1. Damage control principles in critical care
The role of Intensive care unit in the poly-trauma context encompasses patient management and organ support; in other words, on-going physiology resuscitation. The goals of critical care are recognition and treatment of complications which ensue as a result of primary injuries (1st hit) as well as prevention, identification and management of iatrogenic injury (2nd hit). Permissive hypotension, hemostatic resuscitation and damage control surgery are the tools used in trauma-bay resuscitation. Hemostatic resuscitation is further subdivided in massive transfusion, targeted warming, near patient coagulation testing and arterial blood gas analysis. The target is to achieve as soon as possible normothermia, …show more content…
In addition intra-cranial pressure monitoring is mandatory in traumatic brain injury (TBI) …show more content…
These include appropriate update of patient notes, record keeping of imaging results and drug charts. Enteral feeding should commence as soon as possible and gastric protection must be used. Compliance with the hospital’s venous thrombo-embolism prophylaxis policy is mandatory. Intravenous lines must be used judiciously and removed once not necessary. The patient is nursed better in the 30’ head up position, due to its’ offering improved ventilation, decreasing the risk of micro-aspiration and ventilator associated pneumonia and being safe in the presence of spinal injury. VAC (Vacuum Assisted Closure) dressings and regional blocks (both peripheral nerve blocks and epidurals) after correction of coagulopathy are fundamental adjuncts of polytrauma patient care. Compartment syndrome is a devastating complication that can easily be missed in the critical care setting especially in intubated patients, or the ones with TBI; thus a high index of suspicion is needed. Fasciotomies should be performed electively in patients with injury patterns placing them at risk, as well as intra-compartment pressure measurement in selected cases (either in the limbs or the
The role of Intensive care unit in the poly-trauma context encompasses patient management and organ support; in other words, on-going physiology resuscitation. The goals of critical care are recognition and treatment of complications which ensue as a result of primary injuries (1st hit) as well as prevention, identification and management of iatrogenic injury (2nd hit). Permissive hypotension, hemostatic resuscitation and damage control surgery are the tools used in trauma-bay resuscitation. Hemostatic resuscitation is further subdivided in massive transfusion, targeted warming, near patient coagulation testing and arterial blood gas analysis. The target is to achieve as soon as possible normothermia, …show more content…
In addition intra-cranial pressure monitoring is mandatory in traumatic brain injury (TBI) …show more content…
These include appropriate update of patient notes, record keeping of imaging results and drug charts. Enteral feeding should commence as soon as possible and gastric protection must be used. Compliance with the hospital’s venous thrombo-embolism prophylaxis policy is mandatory. Intravenous lines must be used judiciously and removed once not necessary. The patient is nursed better in the 30’ head up position, due to its’ offering improved ventilation, decreasing the risk of micro-aspiration and ventilator associated pneumonia and being safe in the presence of spinal injury. VAC (Vacuum Assisted Closure) dressings and regional blocks (both peripheral nerve blocks and epidurals) after correction of coagulopathy are fundamental adjuncts of polytrauma patient care. Compartment syndrome is a devastating complication that can easily be missed in the critical care setting especially in intubated patients, or the ones with TBI; thus a high index of suspicion is needed. Fasciotomies should be performed electively in patients with injury patterns placing them at risk, as well as intra-compartment pressure measurement in selected cases (either in the limbs or the