Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewProtect That Neck! Management of Blunt and Penetrating Neck Trauma.
Blunt and penetrating vascular injuries to the neck represent a significant burden of mortality and disability among trauma patients. Blunt cerebrovascular injury can present with signs of stroke either immediately or in a delayed fashion. ⋯ In contrast, for patients presenting with penetrating neck injuries, assessment for hard signs of vascular and aerodigestive injury should be done and prompt emergent surgical consultation if present. Overall management priorities for penetrating neck injuries focus on airway management, hemorrhage control, and damage control resuscitation before definitive surgical repair.
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Airway injury, be that penetrating or blunt, is a high-stakes high-stress management challenge for any airway manager and their team. Penetrating and blunt airway injury vary in injury patterns requiring prepracticed skills and protocols coordinating care between specialties. Variables including patient cooperation, coexisting injuries, cardiorespiratory stability, care location (remote vs tertiary care center), and anticipated course of airway injury (eg, oxygenating well and comfortable vs increasing subcutaneous emphysema) all play a role in determining airway if and when airway management is required. Direct airway trauma is relatively infrequent, but its presence should be accompanied by in-person or virtual otolaryngology support.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewMassive Hemorrhage Protocol: A Practical Approach to the Bleeding Trauma Patient.
Damage-control resuscitation is the standard of care for the hemorrhaging trauma patient. This approach combines rapid hemostasis and early-ratio-based blood product administration. ⋯ Emerging evidence supports that this includes more than blood product administration alone but rather a comprehensive suite of treatments. In this article, we review the existing evidence and provide a pragmatic framework, the 7 Ts of massive hemorrhage protocol, to guide the care of patients with life-threatening traumatic hemorrhage.
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Bedside ultrasound assessment has become a routine aspect of care in trauma resuscitation and the critical care setting. Although early research was focused on its role in blunt trauma, it has shown utility in the assessment of penetrating trauma by rapidly identifying hemopericardium and facilitating appropriate intraoperative management. ⋯ The Rapid Ultrasound in Shock and Hypotension and the Focused Rapid Echocardiographic Examination can diagnose etiologies of shock and guide resuscitation in the critically ill patient. Finally, the role of transesophageal echocardiography is expanding in the trauma setting as more research emerges.