Approaches to Trauma Management

The overall message from the development of the management of physical trauma is that an early and systematic intervention which addresses not only the immediate trauma but also the maintenance of life support in the form of airway, breathing and circulation can have a dramatic effect on the outcome. This approach has much relevance to the management of injury from toxic chemical agents. 

We have seen that trauma to the body can be produced from a variety of causes which form part of a spectrum which includes penetrating, and blunt trauma and also thermal trauma from bums and cold injury. These various forms of injury can have both immediate and long-term effects, and there are common terminal pathways of cell and organ damage and death. 

The actions of toxic chemicals on the body can be integrated into the various forms of physical trauma by using the concept of toxic trauma . 

Toxic trauma can be defined broadly as the dismption of somatic systems and their function by exposure to a toxic chemical. Ingested poisoning in its conventional form is only one example of toxic trauma. As we shall see in later chapters, toxic exposure can also arise from inhalation of gases or exposure of the skin to liquids or solids. Like physical trauma, toxic trauma can produce early or late effects with potential fatality at aU stages. 

The deliberate release of chemicals to produce toxic trauma has been familiar in warfare for more than 2000 years. In civil life, although there may have been coincidental exposure (e.g. in siege warfare), most acute toxic trauma up to the twentieth century would have been due to ingested poisonous substances. Since that time, civilians have been increasingly at risk from exposure to both agents of chemical warfare and toxic industrial chemicals. 

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Box 13 Larrey and Percy The Beginnings of a Systematic Approach to Trauma Management... 

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