Difficult Intubation

L – Look Externally

E – Evaluate Internally: The 3-3-2 Rule

M – Mallampati

O – Obstruction

N – Neck mobility

S – Saturation

P – Prepare

P – Preoxygenate

P – Position

P – Put to Sleep

P – Paralyze

P – Pass the Tube

Video Laryngoscopy

The GlideScope

The C-MAC

P – Prove Placement

P – Post-Intubation Management

Ventilator Settings

Post-Intubation Ventilator Settings

Post-Intubation Sedation/Analgesia

Post-Intubation Paralysis

P – Problem Solving

Difficult Intubation

Devices That Facilitate Intubation

Endotracheal Tube Introducer

Flexible Fiberoptic Bronchoscope (FFB)

Devices That Temporarily Substitute for Endotracheal Intubation

Supraglottic Airways

Laryngeal Mask Airway (LMA), the Intubating Laryngeal Mask Airway (ILMA), and the i-Gel

The Failed Airway

Surgical Airway

Conclusion

References

Chapter 3 Transfusion in Trauma

Introduction

Blood Products

Negatives of Crystalloid Resuscitation

Trauma Coagulopathy and the Lethal Triad

Damage Control Resuscitation

Permissive Hypotension

Minimal Volume Normotension

Balanced Resuscitation

Primary Literature for MTP

PROMMTT

PROPPR

When Should Massive Transfusion Be Activated?

How to Run MTP

Other Products

Tranexamic Acid (TXA)

Calcium

PCC

Factor VII

Product Guided Resuscitation

Resuscitation Goals

Anticoagulants

Transfusion Complications

Controversies – Whole Blood

References

Chapter 4 Trauma in Pregnancy

Epidemiology

Anatomical Changes in Pregnancy

Physiologic Changes in Pregnancy

Overview of Initial Evaluation and Management

Airway

Breathing

Circulation

Cardiopulmonary Resuscitation

Peri-Mortem Cesarean Section Procedure

Secondary Survey

Fetal Assessment

Ultrasound Examination

Diagnostic Evaluation

Therapeutic Considerations

Other Considerations

Pitfalls in ED Evaluation and Management

References

Chapter 5 Pediatric Trauma

Epidemiology

Anatomy and Physiology

Anatomical Differences

Airway

Developing musculoskeletal system

Physiological differences

Age-Specific Vitals (Table 5.1)

Breathing

Thermoregulation

Regions

Head

Anatomy

PECARN

Airway Management

Neck

Thorax

Abdomen

Extremities

Pitfalls in ED Evaluation and Management

References

Chapter 6 Geriatric Trauma

Importance

Triage of Elderly Trauma Patients

Prehospital

After Arrival at the Trauma Center

Pathophysiology Concerns in the Elderly

Supporting Evidence

Mechanisms and Injuries That are More Concerning in the Elderly

Falls

Head Injury

Chest Wall Injuries

Cervical Spine Injuries

Pedestrian Struck by Vehicle

Trauma Survey Principles in the Elderly

Elder Abuse

Anticoagulants

Pitfalls

References

Chapter 7 Head Trauma

Neurologic Injuries

Physiologic Goals

Secondary Injuries

ED Evaluation and Management

Airway Management

Pretreatment

Induction

Paralysis

Post Intubation

Blood Pressure Control

Hypotension

Neurogenic Shock

Vasopressors

Hypertension

Hyperosmolar Therapy

Mannitol

HTS

ICP Monitoring

Utility of US in ICP Evaluation

Surgical Indications

Coagulopathy Reversal in Traumatic Intracerebral Hemorrhage

Seizure Management

Tranexamic Acid in Head Trauma

Pitfalls in ED Evaluation and Management

References

Chapter 8 Facial Trauma

Introduction

The ABCs

Anatomy

Approach

History

Examination

Imaging

Management

Specific Injuries

Orbit

Ear

Nasal Injury

Zygomatic Bone Fractures

Tripod Fracture

Maxillary Fractures

TMJ

Mandible Fractures

Parotid Duct

Dental Injuries

Pitfalls in Facial Trauma

References

Chapter 9 Eye Trauma

Introduction and Epidemiology

Approach to the Patient With Eye Trauma

Treat Life-Threatening Conditions First

Involve the Ophthalmologist Early

Focused History

Immediately Identify Acute Visual Threats

Examination of the Injured Eye

Visual Acuity

Periocular Examination

Orbit and Orbital Rim

Lids and Lid Function

Eyelid and Periocular Sensation

Ocular Examination

Pupils

Extraocular Motility

Anterior Segment

Retina and Optic Nerve

Intraocular Pressure Measurement

Fluorescein Staining

Diagnostic Imaging

Vision-Threatening Conditions

Ocular Chemical Burns

Orbital Compartment Syndrome

Carotid-Cavernous Fistula

Open Globe Injury

Traumatic Hyphema

Vitreous Hemorrhage

Retinal Trauma

Optic Nerve Injury

Other Traumatic Eye Presentations

Traumatic Uveitis

Eyelid Lacerations

Corneal Abrasions and Corneal Foreign Bodies

Conjunctival Injury

Subconjunctival Hemorrhages

Conjunctival Lacerations

Conjunctival Foreign Bodies

Conjunctival Abrasions

Orbital Fractures

References

Chapter 10 Cervical Spine Trauma

Anatomy

History and Physical Examination

Immobilization

Decision to Image

Imaging

Types of Fractures/Patterns

General ED Management

Airway Management

Steroids

Complications

Clinical Clearance of Cervical Spine

Consultation Indications

Pitfalls in ED Management

References

Chapter 11 Thoracolumbar Trauma

Anatomy

Pre-Hospital Management

Examination of Suspected Thoracolumbar Trauma

Imaging Thoracolumbar Trauma

Classification

Injury Patterns (Table 11.4)

Compression Fractures

Burst Fractures

Chance Fractures

Translational/Fracture-Dislocation Injuries

Transverse Process, Spinous Process, Pars Interarticularis Fractures

Incomplete Spinal Cord Syndromes

Brown-Sequard Syndrome

Central Cord Syndrome

Anterior Cord Syndrome

Pitfalls

References

Chapter 12 Neck Trauma

Anatomy

Penetrating Injuries

Blunt Injuries

Strangulation and Hanging

Airway Management

Pitfalls

References

Chapter 13 Pulmonary Trauma

Airway Obstruction

Procedure – In-Line Stabilization

Tension Pneumothorax

Procedure – Needle Decompression

Procedure – Pleur-Evac Setup and Troubleshooting

Procedure – Chest Tube Removal

Open Pneumothorax

Massive Hemothorax

Procedure – Autologous Transfusion

Flail Chest

Pulmonary Contusion

Traumatic Diaphragmatic Injury

Tracheobronchial Disruption

Esophageal Disruption

Pitfalls in Thoracic Trauma

References

Chapter 14 Cardiac Trauma

Causes

Anatomy

Pathophysiology

Approach

History

Examination

Penetrating Cardiac Trauma

Cardiac Tamponade

Cardiac Missile

Iatrogenic Injury

Blunt Trauma

Cardiac Rupture

Coronary Vessel Injury/MI

Injury to the Valves, Papillary Muscles, Chordae Tendinae, and Septum

Pericardial Injury

Cardiac Dysfunction

Commotio Cordis

Multisystem Trauma

Great Vessel Injury

Evaluation

Electrocardiogram (ECG)

Laboratory Assessment with Cardiac Biomarkers

Imaging

Ultrasound

Transesophageal Echocardiography (TEE)

Chest X-ray

Computed Tomography (CT)

MRI

Management

Penetrating Trauma

Pericardiocentesis

ED Thoracotomy (EDT)

Blunt Trauma

Great Vessel Injury

Pitfalls in Cardiac Trauma

References

Chapter 15 Abdominal and Flank Trauma

Introduction

Causes

Anatomy

Pathophysiology

History

Examination

Differential Diagnosis

Hepatic Injury

Splenic Injury

Duodenal Injury

Pancreatic Injury

Diaphragmatic Injury

Renal Injury

Evaluation

Laboratory Testing

Imaging

Ultrasound (US)

Radiography

Computed Tomography (CT)

Diagnostic Peritoneal Lavage (DPL)

Management

Pitfalls in Abdominal and Flank Trauma

References

Chapter 16 Genitourinary Trauma

Overview

Signs and Symptoms

Diagnostic Studies

Kidney

Anatomy

Evaluation

Management

Complications

Ureter

Anatomy

Evaluation

Management

Complications

Bladder

Anatomy

Evaluation

Management

Complications

Urethra

Anatomy

Evaluation

Management

Complications

Scrotum and Testicle

Anatomy

Evaluation

Management

Complications

Penis

Anatomy

Evaluation

Management

Complications

Female GU

Anatomy

Evaluation

Management

Complications

ED Management

Surgical Indications

Pitfalls in ED Evaluation and Management

References

Chapter 17 Peripheral Vascular Injury

Vascular Injury Goals

Physiologic Goals

Secondary Injuries

ED Evaluation and Management

Low Risk Penetrating Extremity Injury Management and Disposition

Surgical Indications

Pitfalls in ED Evaluation and Management

References

Chapter 18 Pelvic Trauma

Pelvic Fractures

Anatomy

Diagnosis

Treatment

Pitfalls

Hip Fractures

Anatomy

Diagnosis

Treatment

Pitfalls in ED Management

Hip Dislocations

Diagnosis

Treatment

Techniques

Allis Technique for Reduction of Posterior Hip Dislocation (Figure 18.8)

Stimson’s Technique for Reduction of Posterior Hip Dislocation (Figure 18.8)

Captain Morgan Technique for Reduction of Posterior Hip Dislocation

Whistler Technique for Reduction of Posterior Hip Dislocation

Pitfalls

References

Chapter 19 Upper Extremity Trauma

Introduction

Hand and Finger Injuries

Bone

Distal Phalanges

Proximal and Middle Phalanges

Metacarpal Head

Metacarpal Neck

Metacarpal Shaft

Thumb Metacarpal

Joint Dislocations

Nerve

Soft Tissue

Wrist and Distal Forearm Injuries

Bone

Distal Radius

Distal Ulna

Carpal Fractures

Subluxations and Dislocations

Soft Tissue

Elbow and Forearm

Bone

Distal Humerus Fractures

Ulnar Fractures11

Proximal Radius/Radial Head Fractures

Elbow Dislocations

Nerve Injury

Soft Tissue Injury

Biceps Tendon Rupture

Triceps Tendon Rupture

Shoulder and Upper Arm

Bone

Proximal Humerus Fractures

Humeral Shaft Fractures

Distal Humerus Fractures

Clavicular Fractures

Scapular Fractures

Dislocation

Vessel Injury

Pitfalls

References

Chapter 20 Lower Extremity Trauma

Femur

Mechanism of Injury

Physical Examination

Femoral Shaft Fractures

Distal Femur Fractures

Traction vs Splinting

Pediatric Femur Fractures

Knee

Tibial Plateau Fractures

Mechanism of Injury

Segond Fracture

Reverse Segond Fracture

Imaging Considerations

Complications and Associated Injuries

Management

Tibial Spine Fracture

Knee Dislocation

Mechanism of Injury

Examination

Associated Injuries (Figure 20.3)

Imaging

Initial Management

Definitive Management

Patella Dislocations

Patella Fractures

Examination – Superior Displacement of the Patella (”High Riding”)

Imaging – AP, Lateral, and ”Sunrise” Views (Figure 20.5)

Initial Management

Definitive Management

Evaluation for an Open Knee Joint

Saline Load Test

CT

Proximal Third Tibial Fractures

Initial Management

Tibial Shaft Fractures

Anatomy

Imaging

Vascular Injuries – Compartment Syndrome

Proximal Fibula Fractures

Ankle

Imaging

Isolated Distal Fibular Fractures

Foot

Imaging

Hindfoot

Talus Fractures

Calcaneal Fractures

Midfoot

Cuboid, Navicular, Cuneiform Fractures

Lisfranc Fracture

Forefoot Fractures

Phalanx Fractures

Pitfalls

References

Chapter 21 Burns and Electrical Injuries

Burns

Pathophysiology

ED Evaluation and Management

Airway Management

Estimating Burn Size and Depth

Fluid Resuscitation

Escharotomies

Carbon Monoxide Poisoning

Cyanide Poisoning

Other Considerations

Transfer to a Burn Center

Wound Care

Electrical Injuries

Mechanism of Injury

Current

Voltage

Contact

ED Evaluation and Management

Clinical Features

Cardiopulmonary Injury

Nervous System Injury

Vascular and Muscle Injury

GI Injury

Cutaneous Injury

ENT Injury

Lip Burns in Children

Lightning Strikes

Disposition

Pitfalls in ED Evaluation and Management

References

Chapter 22 Procedural Sedation and Analgesia in Trauma

Background

Indications

Preparation

Medication Choices

Ketamine

Propofol

Ketofol (Ketamine and Propofol)

Etomidate, Midazolam, and Fentanyl

Discharge Considerations

Special Populations – Pediatrics

Special Populations – Pregnancy

Special Populations – Elderly

Pitfalls

References

Chapter 23 Commonly Missed Traumatic Injuries

Introduction

Scope of the Problem

Missed Injuries by Location

Head

Neck

Spine

Thoracic

Abdomen

Pelvis

Extremities

References

Index