Critical care clinics
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Critical care clinics · Jan 2004
ReviewInitial management of pelvic and femoral fractures in the multiply injured patient.
The management of polytrauma patients is clinically challenging and requires a multi-disciplinary team approach. The immediate and definitive operative care of fractures represents the optimal treatment for polytrauma patients with orthopedic injuries. Early orthopedic intervention in long bone fractures and pelvic ring injuries has been shown to decrease pulmonary complications, improve hemodynamic stability, reduce ventilator time, and facilitate early patient mobilization. These factors decrease mortality and improve outcomes for patients with multiple injuries.
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For both SCI and TBI, physicians are unable to affect reversal of the cellular injuries suffered at the time of trauma directly. Unfortunately, understanding such processes is just on the horizon. ⋯ Aggressive and pre-emptive attention to the ABC(D)s with attention to the needs of the injured nervous system, appropriate monitoring in all patients, meticulous medical management, and prompt surgical intervention when indicated have made marked improvements in outcome, particularly in TBI. Focusing on the basics and strict attention to detail appear to be the major roles played in the care of CNS trauma.
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Critical care specialists should be familiar with the initial management of injured patients. Dividing the evaluation and treatment of the patient into the primary, secondary, and tertiary surveys ensures that the multiply injured patient will be managed expeditiously. ⋯ The secondary survey identifies the remaining major injuries and sets priorities for definitive management. The tertiary survey identifies occult injuries before they become missed injuries.
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Damage control is a staged approach to severely injured patients predicated on treatment priorities. Initially, life-threatening injuries are addressed expediently, and procedures are truncated. ⋯ This strategy breaks the bloody vicious cycle and results in improved outcomes. Novel technologies like CAVR and rFVIIa contribute to the effectiveness of damage control.