Trauma, a major attendee in the emergency, needs timely attention and intervention to evade significant morbidity and mortality. The initial few hours remain crucial for the revival of patients from life-threatening injuries. Emergencies in Trauma include Head and spine injuries, chest injuries, abdominal injuries, genitourinary injuries, Limb injuries and fracture/ dislocations among others.
At AIG, we are equipped with a qualified team of Emergency Physicians trained and certified in Advanced Trauma Life support (ATLS). We address trauma with rapid triaging of injured patients, Effective resuscitation strategies, Damage control approach and early interventions based on International standard protocols.
In a multi-disciplinary approach, we collaborate with our in-house trauma team consisting of reputed specialists from Orthopaedics, Neurosurgery, Surgical Gastroenterology, Cardiothoracic and Vascular Surgery and Radiology for improved functional outcomes.
Head injury accounts for one of the major causes of trauma-related mortality and morbidity. The importance of golden hour management lies in evading secondary brain injury and long term neurological sequelae. The cerebral blood flow is reduced during the initial few hours following a head injury leading to depressed conscious levels and neurological deficits
Monro Kellie doctrine: The total volume of contents within the cranial cavity is maintained constant by three components, viz., cerebrospinal fluid, brain tissue and blood vessels. In case of severe trauma, this physiological compensation is lost leading to raised intracranial pressure, which reduces Cerebral perfusion. Prompt neuroprotective measures aimed at maintaining ICP, emergent neurosurgical intervention, all of which are time-critical, can be life-saving.
Spine trauma, commonly incurred in high-speed collisions, with lack of restraints, fall from heights and sports activities, can present with diverse injury patterns and neurological compromise. When missed diagnosing initially, these injuries can lead to catastrophic consequences such as permanent disability.
Primary injury due to direct mechanical force disrupts neurovascular structures of the spine leading to cell damage. Consequently hemorrhage, edema and ischemia involving the surrounding neural tissue lead to Secondary injury further resulting in progressive cell death and loss of neurological function.
Window period: The initial 24 hours remains crucial for neurological recovery in spinal injuries, after which irreversible loss of function ensues. Spine protection measures initiated from prehospital care, during transport and in the Emergency during various procedures, ventilator assistance as needed, early neuroimaging and neurosurgical the consult can lead to better outcomes.
The thoracic or chest cavity constitutes about one-fourth of total body mass, comprising the vital organs, viz.Heart, Great vessels, lungs and pleural cavity encased in a bony rib cage. Hence Life-threatening injuries are seen which include Tracheobronchial injuries, Tension pneumothorax, Massive Hemothorax, cardiac tamponade, traumatic circulatory arrest, to name a few. Rapid clinical recognition with timely interventions like endotracheal intubation, Needle decompression, tube thoracotomy, pericardiocentesis and active Cardiopulmonary resuscitation can be potentially life-saving when initiated early. Clinical acumen with skilful hands is the key to make a difference, which is achieved by the coordinated effort of the Emergency team, cardiothoracic and vascular teams.
Abdominal injuries could be resulting from either blunt (motor vehicle collisions / direct blow) or penetrating trauma (stab and gunshot injuries). A major threat to life is from uncontrolled haemorrhage from injured organs and ensuing shock. Peritonitis with hollow viscous injury is also seen. In the Emergency, bedside ultrasonography, alongside clinical assessment can help to detect major intrabdominal injuries early, aiding early resuscitation. Teaming up with efficient surgical gastroenterology thereby initiating early definitive management, like emergency exploratory laparotomy improves outcomes.
Fractures and dislocations involving the upper and lower limbs commonly present to ER. Excruciating pain can result from bony injuries which require prompt attention. Compromised blood circulation to the injured limb requires an emergent reduction to ensure perfusion. This can otherwise lead to permanent functional loss to the limb. A coordinated approach with teams including Orthopaedics, Vascular Surgery and Plastic surgery aids in reducing associated disability, improving functional quality of life.