Trauma protocol

Ptak T, Rhea JT, Novelline RA (2003) Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method initial experience. Radiology 229 902-905 Resnik CS, Stackhouse DJ, Shanmuganathan K etal. (1992) Diagnosis of pelvic fractures in patients with acute pelvic trauma efficacy of plain radiographs. AJR Am J Roentgenol 158 109-112... 

Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols. 

Other investigators have portrayed psilocybin as "friendlier" - a substance that is not as fierce as LSD in exposing possible traumas hidden within the subconscious mind (see Chapter 3.2). Such differences in comparative evaluations of psilocybin and LSD are likely linked to a variety of factors, such as dosage differences, research protocols less than comprehensive and exhaustive in scope, as well as personality and environmental variables. 

Opioids remain the mainstay of pain treatment. Useful guidelines for their administration have been developed for a number of clinical situations, including treatment of acute pain, trauma, cancer, nonmalignant chronic pain, and pain in children. In the case of cancer pain, adherence to standardized protocols can improve pain management significantly. Guidelines for the oral and parenteral dosing of opioids are presented in Table 21-5. 

Hagiwara A, Sakaki S, Goto H, et al. (2001) The role of interventional radiology in the management of blunt renal injury a practied protocol. J Trauma 51 526-531... 

There are some cormnon misconceptions regarding combat helmet testing. One common misconception concerns the existence of National Institute of Justice (NIJ)-certified Level IDA helmets. The Nil Standard for Ballistic Helmets 0106.1 only certifies up to Level II for ballistic-type helmets. The only comprehensive Level IIIA testing protocol for helmets in the LIS is the H. P. White Helmet Test Procedure (HPW-TP-0401.01B). Additionally, the NIJ Standard does not provide arty information on how to measure blunt trauma deformation a standard operatingprocedure to assess trauma-related injury to the wearer. Testing protocols of NIJ Standard 0106.01 are employed by many manufacturers for testing helmets up to Level IDA (Nielsen, 2008 Scheetz et al., 1973). 

Barba CA, Taggert J, Morgan AS, et al. (2001) A new cervical spine clearance protocol using computed tomography. J Trauma 51 652-656 discussion 656-7 Brant-Zawadzki M, Jeffrey RB Jr, Minagi H, et al. (1982) High resolution CT of thoracolumbar fractures. AJR Am J Roentgenol 138 699-704... 

In 1938, Ugo Gerletti and Lucino Bini introduced a technique called electroconvulsive therapy (EGT), which induced seizures electrically it quickly became the preferred method of treatment for mental illness. In its earliest applications, EGT was highly traumatic for patients it elicited a full-blown seizure that could result in broken bones, muscle tears, and permanent memory loss. The threat, or actual administration, of EGT was commonly used to punish or control patients. In modern psychiatry, EGT is administered with a protocol that minimizes trauma, injury, and memory loss, and it is considered a proven, effective treatment for patients with intractable depression and those who cannot take medication because of medical conditions or pregnancy. 

Whole-body CT (WB-CT) protocols in multisystem trauma usually consist of a non-contrast enhanced head CT, which is followed by a contrast-enhanced chest and abdominal CT. For evaluation of the spine, reformations from the chest and abdomen are of diagnostic image quality if the primary colUmation was 2.5 mm or less, and dedicated scans of the spine are not obligatory (Mann et al. 2003). The cervical spine can be scanned separately with thin coUimations after the head scan, or can be included in the chest scan. The latter option has the advantage that the cervical vessels are contrast-enhanced, and vascular injuries can be ruled out from the same dataset, sparing one additional scan. 

With faster scanners, multiphase imaging is possible. Usually, WB-CT protocols for trauma comprised an arterial phase scan of the chest and neck, and a por-tovenous phase scan of the abdomen (Linsenmaier et al. 2002b Kanz et al. 2004 Wurm B et al. 2005). In cases of suspected pelvic fractures, arterial-phase imaging of the pelvis can be helpful to detect vascular injuries with active bleeding requiring intervention. If injuries of the abdominal aorta are suspected scanning the abdomen during arterial phase should be considered. 

Hauser HB (1999) Radiological emergency management of multiple trauma patients. Emerg Radiol 6 61-69 Heyer CM, Rduch G, Kagel T etal. (2005) [Prospective randomized trial of a modified standard multislice CT protocol for the evaluation of multiple trauma patients.] Rofo 177 242-249... 

Hoppe H, Vock P, Bonel HM et al. (2006) A novel multiple-trauma CT-scanning protocol using patient repositioning. Emerg Radiol 13 123-128... 

Burgess AR, Eastridge BJ, et al. (1990) Pelvic ring disruptions effective classification system and treatment protocols. J Trauma 30(7) 848-56... 

Dries DJ, McGonigal MD, Malian MS, et al. Protocol driven ventilator weaning reduces use of MV rate of early reintubation and VAP. J Trauma 2004 56 943-952. 

Duane TM, Riblet JL, Golay D, et al. Protocol driven ventilator management in a trauma Intensive care unit population. Arch Surg 2002 137 1223-1227. 

Oropharyngeal decontamination was not included in the first protocol of SDD in mechanically ventilated patients. However, gastrointestinal decontamination alone did not influence the incidence of respiratory tract infections among multiple trauma patients when compared to a historical control group (27). Addition to the SDD regimen of an oropharyngeal paste containing topi-... 

This chapter has so far considered the conventional approaches to the management of casualties of toxic trauma as part of existing HAZMAT protocols. Despite the fact that there is increasing interest in providing early medical care in a contaminated area, there are still wide divergences between the medical management of chemical incidents and that of other disasters where the casualties produced suffer from conventional tramna. 

---