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Extensive blunt soft tissue trauma may occur after traffic accidents, falls from significant heights, and crush injuries. It is a common problem after major earthquakes or collapsed buildings (see Chapter 15, Disaster Medicine). Injuries can be closed, open, or both.
Traditionally, a tube thoracostomy is placed using the open technique; however, percutaneous techniques, and those using serial dilation, are also acceptable. Care should be taken with trocar techniques due to the high incidence of iatrogenic injuries.
Chest trauma is estimated to be the primary cause of death in 25% of traumatic mortalities and a contributing factor in another 25% of deaths. Good understanding of the pathophysiology of chest trauma and timely selection of the appropriate investigations and treatment are all critical components for optimal outcome.
In the US, approximately 10,000 spinal cord injuries yearly result in permanent disability. Most spinal cord injuries are caused by motor vehicle collisions (40%), violence (30%), falls (20%), and sporting accidents (6%). Although spinal fractures can occur in any age group, the peak incidence is in males from ages 18 to 25. Certain conditions predispose to spinal fracture, spinal cord injury, or dislocation: old age, rheumatoid arthritis, osteoporosis, and spinal stenosis.
Neck injuries, particularly those due to penetrating trauma, are difficult to evaluate and manage due to the dense concentration of vital structures in a small anatomical space that can be surgically challenging to access. Only 15–20% of patients with penetrating trauma and very few with blunt mechanism require operative intervention. Meticulous clinical examination and well-selected diagnostic investigations are paramount to safely selecting those patients who require an operation and those that can be observed.
Diagnostic peritoneal aspiration (DPA) involves the insertion of a needle or a catheter in the peritoneal cavity and aspiration of any blood or other fluid. Diagnostic peritoneal lavage (DPL) includes infusion of normal saline, lavage of the cavity, and macroscopic and microscopic evaluation of the returned fluid.
Caliber: The caliber of a handgun or rifle is typically described as the diameter of the bore, although this can sometimes vary depending on how the diameter is measured. For example, a 0.38 bullet refers to a bullet that can be fired along a bore that measures 0.38 inches in diameter. The caliber is expressed in inches in the United States (e.g., 0.45 inches) or millimeter (mm) in other countries (e.g., 9 mm).
The extremity compartment syndrome is an acute, limb, and potentially life-threatening emergency that occurs when the pressure in a muscle compartment increases to levels that cause reduced tissue perfusion resulting in ischemic damage to the muscles and nerves.
Head trauma is the most common cause of death and permanent disability following trauma. Blunt head injury is usually the result of motor vehicle collisions, auto versus pedestrian collisions, or falls from significant heights. Gunshot wounds cause the vast majority of penetrating head injuries, although stab wounds and impalement injuries may also be seen.
Pediatric trauma is a leading cause of morbidity and mortality in children. Although the principles of the initial evaluation and management are the same as in adult patients, it is important to take into account the anatomic and physiologic differences, which may affect the clinical presentation, investigations, and management of the pediatric trauma patient.
When attempts at orotracheal intubation or airway rescue techniques (e.g., laryngeal mask airway) have failed in a patient who cannot oxygenate or ventilate, cricothyroidotomy is the emergency surgical airway of choice. It can be performed open or percutaneously. The approach should be dictated by the proceduralist’s preference and experience.