Resuscitation and anaesthesia for penetrating trauma.
OBJECTIVE
The worldwide burden of trauma is increasing, but is unequal between nations. Trauma targets the young and productive in society and imposes a major burden on the health infrastructure. This review provides a distillation of practice in a busy urban trauma centre dealing with large volumes of penetrating trauma.


RESULTS
The anaesthetist holds a pivotal role in the management of penetrating injury; the requirements of prompt airway control, early delivery to theatre and control of a physiologically brittle patient can be challenging. Recognition that attempts at definitive surgery in exsanguinating patients may do more harm than good has made surgery a tool of resuscitation rather than an end in itself.


CONCLUSIONS
Depending on where they practice, clinicians are more or less likely to encounter patients with gunshot wounds. However, adherence to basic principles and attention to the details of temperature control, invasive haemodynamic monitoring, blood product therapy and effective communication should translate to improved outcomes for patients after penetrating trauma.
Bowley
Douglas M
DM
University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa.
Robertson
Simon J
SJ
Boffard
Kenneth D
KD
Bhagwanjee
Sats
S