Shock and trauma

Published on 10/04/2015 by admin

Filed under Surgery

Last modified 10/04/2015

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CHAPTER 4 Shock and trauma

Shock

Hypovolaemic shock

Septic shock

Treatment

This is urgent and involves resuscitation, identification of the source of sepsis, appropriate antibiotic therapy and any necessary surgery to eradicate the focus of infection.

Cardiogenic shock

Trauma

Initial assessment of the trauma patient

Primary survey

This process constitutes the ABCDE protocol of ATLS and aims to rapidly identify immediately life-threatening injuries in a sequence in which the most rapidly fatal conditions are diagnosed first (i.e. airway obstruction will be fatal before splenic injury). The ABCDE of the primary survey is below.

imageABCDE of emergency management:

During the primary survey and in tandem with examining the patient, certain adjuncts are used, including ECG, pulse oximetry, BP and respiratory rate, insertion of NG tube and urinary catheter (as required); also the patient is provided with adequate analgesia.

Secondary survey

The secondary survey is a head-to-toe evaluation of the trauma patient, i.e. a complete history and physical examination, including a reassessment of all vital signs. Each area of the body should be completely examined. A full neurological examination is carried out including a GCS (Glasgow Coma Score) determination (Table 4.1).

TABLE 4.1 Glasgow Coma Scale (GCS)

Responses Score
Eye-opening response  
Spontaneous 4
To voice 3
To pain 2
None 1
Best verbal response  
Orientated 5
Confused 4
Inappropriate speech 3
Incomprehensible speech 2
None 1
Best motor response  
Obeys commands 6
Localizes pain 5
Withdraws to pain 4
Flexion to pain 3
Extension to pain 2
None 1
Total 3–15

A score of 3 indicates a severe injury with a poor prognosis. A score of 13–15 indicates minor injury with a good prognosis.

Head injury (→ Ch. 18)