Emergency medicine clinics of North America
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The approach to airway management in the multiple trauma patient has changed significantly over the past decade. A number of central controversies have been identified, and the debates continue. This article identifies the major controversies in trauma airway management, reviews and summarizes relevant literature, and presents specific recommendations and supporting arguments. Particular emphasis is placed upon the role of endotracheal intubation, use of neuromuscular blocking agents, and the issue of neuromuscular blockade versus rapid tranquilization of the combative trauma patient.
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Penetrating chest trauma causes a broad spectrum of injury that requires a variety of diagnostic and resuscitative skills. Prompt resuscitation and decisive action are mandatory for patients who present in extremis, whereas a thorough diagnostic evaluation and appropriate observation are indicated in less compelling circumstances. ⋯ More sophisticated imaging techniques, with the exception of angiography, are of limited value. A systematic approach based on wound location, be it central, peripheral, or proximate to the diaphragm, should result in timely resuscitation and sound diagnostic evaluation.
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Emergency physicians must diagnose or exclude cervical spine trauma in daily practice. This is a complicated task, as the presentation may be subtle and the manifestations obscured, and no imaging modality is completely sensitive or specific. The research of the past two decades serves as a guide as to which types of patients require cervical radiologic evaluation and which modalities of evaluation are appropriate.
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To improve patient outcome and reduce time at the scene, treatment protocols for specific injuries and rapid transport should be established with individual systems. These standards should be based on such parameters as history, mechanism of injury, physiologic status of the patient on arrival, triage criteria, and predicted transport times. Ensuring airway patency and stability is a vital function that must be rapidly and carefully performed. ⋯ Indeed, more research is necessary in order to confirm, perfect, or dispute the many traditional theories that have been a part of prehospital technology. As the field of emergency medicine continues to develop and expand, so too will the specialty of prehospital medicine. Napoleon would be proud!