Article 5
Lim Ju Boo
Regional Staff Officer for Training
St. John Ambulance Malaysia
The other day, I reviewed some literatures on early care of traumatized patients (1). They cover issues pertaining to the analysis of system function, pre-hospital intravascular volume replacement, diagnosis of proximity vascular injury, the role of emergency thoracotomy (surgical exposure of the thoracic cavity), and the value of transesophageal echocardiography (echogram of the heart, across the chest wall / oesophagus). There were various articles, six of which deal with various aspects of system function, from triage to analysis of outcome. The next series of articles examines the work in progress evaluating optimal fluid resuscitation. Some work on hypertonic saline and dextran combinations has been shown to restore vital signs better than isotonic solutions; they are safe, require smaller volumes, and may improve head injury outcome. Danger lies in the restoration of perfusion without haemorrhage control. There were two articles in the search on emergency thoracotomy that review the indications and outcome in blunt and penetrating trauma. It was demonstrated that survival in blunt trauma is virtually zero. There was also an article and two editorials that summarize the state of art for diagnosis and treatment of proximity (nearest the head and body) vascular injury. Then there are also two articles that describe the potential use of a new technique of transesophageal echocardiography. Unfortunately this new modality has not formed a solid indication at present, and can be considered investigational in trauma care. Hmm! So I have summarized these papers. They are good considerations to ponder on. May I suggest that all doctors, paramedics and those involved in the care of the critically-ill to get hold of the paper.
Reference:
1. Fallom, W.F. Trauma systems, Shock, and Resuscitation. Current Opinion in General Surgery (1993): 40-5.
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