title: Evolving frontiers in severe polytrauma management - refining the essential principles.
abstract: This editorial aims to refine the severe polytrauma management principles. While keeping ABCDE priorities, the termination of futile resuscitation and the early use of tourniquet to stop exsanguinating limb bleeding are crucial. Difficult-airway-management (DAM) is by a structured 5-level approach. The computerised tomography (CT) scanner is the tunnel to death for hemodynamically unstable patients. Focused Abdominal Sonography for Trauma-Ultrasonography (FAST USG) has replaced diagnostic peritoneal lavage (DPL) and is expanding to USG life support. Direct whole-body multidetector-row computed tomography (MDCT) expedites diagnosis & treatment. Non-operative management is a viable option in rapid responders in shock. Damage control resuscitation comprising of permissive hypotension, hemostatic resuscitation & damage control surgery (DCS) help prevent the lethal triad of trauma. Massive transfusion protocol reduces mortality and decreases the blood requirement. DCS attains rapid correction of the deranged physiology. Mortality reduction in major pelvic disruption requires a multi-disciplinary protocol, the novel pre-peritoneal pelvic packing and the angio-embolization. When operation is the definitive treatment for injury, prevention is best therapy.
authors.affiliation: Department of Accident & Emergency, Tuen Mun Hospital, Hong Kong.
authors.forename: Kam
authors.initials: K
authors.lastname: Chak Wah
authors.forename: Choi
authors.initials: C
authors.lastname: Wai Man
authors.forename: Wong
authors.initials: W
authors.lastname: Janet Yuen Ha
authors.forename: Vincent
authors.initials: V
authors.lastname: Lai
authors.forename: Wong
authors.initials: W
authors.lastname: Kit Shing John
keywords: computerised axial tomogram; damage control resuscitation; difficult airway mangement; peritoneal pelvic packing; prevention; trauma; ultrasonography