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Critical pitfalls in the immediate assessment of the trauma patient

Accident and Emergency Department, King’s College Hospital, London, UK, George.Little{at}kingshc.nhs.uk

Michael Kelly

Accident and Emergency Department, King’s College Hospital, London, UK

E Glucksman

Accident and Emergency Department, King’s College Hospital, London, UK

In the immediate assessment of trauma patients, critical pitfalls exist that may interfere with optimal clinical care. Failure to recognize the need for early anaesthesia and endotracheal intubation may put the patient at unnecessary risk and delay the assessment and treatment process. Pressure to clear the cervical spine may lead to inadequate imaging and premature removal of neck immobilization devices. The limitations of the initial chest X-ray in diagnosing pneumothoraces may not be appreciated and needle thoracentesis may be ineffective. ‘Springing’ the pelvis to assess for instability may cause life-threatening haemorrhage and should not be done prior to the initial pelvic X-ray. Log rolling may dislodge crucial clot formation and promote bleeding, and should only be used for diagnostic purposes. Applying clinical common sense to the assessment of trauma patients may avoid the pitfalls whilst allowing the clinician to operate within internationally agreed assessment and treatment frameworks.

Key Words: Trauma • rapid sequence induction • emergency intubation • cervical spine • pneumothorax • computed tomography • pelvic fracture • log roll

Trauma, Vol. 3, No. 1, 43-51 (2001)
DOI: 10.1177/146040860100300106


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