Notorious pitfalls in the care of multi-trauma patients

Abstract

In this review we elaborate on the more specific circumstances that are needed for adequate trauma care, such as the correct recognition and management of a tension pneumothorax, a tracheobronchial disruption, systemic air embolism and hypoventilation. Furthermore the trauma clinician must be aware of the different life threatening causes of haemorrhage and hypovolemia. Traumatic pericardial tamponade, myocardial contusion and a tension pneumothorax can all prove to be difficult diagnoses, but may all present with signs of hypotension with an increase in central venous pressure (CVP). In contrast, internal haemorrhage is most often accompanied by hypotension with a low CVP. Immediate evaluation and treatment of thoracic trauma, such as rupture of the aortal arch, is mandatory, as is the utilisation of the correct diagnostic strategy to evaluate the possibility of intra-abdominal and retroperitoneal injury. Both an unnecessary laparotomy and a delayed diagnosis must be avoided when dealing intra-abdominal injuries, such as kidney trauma. Furthermore, we stress the importance of the swift diagnosis and treatment of fractures of long bones and the pelvis, to prevent ongoing massive haemorrhage. Certain criteria should be met, in a hospital setting with sufficient day-to-day trauma experience, to be able to provide quality care for the multi-trauma patient. This will minimise the risk of errors and serious medical and judicial consequences.