Hospital care in severe trauma: Initial strategies and life-saving surgical procedures.
Severe trauma patients should be received at the hospital by a multidisciplinary team directed by a "trauma leader" and all institutions capable of receiving such patients should be well organized. As soon as the patient is accepted for care, the entire team should be prepared so that there is no interruption in the pre-hospital chain of care. All caregivers should thoroughly understand the pre-established protocols of diagnostic and therapeutic strategies to allow optimal management of unstable trauma victims in whom hemostasis must be obtained as soon as possible to decrease the morbid consequences of post-hemorrhagic shock. In patients with acute respiratory, circulatory or neurologic distress, several surgical procedures must be performed without delay by whichever surgeon is on call. Our goal is to describe these salvage procedures including invasive approaches to the upper respiratory tract, decompressive thoracostomy, hemostatic or resuscitative thoracotomy, hemostatic laparotomy, preperitoneal pelvic packing, external pelvic fixation by a pelvi-clamp, decompressive craniotomy. All of these procedures can be performed by all practitioners but they require polyvalent skills and training beforehand.
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 9, France. Electronic address: tristan.monchal@free.fr.
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T
Monchal
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Percy, Clamart, France.
E
E
Hornez
Fédération d'Anesthésie-réanimation et Urgences, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
B
B
Prunet
Fédération d'Anesthésie-réanimation et Urgences, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
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S
Beaume
Fédération d'Anesthésie-réanimation et Urgences, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
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H
Marsaa
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 9, France.
S
S
Bourgouin
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Percy, Clamart, France.
Y
Y
Baudoin
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Percy, Clamart, France.
S
S
Bonnet
Service de Chirurgie O.R.L., Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
J-B
JB
Morvan
Service de Chirurgie Thoracique et Vasculaire, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
J-P
JP
Avaro
Service de Neurochirurgie, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
A
A
Dagain
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 9, France.
J-P
JP
Platel
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 9, France.
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P
Balandraud
D003399:Craniotomy; D003657:Decision Making; D004636:Emergency Service, Hospital; D006488:Hemostasis, Surgical; D006760:Hospitalization; D006801:Humans; D007813:Laparotomy; D010343:Patient Admission; D010348:Patient Care Team; D010388:Pelvis / Q000293:injuries; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012769:Shock / Q000628:therapy; D013898:Thoracic Injuries / Q000601:surgery; D013908:Thoracotomy; D014140:Tracheotomy; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000601:surgery*
Hemostatic surgery; Salvage; Shock treatment; Trauma; Trauma center