Emergency Resuscitation Procedures in Major Trauma: Operative Techniques
This chapter will describe the common procedures done during the resuscitation of a badly injured patient. We will strive to provide a practical approach to those who deal with injured patients in the hope that this will aid those practitioners and ultimately the patients. Emergency care also entails some immediate lifesaving operations, usually within 1 h with simultaneous resuscitation. During emergency procedures, complications can be minimized if meticulous techniques are adopted. Pleural decompression is a common procedure following major injury and can be a lifesaving procedure; although it is relatively simple, complications can occur if attention to detail is not used. Pericardial window and transdiaphragmatic pericardial window at the time of laparotomy are diagnostic and potential temporarily therapeutic procedures in patients who may have hemopericardium. A median sternotomy is the ideal incision to access the heart and the anterior mediastinal great vessels. The most rapid method of accessing the chest is via an anterolateral thoracotomy: this incision can be performed rapidly and is versatile, as it can be brought across the sternum into a clamshell thoracotomy. Obtaining hemostasis in patients who are bleeding in the pelvis following major pelvic fractures can be challenging: pelvic packing can be lifesaving. Aortic occlusion can be obtained with REBOA which can provide temporary control of hemorrhage almost anywhere in the body.
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