Anaesthesiological approach to the patient in early stage of trauma disease

Abstract

INTRODUCTION. The paper presents 20-year long experience gained in work with traumatized patients at the Emergency Centre in Belgrade. The paper is primarily related to analysis of the so-called secondary approach to the patient in the Resuscitation Unit of the Emergency Centre Admission Department. Secondary approach is carried out in resuscitation room, and implies the restoration of patient?s vital parameters to physiological frame, observation of the patient and application of diagnostic procedures, set up of definitive agenda of treatment and preparation of the patient for surgery. OBJECTIVE. The objective of our study was to define doctrinal postulations in reanimation of traumatized patients considering the specifics of our region. METHOD. Statistical analysis of the patients was based on a one-year period (2006) and the obtained results were compared with the large 10-year mega American study (Scanel Waxman, Steven Baker). RESULTS. The comparison evidenced certain specificities characteristic for our settings. Trauma related death is the leading cause of mortality in population up to 30 years of age in our milieu. According to our statistics, injuries caused by traffic traumatism were most prevalent. Injuries caused by fire-arms were the second, and stabs were in the third place. Resuscitation measures were carried out according to strictly defined agenda based on 20-year experience, in relation to the extent of injuries, jeopardy of vital functions of the injured body and in the line with the definite plan of further treatment of the patient. CONCLUSION. All traumatized patients were hypovolemic, most of them were haemodynamically unstable, consciousness disorders of different degrees were present and in all of the patients morbidity was increased due to trauma. Resolution of each of the above disorders during early admission to hospital is frequently vital for the patient.