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The conflicts of the past decades have given military clinicians a familiarity with blast injury treatment. Management of these complex injuries has significantly advanced since the turn of the millennium. Survival levels amongst UK service personnel increased year on year during the 4th Anglo-Afghan war. Civilian casualties from terrorist activities have also included multiple casualties with similar military-style blast injuries. Civilian clinicians should have an understanding of blast-injured casualties so as to be prepared for future major terrorist attacks involving explosive devices. This article outlines the mechanisms by which blast inflicts injury and describes the management steps required to treat these complex, potentially lethal wounds. It is written from an understanding of UK military operations, and recent information from Ukraine, Gaza and Beirut. [ABSTRACT FROM AUTHOR]

Vascular trauma arises from a variety of causes: penetrating and blast injury in conflict zones, and recently terrorist attacks on civilians; blunt injury from road traffic accidents and falls from height; and iatrogenic injury from modern invasive medicine. Massive haemorrhage is the pre-eminent cause of preventable death. Trauma teams now understand the necessity to control bleeding rapidly with targeted damage-control surgery, and goal-directed resuscitation, before the lethal triad of shock, hypothermia and coagulopathy make attempted salvage futile. Vascular trauma in the extremities may be identified clinically with hard signs of injury alone. Trauma CT scanning rapidly identifies sites of bleeding in chest, abdomen or pelvis. Vascular surgeons are key members of the trauma team, offering control of bleeding and vascular reconstruction, using aspects of open surgical and endovascular techniques. Once haemodynamic stability has been established, definitive surgical care can restore function and allow successful rehabilitation. [ABSTRACT FROM AUTHOR]

Abdominal trauma can result in multiple different injuries affecting a number of organs. Early recognition and management of these injuries will improve patient survival and morbidity. Appropriate intervention involves the use of either definitive or damage control surgery for both haemorrhage and peritonitis. This article discusses the different mechanisms of injury, early assessment and investigations. It goes on to highlight the features of a trauma laparotomy, its preparation, management and the systematic approach for damage control surgery. The main abdominal organs are outlined in more detail to describe the individual approach to them in trauma. [ABSTRACT FROM AUTHOR]

Military clinicians became familiar with blast injuries during recent conflicts. Management of these complex injuries has advanced significantly. Survival amongst UK service personnel increased year on year. Civilian casualties from terrorist activities have included multiple casualties with similar blast injuries. Civilian clinicians should also have an understanding of blast-injured casualties so as to be prepared for a major terrorist attack involving explosive devices. This article outlines the mechanisms by which blast inflicts injury. It describes the management steps required to treat these complex, potentially lethal wounds. [ABSTRACT FROM AUTHOR]

Trauma care in the UK is a rapidly developing subspecialty of multiple disciplines from pre-hospital care through to rehabilitation medicine. In its infancy, the Advanced Trauma Life Support (ATLS) approach was designed for a sole provider to critically assess and manage a multiply injured patient with life-threatening injuries through a systematic resuscitation. With the advent of modern trauma systems, major trauma centres and their trauma teams the Airway, Breathing, Circulation, Disability and Exposure approach (ABCDE) of ATLS often play out simultaneously, during which it is vital that the providers have a common understanding of each contributor's roll in the assessment and care of the patient. The 10th Edition of the ATLS Student Manual has an additional new section on Teamwork, reflecting the most up-to-date scientific knowledge on the importance of the team system in trauma resuscitation. ATLS is also one of the seven pillars of change which have been adopted by the Royal College of Surgeons England for reforming the trauma systems in the UK. This article focuses on the ATLS guidelines as the founding principle of good trauma care and incorporates discussion upon some other important modern concepts utilized in the care of the multiply injured patient. [ABSTRACT FROM AUTHOR]

Vascular trauma arises from a variety of causes: penetrating and blast injury in conflict zones, and recently terrorist attacks on civilians; blunt injury from road traffic accidents and falls from height; and iatrogenic injury from modern invasive medicine. Massive haemorrhage is the pre-eminent cause of preventable death. Trauma teams now understand the necessity to control bleeding rapidly with targeted damage-control surgery, and goal-directed resuscitation, before the lethal triad of shock, hypothermia and coagulopathy make attempted salvage futile. Vascular trauma in the extremities may be identified clinically with hard signs of injury alone. Trauma CT scanning rapidly identifies sites of bleeding in chest, abdominal or pelvis. Vascular surgeons are key members of the trauma team, offering control of bleeding and vascular reconstruction, using aspects of open surgical and endovascular techniques. Once haemodynamic stability has been established, definitive surgical care can restore function and allow successful rehabilitation. [ABSTRACT FROM AUTHOR]

Abdominal trauma can result in multiple different injuries affecting a number of organs. Early recognition and management of these injuries will improve patient survival and morbidity. Appropriate intervention involves the use of either definitive or damage control surgery for both haemorrhage and peritonitis. This article discusses the different mechanisms of injury, early assessment and investigations. It goes on to highlight the features of a trauma laparotomy, its preparation, management and the systematic approach for damage control surgery. The main abdominal organs are outlined in more detail to describe the individual approach to them in trauma. [ABSTRACT FROM AUTHOR]

Military clinicians became familiar with the blast injuries during recent conflicts. Management of these complex injuries has advanced significantly, and survival amongst UK service personnel has increased year on year. Civilian casualties from terrorist activities have included multiple casualties with similar blast injuries. Civilian clinicians should now be ready to receive blast-injured casualties in the event of major terrorist attacks. This article outlines the mechanisms by which blast inflicts injury. It describes the management steps required to treat these complex, potentially lethal wounds. [ABSTRACT FROM AUTHOR]

Trauma remains the leading cause of death in the under 40 year olds, with road traffic accidents and blunt trauma being the predominant mechanisms in the Western world. This article will reinforce the ATLS method, with initial assessment progressing from ‘A’ to ‘B’ to ‘C’ and so forth, with systematic re-assessment starting from ‘A’ after any changes in physiology or interventions. It will also aim to introduce some of the more recent changes in trauma care such as massive transfusion protocols, treatment of traumatic cardiac arrest, basic management of limb-threatening conditions (open fractures and compartment syndrome), damage control surgery versus early total care, and the Major Trauma Network. When managing trauma patients the primary survey and immediate life-saving interventions should be undertaken promptly and at times in trauma teams simultaneously. [ABSTRACT FROM AUTHOR]

Vascular trauma arises from a variety of causes: penetrating and blast injury in conflict zones; blunt injury from road traffic accidents and falls; and iatrogenic injury from modern invasive medicine. Massive haemorrhage is the pre-eminent cause of preventable death and trauma teams now understand the necessity to control bleeding rapidly, so that effective resuscitation can begin. Vascular surgeons are key members of the trauma team, offering control of bleeding and vascular reconstruction, using aspects of open surgical and endovascular techniques. Unstable trauma patients with haemorrhagic shock require targeted damage-control surgery and goal-directed resuscitation, before the lethal triad of shock, hypothermia and coagulopathy make attempted salvage futile. Once stability has been established, definitive surgical care can restore function and allow successful rehabilitation. [ABSTRACT FROM AUTHOR]

Major haemorrhage is associated with significant morbidity and mortality. Prompt recognition and resuscitation is key to improving short- and long-term outcomes and survival. Knowledge of mechanism of injury and potential trauma sustained assists identification of life-threatening bleeding. Management of the patient goes beyond the ‘ABCDE’ approach with a series of clinical interventions known as damage control resuscitation addressing complications of major haemorrhage (coagulopathy, hypothermia and acidosis). Investigations are reserved mostly for the haemodynamically stable patient. For unstable patients the operating theatre is the place to achieve haemostasis by endovascular approaches or damage control surgery (DCS). Damage control surgery sacrifices the completeness of the immediate surgical repair and restoration of anatomy in order to adequately address the combined physiological insult of trauma and subsequent surgery. Surgical strategy in a severely traumatised patient should be considered by the multidisciplinary team prior to operating. Regular discussion between the anaesthetist and surgeon allows progress to be reviewed and realistic goals set for initial surgery. Definitive surgery should be delayed until abnormal physiology is corrected. [ABSTRACT FROM AUTHOR]

Blast injuries can be described by the following five mechanisms: primary blast injury relates to overpressure, secondary blast injury describes fragmentation, tertiary blast injury is caused by physical displacement of bodies, quaternary blast injury is the name given to other harmful mechanisms such as thermal injury, and quinternary injuries are the reactivation of latent diseases due to immunosuppression. Blast typically causes death within 10 minutes of injury, and creates contaminated wounds. Treatment for blast injuries is summarized as: resuscitation, penicillin, anti-tetanus, debridement, wash, fasciotomize, pack, stabilize, and leave. Resuscitation should address the ‘bloody triad’ of hypothermia, acidosis and coagulopathy. Damage control surgery should aim to correct physiology rather than anatomy. Debridement needs to be thorough to remove all contamination. Muscle should be assessed and devitalized tissue removed, with bone ends being delivered and irrigated copiously. Bony stabilization needs to be achieved, and with damage control surgery this is commonly with external fixation. Fasciotomies should be performed in all vulnerable compartments. Amputation may be considered as a primary treatment option if limbs are unsalvageable or resources are limited. [ABSTRACT FROM AUTHOR]

Vascular trauma arises from a variety of causes: penetrating and blast injury in conflict zones; blunt injury from road traffic accidents and falls; and iatrogenic injury from modern invasive medicine. Massive haemorrhage is the pre-eminent cause of preventable death and trauma teams now understand the necessity to control bleeding rapidly, so that effective resuscitation can begin. Vascular Surgeons are key members of the trauma team offering control of bleeding and vascular reconstruction, using aspects of open surgical and endovascular techniques. Unstable trauma patients with haemorrhagic shock require targeted damage-control surgery and goal-directed resuscitation, before the lethal triad of shock, hypothermia, and coagulopathy make attempted salvage futile. Once stability has been established, definitive surgical care can restore function and allow successful rehabilitation. [ABSTRACT FROM AUTHOR]

Abstract: Major haemorrhage is defined as ‘life-threatening bleeding’. It is associated with significant morbidity and mortality and prompt, expeditious control of haemorrhage is essential to improve patient outcome. Understanding the mechanism of injury in trauma and a systematic approach to clinical examination and assessment of blood loss are essential to identify the patient with a life-threatening bleed. Permissive hypotension, correction of coagulopathy and avoidance of hypothermia are important during the resuscitation phase. Special investigations for major haemorrhage are reserved for the haemodynamically stable patient. There are some generic surgical principles, which apply to all scenarios of major haemorrhage, and endovascular interventions have added a further dimension to this management strategy. Recent advances in survivability following polytrauma are credited to the modern concept of an integrated approach to damage control resuscitation and damage control surgery. This article aims to discuss some of these key principles that govern the management of the patient with major haemorrhage. [Copyright &y& Elsevier]

Abstract: In recent years the envelope of survivability for victims of high-energy polytrauma has been continuously extended, thanks to advances at all levels of trauma care in both civilian and military practice. The concept of damage control surgery has been embraced by surgeons of various specialities as a paradigm within which to manage these patients, many of whom reach trauma centres alive, having sustained injuries which would until recently have been considered unsurvivable. This paper summarizes the development and application of this approach, and details the latest research evidence and development of this technique to include an integrated ‘Damage Control Resuscitation–Damage Control Surgery’ (DCR–DCS) protocol. The traditional staged approach to DCS has been superseded by an integrated DCR–DCS approach. This has been driven by a greater understanding of the management of the ‘lethal triad’ of trauma and by technological advances enabling real-time monitoring of physiological indices. This approach can extend initial safe operating times, with concomitant improvement in rates of survival and limb salvage. [ABSTRACT FROM AUTHOR]

Abstract: Major haemorrhage defined as ‘life-threatening bleeding’ is associated with significant morbidity and mortality. Prompt and expeditious control of haemorrhage is essential to improve patient outcome and this requires a sound understanding of the fundamental principles of haemorrhage control. Knowledge of the mechanism of injury in trauma and a systematic approach to clinical examination and assessment of blood loss are essential to identify the patient with a life-threatening bleed. Permissive hypotension, correction of coagulopathy and avoidance of hypothermia are important during the resuscitation phase. Special investigations for major haemorrhage are reserved for the haemodynamically stable patient. There are some surgical principles which apply to the various scenarios of major haemorrhage and in particular the concept of damage control surgery is relevant here. Endovascular interventions have added a further dimension to our management strategy. This article aims to discuss some of the principles that govern the management of the patient with major haemorrhage. [ABSTRACT FROM AUTHOR]