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Adult Trauma Guidelines

Spinal cord injury

  Spinal cord injury (SCI) is a relatively rare, but potentially devastating diagnosis with life-long consequences. There are approximately 80-130 new cases of SCI in New Zealand per year.1 The majority of patients are males aged 24-45 with 40% of injuries resulting from motor vehicle accidents. Types of spinal cord Read more…
By jSdj2sn7eH, ago

Urethral trauma

Due to anatomical differences, urethral trauma is common in men, but can be seen in women with severe pelvis trauma Suspect urethral injury in patient with Anterior pelvis fractures Straddle injuries Penetrating injuries adjacent to urethra Lateral compression with vaginal vault penetration   Clinical signs Inability to void Haematuria Blood Read more…
By jSdj2sn7eH, ago

Pelvic binders

Pelvic binding is an important adjunct in the management of the trauma patient with a suspected “open book” pelvis fracture (AP compression type injury – see pelvis fracture classification below) – correct application can reduce the bony ends of the fracture decreasing pain and bleeding from injured bone cortex. There Read more…
By jSdj2sn7eH, ago

Pelvis trauma

  Clinical assessment Inspection  Abrasions/contusions over bony prominences Skin integrity, open wounds Scrotal/perineal haematoma Blood at urethral meatus Leg length discrepancy When a significant pelvis injury is suspected, obtain an AP pelvis x-ray to guide examination and treatment   Feel/move Pelvic stressing or ‘springing’ should not be performed as it Read more…
By jSdj2sn7eH, ago

Blunt abdominal trauma

  Background The majority of significant blunt abdominal trauma is sustained in road traffic crashes (50-75% of cases). Falls, sporting injuries and assaults are other leading causes. Mechanisms of injury include Direct blows to the abdomen. Injuries to solid organs from direct force Blunt force can press the abdominal contents Read more…
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Primary survey

  Introduction The initial management of major trauma has traditionally been taught with an “ABCDE” approach, with the aim to rule out life threats before progressing to the next step. While this might still be appropriate in settings with single physician coverage or limited resources, the primary survey is ideally Read more…
By jSdj2sn7eH, ago

Penetrating abdominal trauma

Most penetrating abdominal trauma in New Zealand occurs from stab wounds. Gun-shot and other missile/projectile injuries present less frequently.1   Penetrating abdominal trauma management algorithm    Management pearls In patients with upper abdominal stab wounds (or any GSW/projectile), haemodynamic instability may be due to pericardial injury or massive haemothorax/tension pneumothorax. Read more…
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Pneumothorax

A pneumothorax occurs when air collects in the interpleural space. It can be caused by blunt or penetrating thoracic trauma. The most common cause is lung laceration from a rib fracture with air leak.   Clinical signs Patients with massive or tension pneumothoraces are generally unstable – this should be Read more…
By jSdj2sn7eH, ago

Penetrating thoracic trauma

Most commonly occurs from stabbings and gunshot wounds as a result of interpersonal violence. In New Zealand, gunshot wounds are relatively rare – the majority of penetrating chest trauma is from stabbings. Algorithm for management of penetrating thoracic trauma     Potential injuries   Lung injuries Pneumothorax – the most Read more…
By jSdj2sn7eH, ago