[Diagnostic problems of multiple trauma and technical means].
Multiple trauma requires immediate and combined resuscitation and surgery. For resuscitation, the neurological condition must be assessed prior to any sedation, as well as the respiratory and hemodynamic condition, in order to carry out first aid (tubing, ventilation, infusion...). The surgeon who is present must contribute in the quick clinical assessment of the lesions, perform temporary hemostasis as well as hemostatic and anti-infectious dressing, find out associated vascular complications and possible injuries to the spine and cord. Various blood samples must be taken before setting up the venous pathways (peripheral and central), and the various parameters will be followed up. Thoracic aspiration will sometimes be essential for better ventilation. Radiographs of the chest and of the pelvis will be taken with the injured person on the stretcher, without displacing him/her. The rest of the assessment will be performed only when the person with multiple trauma has been resuscitated and is hemodynamically stable, and it will include various radiographs, ultrasound and CT studies, and even angiograms, of the skeleton and of the cranial contents, of the thorax and of the abdomen. However, all these explorations are somewhat time-consuming, and involve a risk of neurological, hemodynamic or ventilatory aggravation. Therefore they must be organized into a hierarchy, and only those that are essential will be performed to avoid delaying the treatment. Neither must the effectiveness of resuscitation be too reassuring, as the morbidity of the lesions increases with the number of units of transfused blood. The vital prognosis is often worsened when a lesion is not recognized or when complications occur.
Durandeau
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Service d'orthopédie-traumatologie A, Hôpital Pellegrin, Bordeaux.
D001921:Brain / Q000000981:diagnostic imaging; D004630:Emergencies; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D006801:Humans; D009104:Multiple Trauma / Q000175:diagnosis* / Q000628:therapy; D011860:Radiography, Abdominal; D012119:Respiration; D012151:Resuscitation / Q000379:methods; D014057:Tomography, X-Ray Computed
Problèmes diagnostiques et plateau technique.