Table Of ContentAcute Trauma Care in
Developing Countries
This evidence-based manual highlights the early management of acutely injured trauma victims
arriving in emergency triage areas. It caters to the needs of developing nations in pre-hospital
as well as in-hospital emergency trauma care and provides clear practical guidelines for the
management of victims of major trauma. The book covers basic principles for managing a
crashing trauma patient, followed by effective treatment by different subspecialties. Input from
experienced anaesthesiologists, intensivists, orthopaedics, vascular surgeons, plastic surgeons
and radiologists make this book a gold standard for good practice for professionals.
Key features:
◾ Covers all aspects of acute trauma, including orthopaedics, vascular surgery, plastic surgery,
neurosurgery, burns and radiology
◾ Elaborates on damage control resuscitation and management of initial and life-threatening
injuries; useful for professionals dealing with trauma patients in the emergency area
◾ Guides in initial fluid therapy and pain control along with initial patient resuscitation
Acute Trauma Care in
Developing Countries
A Practical Guide
Edited by
Chief Editors: Kajal Jain and Nidhi Bhatia
Associate Editors: Tanvir Samra and Vishal Kumar
First edition published 2023
by CRC Press
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and by CRC Press
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CRC Press is an imprint of Taylor & Francis Group, LLC
© 2023 selection and editorial matter, Kajal Jain and Nidhi Bhatia; individual chapters, the contributors
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in this book is intended for use by medical, scientific or healthcare professionals and is provided strictly as a
supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history,
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ISBN: 9781032271576 (hbk)
ISBN: 9781032271552 (pbk)
ISBN: 9781003291619 (ebk)
DOI: 10.1201/9781003291619
Typeset in Palatino
by Deanta Global Publishing Services, Chennai, India
Contents
Foreword by Anjan Trikha . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Foreword by J Balavenkatasubramanian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Foreword by Sameer Aggarwal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxvii
Section I: Principles of Acute Trauma Care
1. Pre-hospital Care of Trauma Victims and Triaging on Arrival ..........................2
Ashish Aditya, Tanvir Samra, Anjuman Chander and Harshit Singla
Learning Objectives ..............................................................2
Pre-hospital Care of Trauma Victims in India ........................................2
Triage ..........................................................................3
Pitfalls of ED Triage ..............................................................5
Conclusion ......................................................................5
Suggested Reading ...............................................................5
2. Primary and Secondary Surveys ...................................................7
Sharad Prabhakar
Learning Objectives ..............................................................7
Primary Survey with Concomitant Resuscitation .....................................7
Secondary Survey ................................................................8
Summary .......................................................................9
Conclusion ......................................................................9
Suggested Reading ...............................................................9
3. Clearing the Cervical Spine .......................................................10
Apinderpreet Singh, Rajesh Chhabra and Pravin Salunke
Learning Objectives .............................................................10
Introduction ....................................................................10
Spinal Stability .................................................................10
Clinical Features Suggesting CSI ..................................................11
Spine Injury Syndromes in Incomplete Spinal Cord Injury ...........................11
When to Suspect CSI ............................................................11
Cervical Spinal Injury in Children ................................................12
Ideal Radiological Investigations ..................................................13
Conclusion .....................................................................13
Suggested Reading ..............................................................13
4. Oxygen Therapy in Trauma ......................................................15
Shyam Charan Meena, Rajeev Chauhan and Ankur Luthra
Learning Objectives .............................................................15
Introduction ....................................................................15
v
CONTENTS
Why Do We Need “Emergency Oxygen Therapy Guidelines”? ........................15
Oxygen Delivery Systems ........................................................16
Escalation of Oxygen Therapy ....................................................16
De-escalation of Oxygen Therapy .................................................16
Suggested Reading ..............................................................17
5. Early Analgesia on Arrival .......................................................19
Rashi Sarna and Nidhi Bhatia
Learning Objectives .............................................................19
Introduction ....................................................................19
Patient Care Objectives in Pain Management .......................................19
Ethics of Pain Control ...........................................................19
Components of Pain Management .................................................20
Pain Management Areas in Emergency ............................................20
Suggested Reading ..............................................................23
6. Role of Intercostal Drainage Tube in Chest Trauma ..................................25
Ajay Savlania
Learning Objectives .............................................................25
Introduction ....................................................................25
History of the Procedure .........................................................25
The Anatomical Basis of Tube Placement ...........................................25
Indications .....................................................................26
Contraindications ...............................................................26
Role of Intercostal Drainage Tube in Thoracic Trauma ...............................26
Complications ..................................................................27
Removal of Intercostal Drainage Tube .............................................27
Conclusion .....................................................................28
Suggested Reading ..............................................................28
7. Intrahospital Transport of Trauma Patients .........................................30
Amarjyoti Hazarika
Learning Objectives .............................................................30
Introduction ....................................................................30
Decisions to Be Made before Transportation ........................................30
Things That Might Go Wrong during Patient Transfer ...............................30
Checklist for Intrahospital Transport (IHT) .........................................32
How to Transport the Patient .....................................................32
Suggested Reading ..............................................................33
8. Care of Intubated Patients in Triage ...............................................34
Shalvi Mahajan and Komal A Gandhi
Learning Objectives .............................................................34
Introduction ....................................................................34
Patient Positioning ..............................................................34
Monitoring .....................................................................34
Endotracheal Tube (ETT) Care ....................................................34
Ventilation Management .........................................................36
Analgesia and Sedation ..........................................................36
Circulation .....................................................................36
Other Precautions ...............................................................37
Investigations ..................................................................37
Conclusion .....................................................................37
Suggested Reading ..............................................................37
vi
CONTENTS
Section II: Crashing Trauma Patient
9. Code Crimson in Trauma Triage ..................................................40
Haneesh Thakur and Kajal Jain
Learning Objectives .............................................................40
Introduction ....................................................................40
Identifying Patients Requiring Code Crimson Activation in Trauma Emergency ........40
Criteria for Activation ...........................................................40
Conclusion and Acknowledgements ...............................................42
Suggested Reading ..............................................................42
10. Traumatic Cardiac Arrest ........................................................43
Bisman Jeet Kaur and Nidhi Bhatia
Learning Objectives .............................................................43
Definition ......................................................................43
Management Priority in TCA .....................................................43
Role of Chest Compressions ......................................................44
Adrenaline Use in TCA ..........................................................45
Role of Conventional CPR ........................................................46
Withholding Resuscitation Efforts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Indications to Stop Resuscitation ..................................................46
Conclusion .....................................................................46
Suggested Reading ..............................................................46
11. Airway Management in Trauma Bay ...............................................48
Anudeep Jafra
Learning Objectives .............................................................48
Introduction ....................................................................48
Primary Survey (ABCDE) ........................................................48
Airway Assessment of Trauma Victims ............................................49
Manoeuvres to Open the Airway .................................................49
Cervical Spine Stabilization ......................................................49
Preoxygenation .................................................................49
Definitive Airway Management Techniques ........................................50
Airway Management Scheme and Checklist ........................................53
Minimum Monitoring in Emergency Department ...................................53
Problems Encountered in Trauma Bay during or after Emergency
Airway Management ............................................................53
Conclusion .....................................................................56
Suggested Reading ..............................................................56
12. Front of Neck Access ............................................................57
Haneesh Thakur and Kajal Jain
Learning Objectives .............................................................57
Introduction ....................................................................57
Indications .....................................................................57
Contraindications ...............................................................57
Surface Landmarks for FONA ....................................................57
Technique ......................................................................57
Equipment Required ............................................................57
Advantages of Emergency Cricothyroidotomy ......................................59
Disadvantages of Emergency Cricothyroidotomy ...................................59
Complications ..................................................................59
Conclusion .....................................................................59
Suggested Reading ..............................................................59
vii
CONTENTS
13. Shock in Trauma Patients ........................................................61
Jeetinder Kaur Makkar and Mandeep Tundak
Learning Objectives .............................................................61
Introduction ....................................................................61
Pathophysiology ................................................................61
Response of Specific Systems .....................................................62
Trauma-Induced Coagulopathy (TIC) ..............................................62
General Approach to Resuscitation ................................................63
Goals of Resuscitation ...........................................................65
Pattern of Patient Response ......................................................65
Suggested Reading ..............................................................66
14. Vascular Access in Bleeding Patients ...............................................67
Amarjyoti Hazarika
Learning Objectives .............................................................67
Why Vascular Access Is Required .................................................67
Peripheral Venous Cannulation ...................................................67
Central Venous Cannulation (CVC) ................................................68
Peripheral Venous Cutdown ......................................................69
Intraosseous Access .............................................................71
Suggested Reading ..............................................................72
15. Central Venous Access in Trauma Bay .............................................73
Anjuman Chander, Ashish Aditya, Tanvir Samra and Harshit Singla
Learning Objectives .............................................................73
Introduction ....................................................................73
Indications for Central Venous Catheterization .....................................73
Contraindications of CVC for Patients in Trauma Bay ................................73
Site Selection ...................................................................73
Use of Ultrasonography in Central Venous Catheterization ...........................74
Preparation and Procedural Technique of Central Venous Catheterization. . . . . . . . . . . . . . 75
Conclusion .....................................................................75
Suggested Reading ..............................................................76
16. A Guide to Use of Crystalloids ....................................................77
Jeetinder Kaur Makkar and Mandeep Tundak
Learning Objectives .............................................................77
Introduction ....................................................................77
Fluid Resuscitation Strategies .....................................................77
Choice of Fluid for Resuscitation ..................................................78
Practical Approach to a Major Trauma Patient in Triage ..............................79
Post-resuscitation Fluid Management ..............................................79
Suggested Reading ..............................................................80
17. Blood Transfusion Strategies in Trauma Patients ....................................81
Lakhvinder Singh
Learning Objectives .............................................................81
Introduction ....................................................................81
Coagulopathy in Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Management Strategies for Post-traumatic Haemorrhage .............................81
Suggested Reading ..............................................................85
18. Interpreting Arterial Blood Gases in Trauma Patients ................................86
Narender Kaloria
Learning Objectives .............................................................86
viii
CONTENTS
Introduction ....................................................................86
Common Terminology and Normal ABG Values ....................................86
Acid-Base Disorders Which Can Be Diagnosed with ABG ............................86
Sample Collection and Transport .................................................87
ABG Interpretation Steps ........................................................89
Suggested Reading ..............................................................89
19. Point-of-Care Ultrasound: Applications in Triage ....................................91
Haneesh Thakur and Kajal Jain
Learning Objectives .............................................................91
Introduction ....................................................................91
FAST and eFAST Examination ....................................................91
Cardiac Parasternal Long Axis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Emergency Resuscitation ........................................................96
Emergency Airway Management .................................................97
Procedural Focus: A Great Help. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Conclusion .....................................................................97
Suggested Reading ..............................................................98
20. Desaturating Patient with Long Bone Fractures: Diagnosis and Management ...........99
Devendra Kumar Chouhan and Narendra Chouhan
Learning Objectives .............................................................99
Definition ......................................................................99
Aetiology and Differential Diagnosis ..............................................99
Fat Embolism Syndrome (FES) ....................................................99
Acute Respiratory Distress Syndrome (ARDS) .....................................102
Orthopaedic Care in Desaturating Patient with Long Bone Fracture ..................104
Suggested Reading .............................................................104
Section III: Subspeciality Trauma Care
21. Paediatric Mild Head Injury .....................................................108
Apinderpreet Singh, Chandrasekhar Gendle and Sushant K Sahoo
Learning Objectives ............................................................108
Introduction ...................................................................108
Measuring the Glasgow Coma Scale in Children ...................................108
Classification of Head Injury According to Severity ................................109
Role of CT Scan ................................................................109
Indications for Magnetic Resonance Imaging (MRI) in Head Injury ..................109
Child Abuse/Non-accidental Trauma ............................................. 110
Clearing the Patient for Discharge or Transfer ..................................... 110
Conclusion .................................................................... 110
Suggested Reading ............................................................. 110
22. Early Management of Adult Head Injury ..........................................112
Karthigeyan M, Pravin Salunke and Sunil K Gupta
Learning Objectives ............................................................112
Introduction ...................................................................112
Classification of Head Injury ....................................................112
Assessment in the Emergency Department ........................................112
Clinical Evaluation ............................................................. 113
Observation of Admitted Patients ................................................ 115
Seizures in Head Injury ......................................................... 115
Management Principles in Raised ICP ............................................ 116
Suggested Reading ............................................................. 116
ix
