ISCCM Manual of Trauma Care Simant Kumar Jha, Jayant Kumar, Abhinav Gupta, Srinivas Samavedam, Arindam Kar
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table
A
Abbreviated injury score 228
Abdomen 139
anatomy of 72
dermatomes of 109f
examination 156
missile injuries of 197
regions of 72t
tenderness 206
Abdominal aorta, primary arteriography of 199f
Abdominal trauma 71, 80f, 167, 222
computed tomography of 76, 77
emergency radiological imaging 71
ultrasound evaluation of 72
Acetabular fracture 131
Acid 207
electrolyte imbalances 191
Acidosis 44f, 189, 223
metabolic 128
Adequate airway, loss of 219
Advanced cardiac life support 190, 219
Advanced trauma life support 124, 137, 161, 194, 219
classification 46, 47t
guidelines 73
principles 88, 162
Aerosol 249
Air hunger 60
Airbag injuries 209
Airway 13, 14, 25, 88, 89, 170, 175, 197, 228
control 139
decision plan 20
difficult surgical 20
evaluation 162
loss of 1
maintenance 2
techniques 21
management 13, 17, 162, 219, 222
trauma scenarios 14
normal 16f
obstruction 15, 16, 60, 243
acute 59
complete 60
partial 60
protection 25
surgical 33
types of definitive 25
Alcohol intoxication 88
Allergy 221
American Association for Surgery of Trauma
Grades 78
Kidney Injury Scale 81t
Liver Injury Scale 78t
Splenic Injury Scale 78t
American Association of Neurology 98
Amniotic fluid 159
embolism 157, 158
Amputations, traumatic 126, 196
Analgesics 94
class summary 212
Anatomical trauma score 228
Ancillary services 250
Anesthetics 94
Aneurysm
abdominal aortic 45
rupture of 42
Angiotensin-converting enzyme 178
Anterior cord syndrome 112
Antibiotic
broad-spectrum 65
therapy, topical 211
Antimicrobial 143
ointments 144
solutions 144
spectrum 144
Aorta 51
Aortic rupture 59
Aortotomy 199f
Apnea 26
test 98
Arrhythmia 186
Arterial blood 93, 209
gas 17, 187
Arterio-jugular venous oxygen 97
Artificial system 239
Asepsis, surgical 38
Aspiration 219
prophylaxis 228
Assault linear hypodensity 77f
Atlanto-occipital dislocation 112
Atlas C1 vertebrae 104f
Atlas fracture 112
Avulsion fractures 131
Axis fracture 112
B
Bacitracin 144, 212
Bag-mask
single-hand technique for 29f
ventilation 29, 29f
Bag-valve-mask, self-inflating 220
Balloon dilatation 66
Barbiturates 94
Basal metabolic rate 175
Basic airway equipment 219
Basic life support 219
Battle sign 88f
Biobrane 145
Biological attack 241
Bizarre injuries 169
Blast
injuries 201
victim, clinical photograph of 202f
Bleaches 208
Bleeding
complications 147
control 2, 4
vaginal 155
Blood
bank 250
gas analysis 139
loss 5, 126, 165t
severe 42
pressure 97, 218
systolic 49, 89, 230, 242
replacement 159
supply 114f
urea nitrogen 209
Blunt abdominal
CT protocol 83
trauma, mechanism of injury in 71
Blunt esophageal rupture 58
Blunt trauma 58
abdomen 82fc
Bone 196
X-ray of 196f
Bowel
gas patterns 75
injuries 79
Bradykinin 234
Brain 176, 195
contusion 86
death 98
injury, traumatic 14, 87, 87, 89, 200, 232
tissue oxygen 97
trauma foundation 91
guideline 232
volumes of 86
Brainstem reflexes 91t
absent 98
Breath sound 16
Breathing 13, 88, 89, 139, 170, 175, 197, 220
evaluation 163
management 163
mechanical block to 139
problem 25
regular 121
Brown-Séquard syndrome 112
Bucket handle fracture 131
Burn 25, 137, 158
care, final phase of 149
classification of 137
deep
dermal 144f
second-degree 137
depth of 142f
dermal 211-213
electrical 138, 149
esophagogastric 205
extent of 139, 140
face 139
facial 15, 149
first degree 137, 142
fourth-degree 137, 142
full-thickness 142, 146f
hand 149
immediate life-saving measures 138
injury 139
large 137
surface 210
management 222
mild 211
moderate corneal 213
ocular 211
partial-thickness 138
pathophysiology of 137, 138fc
physiology 137
severe corneal 213
sharply demarcated 169
superficial second-degree 137
third-degree 137, 138, 142
wound excision 144
fascial excision 145
full-thickness excision 145
layered excisions 145
tangential excision 145
wound management 143
components of 143
Burst fracture 116f
C
Calcium 211
injections of 211
oxide 207
Canadian C-spine rule 117
Cancer 174
Cannulation, arterial 186
Carbon deposits 139
Carbon dioxide
end-tidal 17
partial pressure of 93
Carbonaceous sputum 139
Carboxyhemoglobin 139
Cardiac arrest 185
Cardiac tamponade 58, 60, 66
presence of 73
treatment of 66
Cardiotocographic monitoring 157
Carotid pulse 186
Cataract, traumatic 201
Catecholamine surge 42
Cell death 87
Cellular energy crisis 87
Central cord syndrome 110
Central nervous system 165, 169, 184
depression 16
Central venous pressure 157
Cerebellum 90
Cerebral
blood flow 86
fluid drainage 93
hypoperfusion 25
metabolic rate of oxygen 199
monitoring, advanced 96
perfusion pressure 86
monitoring 96
thresholds 97
Cerebrospinal fluid 86, 176
Cervical
cord injury 16
immobilization, maintenance of 222
spine 103, 104
injury 103, 112, 117, 118fc, 167
movement, restriction of 2
Chemical
agents 241
burn 138, 148
injuries 205
pathophysiology 205
Chest 139
asymmetrical movement of 59
dermatomes of 109f
injury 175, 222
missile injuries of 200
pain 64, 66
retraction 15
trauma 167
tube insertion 38
complications 38
indications 38
procedure 38
X-ray 69
Chin-lift maneuver 21, 21f
Chloroacetic acids 207
Chromates 208
Chromic acid burns 209
Chronic obstructive pulmonary disease 174
Circulation 2, 4, 88, 89, 139, 164, 165, 170, 176, 197
Citrate 48
Coagulopathy 223
early treatment of 5
lethal triad of 44f
process of 43
Coccyx 103
fracture 131
Collar sign 80
Colloids 50, 234
Coma 98
Combitube 27f
Comet tail sign 68
Communication 224
Compartment syndrome 127, 133
Complete blood count 45, 187
Compression
external 72
fractures 113
injury, lateral 128
Computed tomography 69, 89
chest 69
contrast-enhanced 79f
noncontrast 90
Consciousness 14
level of 218
loss of 26, 169
Continuous positive airway pressure 191
Controlled oxygen therapy 36
Contusion 81
myocardial 59, 66
Cool burn wound 138
Corneal reflex 91
Corpus callosum 90
Cough 91, 222
Craniectomy, decompressive 91
Crepitus 206
suggesting subcutaneous emphysema 15
Cresols 207
Cricoid
cartilage 164
pressure 29
Cricothyroid membrane 34
Cricothyroidotomy 163
surgical 34, 35, 35f
Crush syndrome 127, 128
Crushing forces 72
Crystalloid 234
C-spine fractures 174
Cuff deflation 24f
Cyanosis 15, 37, 60
Cyclones 239
Cytokines, inflammatory 231
D
Daily living, activities of 91
Damage control
resuscitation, principles of 48
surgery 223
Deaths
injury-related 13
trimodal distribution of 218f
Deep vein thrombosis 120, 231
prophylaxis 95
Diagnostic peritoneal lavage 176, 222
Diaphragmatic injury 65, 80
diagnosis 65
management 66
Diaphragmatic rupture 59
Diencephalon 90
Diluted potassium permanganate 208
Disability 6, 25, 88, 139, 140, 176
Disaster 238
classification of 238
effects 251
major 240f
management 245
act 238
cycle 246f
principles of 238
team 248
man-made 238, 239
natural 238, 246
recovery, process of 251
risk reduction 239
supply kit 248
triage criteria for 249
Disseminated intravascular coagulation 128
Distress, fetal 157
Domestic abuse 158
Double unilateral rami fractures 131
Drowning 183
pathophysiology of 183
process 184fc
secondary 183
victims 190b
Drug
interactions 178
therapy 175
Duplex sonography 96
Duverney fracture 131
Dysphagia 205, 206
Dyspnea 206
E
Ear
injuries, external 200
missile injuries of 200
Earth's crust 238
Earthquakes 238
Ecchymosis, inspect for 156
Edema 139, 206
pulmonary 184, 188, 191
Elbow
extension 109
flexion 109
Elderly abuse 178
signs of 178
Electrocardiography 187
Electrolyte
balance 188
disturbances 196
Emergency department 128, 250
care 210
Emphysema, subcutaneous 39, 58
E-mycin 212
Endocrine system 155
Endothelial injury 231
Endotracheal intubation 27, 149, 210
readiness for 28f
Endotracheal tube 27f, 164, 222
placement of 163
Epilepsy 184
Erythromycin ophthalmic 212
Escharotomy 139, 146f
Eschmann tracheal tube introducer 30, 31f
Esophageal airway, multilumen 25
Esophageal perforation 65
diagnosis 65
management 65
Esophageal rupture 59
Esophagoscopy 209
Etomidate 32, 162
Excess plasmin activity 43
Exercise 148
Exposure 7, 88
Extracorporeal membrane oxygenation 187
Eye, missile injuries of 201
Eyeball, ruptured 201
F
Face mask 37
simple 36f
Fascia, deep 196
Fasciotomy 139, 143
plan of 139
Fat embolism syndrome 127
Federal Emergency Management Agency 247
Femur fractures, shaft of 127
Fentanyl 162
Fetal demise 158
Fetal heart
rate, abnormal 157
sound 157
Fetal movement 155
Fiberoptic bronchoscopy 32
Finger
abduction 109
extension 109
flexion 109
pulse oximetry 3
Flail chest 3, 58, 59, 63, 243
diagnosis 64
management 64
Floods 239
Fluid 77f, 188f
administration, methods of 233
balance 95
collection of 68
lost, volume of 137
management 233
resuscitation 139, 140, 142, 164, 220, 225
cautious 64
volume 75
Foley’ catheterization 187
Formal thoracotomy, indications for 200
Fracture 112, 116f, 132, 221
facial 25
femoral 126, 127
multiple 125
odontoid 116f
palpable 15
ribs 3, 59
skull 86
straddle 131
Free peritoneal fluid 77
Fresh frozen plasma 49
G
Gag reflex 91
Gas 249
Gastric
distension 120
tube 6
Gastrointestinal
complications 131
endoscopy, upper 209
system 120
tract 155, 175
Genitourinary system 120
Geriatric trauma 179
basics of 174
Glasgow coma scale 25, 86, 89, 91t, 162, 190, 229, 230t
score 118fc
Global report on road safety 2013 13
Global wall motion abnormalities 73
Glomerular filtration rate 155, 175
Glottis, view of 30f
Glucocorticoids 95
Great vessel injury 64
Growth factor, insulin like 148
Gum elastic bougie 31f
Gunshot wounds 113
H
Hair coloring agents 208
Hand burn 149
treatment of 211
Head injury 14, 25, 90, 92, 221
classification 87
clinical pathophysiology 86
etiology 86
evidence-based management guidelines 90
mild 88fc
moderate 89
motorcycle-related 86
severe 89
Head trauma 86, 166, 174
severe 96
Headache, persistent 88
Health system 241fc
Healthcare system, level of 220
Heart 39
diseases 174
evaluation of 73
rate 230
Heavy metal toxicity 202
Helmet removal 17, 18f
Hematoma 78
extradural 90f
intracranial 86
large intraparenchymal 79f
mesenteric 79
multiple subdural 169
spinal 117
Hemodynamic status, classification of 5t
Hemoperitoneum 77
Hemorrhage 52, 201
arterial 126
control 126
fetomaternal 157, 159
gastrointestinal 42
induced profound changes 42
intra-abdominal 161
intracranial 161
major arterial 126
maternal 42
perioperative 42
severe 45f, 46
Hemorrhagic shock 42, 46, 52, 234
classification of 47t
diagnosis 44
management 44, 131fc
pathophysiology of 42, 43f
resuscitation 49fc
signs of 63
Hemostasis 50
Hemothorax 58, 163
evaluation 68
simple 3
Heparin 231, 232
Hepatic failure 147
Hepatorenal pouch 74
Herniated disk 117
Herniation 26
Heterotopic ossification 202
High flow oxygen 17, 37, 61
High speed motor vehicle
accidents 124
collisions 59
High velocity missile 194, 195f
Hip injuries 125
Homeostasis, temperature 120
Household-grade hydrogen peroxide 208
Human growth hormone, recombinant 148
Hunshot wounds 158
Hydrochloric acid 207
Hydrofluoric acid 207
burns 210
Hydroxyethyl starch 234
Hyomental distance 18
Hyperkalemia 189
Hyperosmolar therapy 92
Hypertonic saline, use of 46
Hypoperfusion complex 79
Hypotension 196
postural 4
supine 4
Hypothermia 44f, 118, 119, 184, 186, 189, 191, 210, 223
prophylactic 92
Hypovolemia 191
Hypoxia 13, 191
I
Ibuprofen 212
I-gel 25f
fixing 27f
insertion steps 26f
supraglottic airway 27f
Iliac wing fracture 131
Immersion syndrome 183
Immobilization 118
principle of 169
Immune
nutrition, role of 233
system 177
Infarction, myocardial 186
Infection 210, 228
prophylaxis 95
Inflammation 44
Inflammatory reaction 137
Infusions, intra-arterial 211
Ingestion, caustic 211
Inhalational injury 138, 139
management of 146
Injury 39
abdominal 170, 222
adrenal 80
alkaline 205
anatomical 58
aortic 60, 64
around airway passage 25
assessment 194
blunt 155
cardiac 58, 66
hepatic 78
bronchial 3
bullet 194
closed 125
description of 81
diffuse axonal 86, 87
duodenal 168
grade for bilateral 81
head 14, 25, 90, 92, 221
hepatic 78, 200
inhalational 138, 139
intracranial 16
laryngeal 25
level of 106, 109
life-threatening 126
lightning 138
limb-threatening 132
location of 75
mesenteric 79
missile 194, 198fc
musculoskeletal 124
myocardial 60
neurological 133
nonaccidental 186
open-book 131
pancreatic 79, 80f
pediatric abdominal 167
penetrating missile 194
perioral 169
septal 66
severity
classification, revised 230
score 59, 229, 230
small intestinal 168
splenic 78
stab 113
stomach 168
thoracic 167
tracheal 3, 25
traumatic 174
vascular 81
vertical displacement 128
visceral 81f
Institutional framework disaster management structure 251
Insulin 148
Intensive care unit 49, 86, 199, 228, 250
management 228
Intercostal drain insertion 37
Intervertebral fibrocartilaginous disk 103
Intracompartmental pressure, increased 133
Intracranial pressure 86, 97
management of 228
reduction of 199
Intraperitoneal free fluid 75
movement of 75
Intravascular volume 48
appropriate replacement of 4
resuscitation 125
Intravenous fluid 119
resuscitation 142
Intubating laryngeal
mask airway 23
tube airway 24
Intubation
criteria for 162
drug assisted 32
Ischial body fractures 131
Ischial rami 131
Isotonic crystalloids 50
J
Jaw-thrust maneuver 21, 22f
Jefferson fracture 115f
K
Ketoprofen 212
Kidney function test 187
Kinking 39
Kissing papillary muscles 76
Klebsiella 146
Kleihauer-Betke test detects 157
L
Labored breathing 16
clinical signs of 26
Laceration 78, 81
Lactated ringer solution 49
Large zipper compartment 260
Laryngeal handshake 34f
Laryngeal mask airway 23, 24f
insertion 24f, 25f
Laryngeal tube airway 24, 27f
Limb
missile injuries of 196
muscles 196
Liver 39
function test 187
missile injuries of 200
right lobe of 79f
spleen 195
Living guidelines 91
model 91
Local tissue oxygen, measurements of 96
Low flow oxygen devices 36
Low molecular weight heparin 231, 232
Low oxygen saturation 15
Lower limb 139
dermatomes of 108f
myotomes 111f
Lumbar spine 117
Lumbar vertebral fracture 113
Lumbosacral regions 103
Lung
contusions 59
infection 189
protective ventilation 146
sliding, absence of 68
M
Macronutrient formulation 233
Mafenide acetate 144
Malgaigne fracture 131
Mallampati score 19f
Manganates 208
Manual in-line stabilization 20
Massive blood transfusion 5
protocol transfusion 6t
Massive cardiac tamponade subcostal view 74f
Massive hemothorax 3, 58, 59, 63
diagnosis 63
management 63
Maxillofacial trauma 15
Mechanical plus pharmacological prophylaxis 232
Medical antishock trouser 124, 130
Medical equipment kit 247
Medical triage cold zone 242
Membrane, premature rupture of 155
Mental
health 201
status, altered 4
Metallic lithium 210
Metformin 148
Microvascular reaction 137
Missile factors 194
Mitigation 246, 251
Mitochondrial dysfunction 87
Mobility, loss of 120
Monitor adequate oxygenation and ventilation 17
Monitoring transplantation activity, advisory bodies for 99
Monochloroacetic acid 207
Morison's pouch 74, 74f, 77f
Morphine 212
sulfate 212, 213
Mortality, fetal 152
Mortuary services 250
Motor function 106
Motor vehicle
collision 80
crashes 13
Mounting oxygen debt 42
Multicolored bruises 169
Multiorgan
dysfunction 58, 198
failure, prevention of 146
Mupirocin 144
Muscle function grading 111t
Musculoskeletal injury 124
treatment of 177
Musculoskeletal system 177
injuries 125
Musculoskeletal trauma 124, 168
classification of 124
injuries 125
prehospital management of 124
resuscitation of 125
types of 124
Myocardial infarction 186, 243
Myocardial wall, rupture of 58
Myometrium protects 159
Myotome 106
N
Naproxen 212
Narcotic analgesics 143
Nasal hairs 222
Nasal prongs 36f
Nasogastric tube insertion 143
Nasopharyngeal airway 22, 22f
in situ 22f
National Disaster Management Authority 251
National Disaster Management Plan 246
National Disaster Response Force 252
National Emergency X-radiography Utilization Study 117, 117b
National Institute of Disaster Management 251
Near drowning 183
Neck
and extension, flexion of 29f
burn 139
hematoma 25
injuries 168
mobility 19
trauma 15
Needle
and surgical cricothyroidotomy 223
chest decompression 223
cricothyroidotomy 33, 33f, 34f
thoracocentesis 37
Neomycin 144, 212
Neurologic deficit 117, 197
severity of 106, 110
Neurological system 155
New injury severity score 229
Nitric acid 207
N-methyl-D-aspartate, antagonist of 95
Nonsteroidal anti-inflammatory drugs 211
Nutrition
and intravenous fluids 95
and metabolism 177
in trauma patient 232
route of 232
Nutritional status, monitoring of 233
Nutritional support 147
site for 232
timing of 232
Nystatin 144
O
Obstruction
complete 15
incomplete 15
signs of 16
Occult skeletal injuries 133
Ocular surface, pH of 209
On-site triage hot zone 241
Open fracture 132
wound 132f
Open pneumothorax 3, 37, 59, 63
management 63
recognition 63
Optic nerve injuries 201
Optimum resuscitation fluid, characteristics of 233
Oral burns, caustic 205f
Organ
donation 98
failure, management of 147
parenchymatous 195
systems 106
Oropharyngeal airway 22, 23f
in situ 23f
Oropharynx 139
Orotracheal intubation 28, 162
Oxandrolone 148
Oxidants 208
Oxygen
delivery devices 249
supplementation 63
therapy 35
devices 36
Oxygenation
inadequate 25
management of 35
P
Packed red blood cell 49
Pain
assessment 165
management 143, 178, 225
Pancreas, missile injuries of 200
Pancreatic transection 79
parenchyma suggestive of 80f
Paralysis
complete 111
neuromuscular 26
Parenchyma, pancreatic 79
Pediatric trauma 161
score 169, 169t
Pediatric victims 185
Pelvic 68, 75
binding, external 130
fracture 81, 81f, 126, 128, 131fc, 174
types of 129f
unstable 128
Pelvis dislocation 131
Penetrating injury 58, 112, 155
mechanism of injury in 72
type of 117
Pericardial tamponade 59, 64
diagnosis 64
management 64
Pericardium 39
Perimortem cesarean section 158
Peripheral pulses, return of 164
Peroxides 208
Phenol 207, 210
Phosphates 208
Phosphoric acid, uses of 207
Physiotherapy 148
Pigmentation, return of 143f
Pigskin 145
Placental abruption 153f, 158
Plasma 48
electrolytes 188
Platelet 48
function, suboptimal 43
Pleural effusion 69
Pneumatic antishock garment 124, 130
Pneumonia 189
ventilator associated 146
Pneumoretroperitoneum 79
Pneumothorax 62
evaluation 68
simple 3, 37, 58
tension 58
Poisoning, metabolic 139
Polyethylene glycol 210, 212
Polymyxin B 144, 212
Polytrauma 132
computed tomography protocol 77
Positive end-expiratory pressure 187, 188
Potassium 210
Pregnant Rh-negative trauma 159
Prehospital care 45, 138, 210, 217
Pressure
intra-abdominal 80
intracranial 86, 97
ulcer 120
develops 121
Propofol 94
Propranolol 148
Pseudomonas 146
Pubic symphysis subluxation 131
Pulmonary contusion 3, 58, 59, 66
diagnosis 66
management 66
Pulmonary embolism 120
risk of 231
Pulmonary system 120
Pulse 4
oximetry 16, 157
rates 242
Pulseless electrical activity 185
Pulselessness 42
Pupillary light reflex 91
R
Radiation hazard 241
Rancho los amigos scale 87b
Random blood sugar 209
Rapid neurologic evaluation 6
Rapid respiratory rate 16
Reconstructive operative procedures 149
Red blood cells 184
Reflex, oculocephalic 91
Rehabilitation 149
Renal failure 147
Renal functional tests 209
Renal injury 80, 187
Respiratory distress 60, 220
management of 220
Respiratory failure 190
Respiratory muscle paresis 16
Respiratory system 155
Resuscitation 2, 121, 185, 186
cardiopulmonary 190
endpoints of 51, 179
Retina 201
Retinal detachment 201
Retroperitoneal space after laparotomy, exposure of 199f
Revised trauma score 230
Rh immunoglobulin therapy 159
Rhabdomyolysis 210
Rib 67
fractures 174
shadow 75
Rigid suction cannula 17
Road traffic
accidents 86
injuries 218f
Rule of nine for burn surface area calculation 140f
S
Sacral fracture 131
Sacrum 103
Scald 137
Scapula fracture 59, 67
Sedatives 94
Seizure 186
post-traumatic 96
prophylaxis 96
Seldinger technique 33f
Sensation, loss of 120
Sensorium, clearing of 164
Sensory tract 106f
Sentinel sign 77
Septicemia 189
Sexual abuse 158
Shaken body syndrome 166
Shock 165, 179, 220, 221
cardiogenic 221
hemorrhagic 42, 46, 52, 234
neurogenic 106
pathophysiology of 137
spinal 106
thermoregulation 165
Shoulder abduction 109
Silver
nitrate 144
sulfadiazine 144, 212
Skin 4
color, return of normal 164
grafting 213
Sodium 210
carbonate 208
hydroxide 207, 211
Soft tissue injury 58, 117
Spinal column 103
ligamentous part of 103
Spinal cord 16, 105, 112f, 114f
cross-section of 115f
injury 103, 112, 167, 176
prevention of secondary 119
missile injuries of 197
pediatric 105
syndrome 106, 110
tracts 105f
trauma 103
Spinal injury
classification of 106
improper handling of 103
Spinal needle 221
Spine 103, 177
injury 103, 112, 177
management of 118
Spinothalamic tract 106f
Spleen, missile injuries of 200
Spontaneous abortion trauma 157
Stab wound 158
Stable pelvic fracture 131
State Disaster Management Authority 252
Sterile speculum examination 156
Sternum 67
Steroid 95, 211
role of 119
Stop bleed, methods of 126f
Stress 162
Stridor 60, 206
Stroke 174
Sulfuric acid 207, 211
Supraglottic airway devices 23
Swelling 139
Syncope, recovery 183
T
Tachypnea 206
Tension pneumothorax 3, 37, 59, 60, 62, 243
causes 62
management 62
recognition 62
Thermal burn injury 139
Thiopentone 163
Thoracic
cage 58
spine 105, 113, 117
trauma 58, 62
classification of 58t
vertebra fracture 58
Thoracoscopic surgery, video-assisted 63
Thoracotomy 63
Thrombocytopenia 147
Thromboelastography 5, 45, 47, 51, 51f
rotational 51
Thromboelastometry 45
rotational 47
Thromboprophylaxis 231, 232
Tissue
factors 194
monitors 97
transplant organization 99
type of 194
Tongue, caustic burns of 206f
Tornadoes 239
Toxins 241
Tracheobronchial injury 59, 61, 167
management 61
recognition 61
Tracheotomy 220
Tranexamic acid 220
Transcranial Doppler 96
sonography 96
Transcyte 145
Transfusion, massive 50
Transplantation of Human Organs Act 98
Transtracheal oxygenation, percutaneous 33
Trauma 9fc, 112, 179, 230, 231, 233
assessment of 1
care 217, 228
causes of 217
deaths 9
extended focused assessment with sonography for 68f
facial 15
focused assessment with sonography for 45, 67f, 73
head 86, 166, 174
in elderly 174
in pregnancy 152, 153
initial management of 1
kills 1
laryngeal 15
lethal trial of 223
major 232, 243
mortality prediction model 229
multidisciplinary 174
musculoskeletal 124, 168
ocular 168
protocol 139
resuscitation guidelines 170t
score 228, 230
systems 228
severe musculoskeletal 127f
severity characterization of 230
team activation 174
victim 1, 220
management of 219, 224
Traumatic circulatory arrest 58, 60
Traumatic head injury, surgical management 98
Tricarboxylic acid 207
Trimodal death pattern, concept of 1
Tsunamis 239
Two hand C-E technique 29f
Tympanic membrane perforation 200
U
Ultrasonography, emergency 224
Upper airway
bronchoscopy of 146
obstruction 25
Upper limb 139
dermatomes of 107f
myotomes 109t
Urinary system 155
Urine
alkalization of 128
output, decreased 4
Uterine
contractions 155
rupture 158
torsion 158
V
Valvular injuries 66
Vascular access 140
Ventilation 16, 139, 162, 175, 228
inadequate 16, 25
supplemental 17
therapies 93
Ventricular fibrillation 186
Venturi mask 36, 36f
Verbal rating score 166
Vessels
endothelium of 42
missile injuries of 195
Victims, triaging for 241
Videolaryngoscope 30, 30f
Viscera, abdominal 159
Visual analog score 166
Voice, hoarseness of 15, 139
W
Warfarin 72, 231
Wet drowning, mechanism of 183
Wheezing 206
White phosphorus 208
World Health Organization 13, 217
Wound
healing function 177
open 126
Wrist
extension 109
flexion 109
X
Xenografts 145
×
Chapter Notes

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ISCCM Manual of TRAUMA CARE
ISCCM Manual of TRAUMA CARE
Editors Simant Kumar Jha DA DNB PGDHM PDCR ATLS Faculty FCCS Course, Director and Senior Consultant Department of Critical Care Pushpawati Singhania Hospital and Research Institute New Delhi, India Associate Editors Jayant Kumar MS (Ortho) Fellowship in Arthroscopy and Sports Injury (Coimbatore, Seoul, South Korea) Fellowship in Joint Replacement (New Delhi, Germany) Fellowship in Orthopedic Trauma (Seoul, South Korea) ISKSAA Travelling Fellowship (Liverpool, UK, ATLS Certified) Former Assistant Professor Department of Orthopedics PDU Medical College, Rajkot, Gujarat Al-Falah School of Medical Science Faridabad, Haryana Presently Consultant Orthopedic and Joint Replacement, Tata Main Hospital Jamshedpur, Jharkhand, India Abhinav Gupta FNB EDIC Consultant Department of Critical Care Homerton Hospital London, UK Srinivas Samavedam MD DNBFRCP FNB EDIC FICCM Diploma in Health Care Quality Management Diploma in Medical law and Ethics MBA (Hosp Admin) Head, Critical Care Medical Director Virinchi Hospitals Hyderabad, Telangana, India Arindam Kar MD DNB FNB EDICM FCCP FICCM FCCM Director and Head CK Birla Hospitals and CMRI Institute of Critical Care Kolkata, West Bengal, India Forewords Subhal Bhalchandra Dixit Mahesh C Misra
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ISCCM Manual of Trauma Care
First Edition: 2020
9789389776874
Printed at
Contributors Foreword
As, President of Indian Society of Critical Care Medicine (ISCCM), it is my proud privilege to introduce the book Manual of Trauma Care to the critical care community.
With the ever-expanding field of critical care, an endeavor to strengthen the academics and ICU practices across the country, the ISCCM has come up with this book to serve as a bedside reference guide.
Trauma the leading cause of death in young adults is trauma. Traumatic injuries may range from small lesions to life-threatening multiorgan injury. In order to achieve the best possible outcomes while decreasing the risk of undetected injuries, the management of trauma patients requires a highly systematic approach. Prehospital trauma care involves first aid and basic life support administered by emergency services personnel. In the hospital setting, the treatment of trauma patients is traditionally divided into primary, secondary, and tertiary survey. Each consists of an algorithm designed to diagnose and manage injuries in order of decreasing morbidity and mortality.
Experts from across the country have come together through the book to share their wide evidence-based literature and knowledge in the field of trauma.
All the contributors are renowned critical care experts from leading institutions across India.
The book represents an invaluable resource for critical care professionals, and covers the full spectrum of critical care ultrasound.
Intensivists and postgraduates across the country will find this book an invaluable reference text.
I would like to congratulate Dr Simant Kumar Jha and team on accomplishing the difficult task successfully.
I hope the book serves the purpose for the critical care community in saving lives!
Best Wishes!!
Subhal Bhalchandra Dixit MD IDCCM FICCM FICP FCCM
Consultant Critical Care and Director ICU
Department of Critical Care
Sanjeevan and MJM Hospitals
Pune, Maharashtra, India
President
Indian Society of Critical Care Medicine (2019–2020)
Foreword
The book Manual of Trauma Care has been compiled by Indian Society of Critical Care Medicine (ISCCM). The Chapter on Trauma has been contributed by multiauthors outlining management protocols on injury to different body regions. There are 12 chapters in the book.
Chapter 1 deals with rapid and accurate assessment and initial management of injured patient.
Subsequent Chapter 2 [Airway (A) and Breathing (B)] emphasizing the importance of airway with cervical spine protection since airway kills injured patient before breathing issue. Next in sequence is the breathing problem, which kills the injured patients (particularly those in shock and/or have sustained significant brain injury. Only after taking care of A and B, hypotension (largely due to blood loss) in Chapter 3 (circulation) has been discussed in detail with algorithmic approach.
Other chapters include Chapter 4 on Thoracic Trauma discussing the life- threatening thoracic injury and potentially life-threatening scenarios.
Abdominal Trauma Emergency Radiological Imaging has been described in Chapter 5, Head Trauma has been dealt with in Chapter 6, Spine and Spinal Cord Trauma in Chapter 7, Musculoskeletal Trauma in Chapter 8, Chapter 9 deals with special situations like Management of Burns, Trauma in Pregnancy, Pediatric Trauma, Trauma in Elderly and Drowning, Chapter 10 deals with Essentials of Managing Trauma in Rural/Remote Areas, Chapter 11 on Trauma Scores and ICU Management of Trauma Patients, and last Chapter 12 deals with Triaging and Principles of Disaster Management.
I am sure that this book will serve as handbook for postgraduate and DNB students across specialties those are involved in the acute care of injured patients.
I take this opportunity to congratulate the authors who have worked hard to prepare the manuscripts for various chapters on the basis of Advanced Trauma Life Support (ATLS) protocol to deal with immediate care of trauma patients. Editors of Trauma Section, viz., Simant Kumar Jha, Jayant Kumar, Abhinav Gupta, Srinivas Samavedam, and Arindam Kar need to be complimented.
I wish the book manual a wide readership and hope that a digital/online version will also be available for the benefit of the current generation of students.
Mahesh C Misra
Emeritus Professor, Jai Prakash Narayan Apex Trauma Center
All India Institute of Medical Sciences, New Delhi
ATLS India Chair, Program and Course Director, ATLS India Program
Former Director, All India Institute of Medical Sciences, New Delhi
Member French Academy of Medicine (Elected 2017)
Invited Member International Endo-Hernia Society (IEHS)
IMA Eminent Medical Teacher Award 2016 (In 2017)
Professor of General and Minimally Invasive Surgery
Director of Surgical Disciplines, The President cum Vice Chancellor
Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
Visiting Consultant, Department of General and Laparoscopic Surgery
Sir Ganga Ram Hospital, New Delhi, India
Preface
In my 22 years of career in medicine and 13 years of it in orthopedics, I have realized the challenges faced by a doctor during implementing his knowledge at the scene of trauma especially in developing countries like India which have a nonuniformity of medical resources. The book intends to guide all medical professionals on how to utilize their skills to manage different trauma scenarios with a special chapter on managing trauma in rural and remote areas. The chapters spread over from the ABCD of trauma management to how to apply them in special scenarios. A chapter on Trauma and ICU scores has been added to help in objective assessment of the trauma patient. The authors of individual chapters are experts in their fields and have enriched the book with their individual experiences as well. I would like to thank each contributor and especially Dr Simant Kumar Jha for coordinating among all the authors and editing the contents to compile it into a compact user-friendly source of knowledge. I hope the book provides an even mix of knowledge and it is application in the Indian perspective.
Jayant Kumar
Acknowledgments
I would like to start by expressing my sincere gratitude to my teacher and mentor, Professor Mahesh C Misra, Former Director, All India Institute of Medical Sciences, New Delhi, India and presently Vice Chancellor and President, Mahatma Gandhi University of Medical Sciences and Technology (MGUMST), Jaipur, Rajasthan who has taught me everything about trauma. I am grateful for his constant encouragement, guidance and support.
I am thankful to all my advanced trauma life support (ATLS) teachers, especially Drs Amit Goyal, Sunil and Sanjay Shah.
A note of special heartfelt thanks to Dr Subhal Bhalchandra Dixit, who constantly guided and supported me throughout this journey.
I am also thankful to Drs Atul Kulkarni, Yatin Mehta, Deepak Govil and Pradeep Bhattacharya for their support.
I would like to thank the Associate Editors, Dr Srinivas Samavedam, Dr Abhinav Gupta, Dr Arindam Kar and my friend Dr Jayant Kumar for their able assistance in completing this book.
Deep regards and gratitude to Dr Khilnani and Dr Anurag Mahajan for their patronage and motivation that inspired me to keep going.
I am thankful to my co-authors Drs Srikant Behera, Sandeep K Jha, Nidhi Jha, Bhavya Jha, Rahul Deb Das, Kamal Lashkari, Sandeep Sahu, Amit Goyal and everyone else.
Love, thanks and appreciation to my parents; my wife, Neha; my sister, Dr Shalini; and my daughter, Ira, for being there as rock support for successful completion of this publication.
Lastly, I would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their untiring support.
Thank you.
Simant Kumar Jha