Skip to main content
SpringerLink
Log in
Book cover

The Modern Hospital pp 231–245Cite as

Trauma Room: “A Minute Man” Operating Room – Managing the Chaos Using Technologies

  • Chapter

  • 943 Accesses

Abstract

Trauma is the leading cause of mortality and years of life lost in the United States. Trauma victims require emergent evaluation and definitive care of their injuries in the trauma room. Every 3 min delay in management can increase the mortality of trauma patient by 1%. Over the recent years, latest advances in technology and their successful integration in healthcare sector led to the development of state-of-the-art diagnostic and treatment modalities. It has improved the organizational efficiency of hospitals and the standard of care for time-sensitive ailments especially trauma. In this chapter, we’ll discuss evidence-based guidelines to manage patients in the trauma bay using latest therapeutic modalities.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. World Health Organization. Injuries and violence: the facts. Accessed on 12 July 2018; Available from: http://www.who.int/violence_injury_prevention/key_facts/en/.

  2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cost of injuries and violence in the United States. Accessed on 12 July 2018; Available from: https://www.cdc.gov/injury/wisqars/overview/cost_of_injury.html.

  4. Chasm Q. A new health system for the 21st century. Washington, DC: National; 2001.

    Google Scholar 

  5. Gawande A, Bates DW. The use of information technology in improving medical performance. Part II. Physician-support tools. Med Gen Med. 2000;2(1):E13.

    CAS  Google Scholar 

  6. Clarke JR, et al. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma Acute Care Surg. 2002;52(3):420–5.

    Article  Google Scholar 

  7. US Centers for Disease Control and Prevention. Injury prevention and control: data and statistics. Accessed on 20 April 2018; Available from: https://www.cdc.gov/injury/wisqars/fatal.html.

  8. Subcommittee A, Tchorz KM, I.A.w. group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363.

    Google Scholar 

  9. Spinella PC, Holcomb JB. Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev. 2009;23(6):231–40.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Holcomb JB, et al. Transfusion of plasma, platelets, and red blood cells in a 1: 1: 1 vs a 1: 1: 2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Nunez TC, et al. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J Trauma Acute Care Surg. 2009;66(2):346–52.

    Article  Google Scholar 

  12. Joseph B, et al. Massive transfusion: the revised assessment of bleeding and transfusion (RABT) score. World J Surg. 2018;42(11):3560–7.

    Google Scholar 

  13. Brohi K, et al. Acute traumatic coagulopathy. J Trauma Acute Care Surg. 2003;54(6):1127–30.

    Article  Google Scholar 

  14. Collaborators C. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. The Lancet. 2011;377(9771):1096–1101. e2.

    Article  Google Scholar 

  15. Kushimoto S, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate for rapid vitamin K antagonist reversal in Japanese patients presenting with major bleeding or requiring urgent surgical or invasive procedures: a prospective, open-label, single-arm phase 3b study. Int J Hematol. 2017;106(6):777–86.

    Article  CAS  PubMed  Google Scholar 

  16. Jehan F, et al. The role of four-factor prothrombin complex concentrate in coagulopathy of trauma: a propensity matched analysis. J Trauma Acute Care Surg. 2018;85(1):18–24.

    Article  CAS  PubMed  Google Scholar 

  17. Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89(2):228–32.

    Article  CAS  PubMed  Google Scholar 

  18. Tapia NM, et al. TEG-guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients. J Trauma Acute Care Surg. 2013;74(2):378–86.

    Article  CAS  PubMed  Google Scholar 

  19. Inaba K, et al. 2014 consensus conference on viscoelastic test–based transfusion guidelines for early trauma resuscitation: report of the panel. J Trauma Acute Care Surg. 2015;78(6):1220–9.

    Article  PubMed  Google Scholar 

  20. Ward KR, et al. Near infrared spectroscopy for evaluation of the trauma patient: a technology review. Resuscitation. 2006;68(1):27–44.

    Article  PubMed  Google Scholar 

  21. Davies DJ, et al. Near-infrared spectroscopy in the monitoring of adult traumatic brain injury: a review. J Neurotrauma. 2015;32(13):933–41.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Macknet MR, et al. The accuracy of noninvasive and continuous total hemoglobin measurement by pulse CO-oximetry in human subjects undergoing hemodilution. Anesth Analg. 2010;111(6):1424–6.

    Article  PubMed  Google Scholar 

  23. Joseph B, et al. Continuous noninvasive hemoglobin monitor from pulse ox: ready for prime time? World J Surg. 2013;37(3):525–9.

    Article  PubMed  Google Scholar 

  24. Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013. Accessed on 18 July, 2018; Available at https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm.

  25. Haydel MJ, et al. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–5.

    Article  CAS  PubMed  Google Scholar 

  26. Goldstein J, Loyd L. Abington suspends trauma center. In: Philadelphia inquirer. Philadelphia. Accessed on 12 July 2018; Available from http://articles.mcall.com/2002-12-19/news/3427446_1_trauma-center-trauma-patients-emergency-room.

  27. Stiell IG, et al. The Canadian CT head rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6.

    Article  CAS  Google Scholar 

  28. Nakhjavan-Shahraki B, et al. Pediatric emergency care applied research network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury. Eur J Trauma Emerg Surg. 2017;43(6):755–62.

    Article  CAS  PubMed  Google Scholar 

  29. Joseph B, et al. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014;76(4):965–9.

    Article  PubMed  Google Scholar 

  30. Joseph B, et al. Changing paradigms in the management of 2184 patients with traumatic brain injury. Ann Surg. 2015;262(3):440–8.

    Article  PubMed  Google Scholar 

  31. Azim A, et al. Big for small: validating brain injury guidelines in pediatric traumatic brain injury. J Trauma Acute Care Surg. 2017;83(6):1200–4.

    Article  PubMed  Google Scholar 

  32. Martin GE, et al. Safety and efficacy of brain injury guidelines at a level III trauma center. J Trauma Acute Care Surg. 2018;84(3):483–9.

    Article  PubMed  Google Scholar 

  33. Pitts SR, et al. National hospital ambulatory medical care survey: 2006 emergency department summary. Natl Health Stat Rep. 2008;7(7):1–38.

    Google Scholar 

  34. Hoffman JR, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343(2):94–9.

    Article  CAS  PubMed  Google Scholar 

  35. Stiell IG, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841–8.

    Article  CAS  PubMed  Google Scholar 

  36. Stiell IG, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510–8.

    Article  CAS  PubMed  Google Scholar 

  37. Biffl WL, et al. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann Surg. 1998;228(4):462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Bromberg WJ, et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2010;68(2):471–7.

    Google Scholar 

  39. Biffl WL, et al. Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2009;67(6):1150–3.

    Article  Google Scholar 

  40. Carney N, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6–15.

    PubMed  Google Scholar 

  41. Kazim SF, et al. Management of penetrating brain injury. J Emerg Trauma Shock. 2011;4(3):395.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kaufman H, et al. Patients with Glasgow Coma Scale scores 3, 4, 5 after gunshot wounds to the brain. Neurosurg Clin Nṣ Am. 1995;6(4):701–14.

    Article  CAS  Google Scholar 

  43. Joseph B, et al. Improving survival rates after civilian gunshot wounds to the brain. J Am Coll Surg. 2014;218(1):58–65.

    Article  PubMed  Google Scholar 

  44. Joseph B, et al. Prothrombin complex concentrate use in coagulopathy of lethal brain injuries increases organ donation. Am Surg. 2014;80(4):335–8.

    PubMed  Google Scholar 

  45. Aarabi B, Mossop C, Aarabi JA. Surgical management of civilian gunshot wounds to the head. In: Handbook of clinical neurology. New York: Elsevier; 2015. p. 181–93.

    Google Scholar 

  46. Lin DJ, et al. “Time is brain” the Gifford factor-or: why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide. Surg Neurol Int. 2012;3:98.

    Article  PubMed  PubMed Central  Google Scholar 

  47. United States Army (2012) Institute of Surgical Research. Joint theater trauma system clinical practice guidelines-management of patients with severe head trauma. Accessed on 12 July 2018; Available from http://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs.

  48. Bayston R, et al. Use of antibiotics in penetrating craniocerebral injuries. Lancet. 2000;355(9217):1813–7.

    Article  CAS  PubMed  Google Scholar 

  49. Mittal V, et al. Carotid artery injuries and their management. J Cardiovasc Surg. 2000;41(3):423.

    CAS  Google Scholar 

  50. Prichayudh S, et al. Selective management of penetrating neck injuries using “no zone” approach. Injury. 2015;46(9):1720–5.

    Article  PubMed  Google Scholar 

  51. Ibraheem K, et al. “No zone” approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations. J Surg Res. 2018;221:113–20.

    Article  PubMed  Google Scholar 

  52. Graber G. Blunt and penetrating injuries of the chest wall, pleura, and lungs. Gen Thorac Surg. 2005;2:951–71.

    Google Scholar 

  53. Dongel I, et al. Management of thoracic trauma in emergency service: analysis of 1139 cases. Pak J Med Sci. 2013;29(1):58.

    PubMed  PubMed Central  Google Scholar 

  54. Demetriades D, et al. Diagnosis and treatment of blunt thoracic aortic injuries: changing perspectives. J Trauma Acute Care Surg. 2008;64(6):1415–9.

    Article  Google Scholar 

  55. Gracias VH, et al. Defining the learning curve for the focused abdominal sonogram for trauma (FAST) examination: implications for credentialing. Am Surg. 2001;67(4):364.

    CAS  PubMed  Google Scholar 

  56. Montoya J, et al. From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment. Eur J Trauma Emerg Surg. 2016;42(2):119–26.

    Article  CAS  PubMed  Google Scholar 

  57. Ho M-L, Gutierrez FR. Chest radiography in thoracic polytrauma. Am J Roentgenol. 2009;192(3):599–612.

    Article  Google Scholar 

  58. Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg. 2001;67(7):660.

    CAS  PubMed  Google Scholar 

  59. Kea B, et al. What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma? Am J Emerg Med. 2013;31(8):1268–73.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Rodriguez RM, et al. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT). PLoS Med. 2015;12(10):e1001883.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Joseph B, et al. Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury. Am J Surg. 2016;211(6):982–8.

    Article  PubMed  Google Scholar 

  62. Kulvatunyou N, et al. 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? J Trauma Acute Care Surg. 2012;73(6):1423–7.

    Article  PubMed  Google Scholar 

  63. Kulvatunyou N, et al. Two-year experience of using pigtail catheters to treat traumatic pneumothorax: a changing trend. J Trauma Acute Care Surg. 2011;71(5):1104–7.

    Article  Google Scholar 

  64. Bauman ZM, et al. A prospective study of 7-year experience using percutaneous 14-French pigtail catheters for traumatic hemothorax/hemopneumothorax at a level-1 trauma center: size still does not matter. World J Surg. 2018;42(1):107–13.

    Article  PubMed  Google Scholar 

  65. Miniño AM, et al. Deaths: injuries, 2002. Accessed on 12 July 2018; Available from https://stacks.cdc.gov/view/cdc/43296.

  66. Meyer DM. Hemothorax related to trauma. Thorac Surg Clin. 2007;17(1):47–55.

    Article  PubMed  Google Scholar 

  67. Nicol AJ, et al. Sternotomy or drainage for a hemopericardium after penetrating trauma: a randomized controlled trial. Ann Surg. 2014;259(3):438–42.

    Article  PubMed  Google Scholar 

  68. Beall AC, et al. Surgical management of penetrating thoracic trauma. Chest. 1966;49(6):568–77.

    Google Scholar 

  69. Working G, A. Ad Hoc Subcommittee on Outcomes. Practice management guidelines for emergency department thoracotomy. Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons-Committee on Trauma. J Am Coll Surg. 2001;193(3):303.

    Article  Google Scholar 

  70. Burlew CC, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359–63.

    Article  PubMed  Google Scholar 

  71. Seamon MJ, et al. An evidence-based approach to patient selection for emergency department thoracotomy: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;79(1):159–73.

    Article  PubMed  Google Scholar 

  72. Fabian TC, et al. Current issues in trauma. Curr Probl Surg. 2002;39(12):1160–244.

    Article  PubMed  Google Scholar 

  73. Isenhour JL, Marx J. Advances in abdominal trauma. Emerg Med Clin. 2007;25(3):713–33.

    Article  Google Scholar 

  74. Peitzman AB, et al. Prospective study of computed tomography in initial management of blunt abdominal trauma. J Trauma. 1986;26(7):585–92.

    Article  CAS  PubMed  Google Scholar 

  75. Holmes JF, McGahan JP, Wisner DH. Rate of intra-abdominal injury after a normal abdominal computed tomographic scan in adults with blunt trauma. Am J Emerg Med. 2012;30(4):574–9.

    Article  PubMed  Google Scholar 

  76. Nishijima DK, et al. Does this adult patient have a blunt intra-abdominal injury? JAMA. 2012;307(14):1517–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Jansen JO, et al. Selective non-operative management of abdominal gunshot wounds: survey of practise. Injury. 2013;44(5):639–44.

    Article  PubMed  Google Scholar 

  78. Inaba K, et al. Prospective evaluation of the role of computed tomography in the assessment of abdominal stab wounds. JAMA Surg. 2013;148(9):810–6.

    Article  PubMed  Google Scholar 

  79. Vaidya R, et al. Patients with pelvic fractures from blunt trauma. What is the cause of mortality and when? Am J Surg. 2016;211(3):495–500.

    Article  PubMed  Google Scholar 

  80. Hughes CW. Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery. 1954;36(1):65–8.

    CAS  PubMed  Google Scholar 

  81. Biffl WL, Fox CJ, Moore EE. The role of REBOA in the control of exsanguinating torso hemorrhage. J Trauma Acute Care Surg. 2015;78(5):1054–8.

    Article  PubMed  Google Scholar 

  82. Martinelli T, et al. Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures. J Trauma Acute Care Surg. 2010;68(4):942–8.

    Google Scholar 

  83. Joint Trauma System Clinical Practice Guideline (JTS CPG) for resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock. Accessed on 2 April 2018; Available from: http://prytimemedical.com/wp-content/uploads/2017/07/REBOA_-CPG_FINAL.pdf.

  84. Latifi R, Rhee P, Gruessner R, editors. Technological advances in surgery, trauma and critical care. New York: Springer Science + Business Media; 2015.

    Google Scholar 

  85. Latifi R, et al. Initial experiences and outcomes of telepresence in the management of trauma and emergency surgical patients. Am J Surg. 2009;198(6):905–10.

    Article  PubMed  Google Scholar 

  86. Latifi R, et al. Telemedicine and telepresence for trauma and emergency care management. Scand J Surg. 2007;96(4):281–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA

    Muhammad Zeeshan & Bellal Joseph

Authors
  1. Muhammad Zeeshan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bellal Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bellal Joseph .

Editor information

Editors and Affiliations

  1. New York Medical College, School of Medicine, Department of Surgery and Westchester Medical Center, Valhalla, NY, USA

    Rifat Latifi

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Cite this chapter

Zeeshan, M., Joseph, B. (2019). Trauma Room: “A Minute Man” Operating Room – Managing the Chaos Using Technologies. In: Latifi, R. (eds) The Modern Hospital. Springer, Cham. https://doi.org/10.1007/978-3-030-01394-3_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-01394-3_22

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01393-6

  • Online ISBN: 978-3-030-01394-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation