Index

abbreviated injury score AMPLE, 48 (AIS), 21 anaerobic metabolism, 37 abdominal anatomy, 122 analgesia, 46, 144 four quadrants of the burns, 187 abdomen, 123 children, 211 retroperitoneum, 123 older people, 223 abdominal assessment, 129 anatomical and physiological abdominal injuries, 121 changes in pregnancy, A,B,C,D,E, 28 232 advanced warning, 27 anatomical and physiological aerobic metabolism, 37 differences in children, ageing (physiological 196 changes associated anatomy of the head, 54 with), 219 anatomy of the pelvis, airbags, 11 139 airway adjuncts, 32 anatomy of the spine, 101 nasopharyngeal airway, 32 spinal column, 101 oropharyngeal airway, 32 spinal cord, 101 airway assessment, 30 anatomy of the thorax, 76 airway burns, 177 angiography and airway management, 30 embolisation, 150 paediatric patients’, 200 anterior-posterior pelvic airway obstruction, 30, 80 injuries, 141 airway with cervical spine antiemetic, 46 control,COPYRIGHTED 29 arterial MATERIAL blood gases, 38 altered vital signs arterial injury, 165 hypovolaemic older assaults, 15 patients, 224 assessment of extremity pregnancy, 238 trauma, 167

275 Index assessment of level of brain, 57 consciousness, 44 brain regions, 54 assessment of the injured breaking bad news, 268 child, 200 breathing assessment ‘look, assessment of pelvic injury, listen and feel’, 38, 94 144 breathing and ventilation, 37 assessment of the pregnant burn depth 181 trauma patient, 235 burn injury referrals, 189 assessment of thoracic burn surface area, 183 injury, 93 burn wound care, 188 attending a coroner’s burns, 173 inquest, 250

AVPU, 44, 209 CO2 monitoring, 38 calculation of ET tube size, base of skull fractures, 55 202 Battle’s sign, 56 Canadian C-Spine Rules, 116 Beck’s triad, 87 carbon monoxide poisoning, behavioural evidence, 266 179 bereaved relatives, 268 cardiac tamponade, 78, 86 biological evidence, 265 cardiovascular assessment in bladder injury associated older trauma patients, with a pelvic injury, 147 223 blast injuries, 19 cavitation, 16 primary, 19 cerebral herniation, 61 secondary, 20 cerebral perfusion pressure tertiary, 20 (CPP), 60 blood pressure, estimation in cerebral vasodilation, 67 children, 199 cervical spine blood samples to police, 255 immobilisation, 36, 110 blood tests, 42 older patients, 218 blood transfusion, 43 paediatric patients, 203 blunt abdominal trauma, 124 cervical spine blunt thoracic trauma, 78, 91 immobilisation in blunt trauma (defi nition), 3 agitated patients, 111 bony injuries, 155 cervical spine bradycardia associated with immobilisation in spinal injuries, 110 children, 203

276 Index cervical spine CT scanning, 46 immobilisation in head injured patients, vomiting patients, 112 71 chemical burns, 174 Cushing’s response, 60 chest drain insertion, 82 CWILTED, 214 child protection, 213 cycle accidents, 13 children, normal observation parameters, 195 debridement, 161 chin lift, 31 deceased patients, 249 circulation and haemorrhage deceleration, 4 control, 39 decision making algorithm circulatory assessment, 41 for pelvic injury clamping underwater seal management, 149 chest drains, 83 defi nitive airway 33, classifi cation of pelvic defi nitive care, 49 fractures, 141 de-gloving injuries, 161 clearing the cervical spine, diagnostic imaging, 46 116, 212 CT scan, 46 coagulopathy, 42 X-rays, 46 compartment syndrome, 163 diagnostic imaging for complex pattern pelvic abdominal injuries, injury, 144, 132 compound (open) fractures, diagnostic imaging for the 158 SCI patient, 117 concussion, 62 diagnostic peritoneal confi dentiality and lavage/aspirate (DPL/ disclosure to police DPA), 134 offi cer, 252 diaphragmatic injury, 126 contusion, 62 diaphragmatic paralysis, cooling (hypothermia) for 113 brain injuries, 71 diaphragmatic rupture, 93, coroner (role of), 246 126 coroner’s inquest, 250 disability and dysfunction, cricoid pressure, 34 44 crush injuries, 163 disclosure (other agencies), CSF leak, 56, 70 256 halo test, 71 dislocation, 155

277 Index documentation, 48, 266 fl uid replacement formulae recording accurate in burns, 185 medical terminology, fl uid resuscitation, 42 261 fl uid resuscitation for domestic violence thoracic injury, 96 (pregnancy), 241 focussed assessment with domestic violence (red sonography in trauma fl ags), 242 (FAST), 39, 132, 149, 224 dying declarations, 254 foetal assessment, 240 forensic evidence, 259 ECG, 95 forensic medical examiner elder abuse, 227 (FME), 255 electric burns, 175 foreign body removal, 31 cardiac involvement, 176 four-person logroll, 37, 45 renal involvement, 176 fractures, 157 electrical burn injury, 175 fundal height, 239 emergency caesarean section, 241 Glasgow Coma Scale (GCS), endotracheal intubation, 33 44, 68 energy transmission, 2 gunshot wounds, 16 evisceration, 128, exposure and environmental haemorrhage (altered vital control, 45 signs), 41 external fi xation for pelvic haemorrhage (common injuries, 150 sites), 39 external haemorrhage haemorrhage control for control, 168 pelvic injuries, 146 extradural haematoma, 63 haemothorax, 81 extremity trauma, 154 haemotympanum, 56 hard and soft signs of facial fractures, 56 vascular injury, 165 falls, 15 head anatomy, 54 fasciotomy, 165 head injuries, 53 femoral fractures, 158 hidden six, 80 fi rearm wounds, 254 high energy wounds, 17 fl ail chest, 88 horizontal assessment, 28 fl uid loss in burns, 181 human factors, 27

278 Index hypercarbia, 67 jet insuffl ation, 35, 203 hypertonic saline solution (HTS), 67 ketamine, 46 hyperventilation, 67 kyphosis, 222 hypoperfusion (spinal cord), 107 lateral compression pelvic hypotension injuries, 142 hypovolaemic shock, 40 Le Fort injuries, 56 neurogenic shock, 114 lethal six, 80 hypovolaemic shock, 40 life and limb threatening compensation, 40 extremity trauma, 156 older people, 224 limb assessment, 169 hypoxia, 37 liver injuries, 124 hypoxia of the spinal cord, logrolling injured children, 106 210 ‘look, listen and feel’, 38, 94 impalements, 19 loss of sympathetic inhalation injury, 178 innervations, 108 initial assessment and loss of vasomotor tone, 108 resuscitation of the low energy wounds, 18 trauma patient, 24 low volume fl uid injury scoring systems, 20 resuscitation, 43 injury severity score (ISS), 21 Lund and Browder chart, intercostal nerve paralysis, 184 113 intracerebral haematoma, 65 magnetic resonance imaging intracranial pressure (ICP), (MRI), 117, 218 59, 70 massive haemothorax, 81 intraosseous needle mastoid process bruising, insertion, 207 56 intravenous fl uids, 42 maternal assessment, 239 abdominal injuries, 131 mean arterial pressure, intubation, 33 (MAP), 60 head injured patients, 73 mechanical instability, 106 mechanism of burn injury, jaw thrust, 31 174 children, 201 mechanism of injury, 1

279 Index mechanism of pelvic injury, occupant collision: frontal 140 impact, 5 mechanisms of spinal injury, occupant collision: lateral 103 impact, 7 medical records, 250 occupant collision: rear medium energy wounds, impact, 8 17 occupant collision: rollover, meninges, 57 8 metabolic acidosis, 37 oesophageal perforation, methylprednisilone, 115 90 minor head injury, 70 older abuse (red fl ags), 228 moderate head injury, 70 open pelvic fractures, 144 morphine, 46 open pneumothorax, 85 motorcycle accidents, 13 organ collision, 5 myocardial contusion, 91 organ collision: compression myoglobinuria injury, 9 compartment syndrome, organ collision: deceleration 163 injury, 10 electric burns, 176 organ collision: restraint injury, 10 National Confi dential organ and tissue donation Enquiry in Patient following a trauma Outcome and Death death, 257 (NCEPOD), viii otorrhoea, 56 Needle decompression, 85 oxygen saturation Nerve injury, 166 measurement, 38 Neurogenic shock, 107 burns, 179 Neurosurgical referral for the brain injured paediatric Glasgow Coma patient, 72 Scale, 209 NEXUS, 116 paediatric trauma, 194 NICE head injury guidance, painful stimulus (GCS), 69 71 paradoxical chest movement, 88 occupant collision, 5 Parkland formula, 185 occupant collision: ejection, pedestrian impact, 12 9 pelvic anatomy, 139

280 Index pelvic fractures, 141 property, 48 pelvic injuries, 138 deceased trauma patients’, pelvic wedge, 236 249 penetrating abdominal psychological effects of trauma, 124 trauma on children, 214 penetrating brain injury, 65 public interest disclosure, penetrating injuries 253 (defi nition), 16 pulmonary contusion, 92 penetrating neck injury, pulsus paradoxus, 87 103 pupil reaction, 70 penetrating objects in situ, pupil size, 70 128 penetrating thoracic trauma, raccoon eyes, 56 79, 86 rapid sequence induction pericardiocentesis, 87 (RSI), 33 periorbital bruising, 56 referring the burn injured permissive hypotension, 43 patient, 189 physical evidence, 262 relatives (care of), 48, 268 clothing, 263 renal injuries, 127 physiology of ageing, 218 reporting deaths, 247 placental abruption, 241 respiratory rate, 38 poikilothermia, 116 revised trauma score (RTS), police family liaison offi cers, 21 256 rhabdomyolysis police service (the role of), compartment syndrome, 252 163 polypharmacy, 224 electric burns, 176 pre-hospital information, 3 rhinorrhoea, 56 premature labour, 240 rigid spine board, 111 pre-transfusion blood road traffi c accidents (RTAs), samples, 255 4 priapism, 107 rule of nines, 184 primary and secondary brain injuries, 58 scalp assessment, 71 primary and secondary scalp wounds, 54 spinal cord injury, 105 scapulae fractures, 88 primary survey, 29 SCIWORA, 117, 212

281 Index secondary survey, 48 thoracic anatomy, 76 semi-rigid collar, 36 diaphragm, 77 severe head injury, 70 heart, 78 skull fractures, 55 lungs, 77 depressed, 55 mediastinum, 77 linear, 55 parietal pleura, 77 spinal anatomy, 101 ribs, 76 spinal injuries, 100 scapula, 76 spinal injuries units, 118 sternum, 76 spinal shock, 107 thoracic cage, 76 splenic injuries, 125 thoracic cavity, 76 splinting limb injuries, 168 visceral pleura, 77 stab wounds, 18 thoracic injury, 75 statement (writing), 268 thoracic suction, 83 sternum fractures, 88 thoracic trauma, 75 steroids (SCI), 115 thoracotomy in the ED, 97 stridor, 39 three phases of injury, 12 subconjunctival trace evidence, 264 haemorrhage, 56 tracheobronchial tree injury, subdural haematoma, 64 90 subluxation, 157 traditional fl uid sucking chest wound, 85 replacement, 43 suction, 31 transfer supplemental oxygen, 38 burn injured patients, 190 surgical airway, 35 defi nitive care, 49 needle cricothyroidotomy, head injured patients, 72 35 spinal cord injured surgical patients, 118 cricothyroidotomy, 35 trauma injury severity score surgical fi xation of pelvic (TRISS), 21 injuries, 151 trauma in older people, 217 trauma in pregnancy, 231 tension pneumothorax, 84 trauma related deaths, 245 tetanus immunisation, 47 trauma team, 26 tetanus prophylaxis, 46, 162 trauma team activation, 27 tetanus toxoid trauma team roles, 26 immunisation, 162 traumatic amputation, 159

282 Index traumatic aortic disruption, vascular injury, 165 89 vena cava compression, 236 traumatic axonal injury, 63 vertical assessment, 28 traumatic wounds, 161 vertical shear pelvic injuries, trimodal death distribution, 143 25 visual evidence, 260 tube thoracostomy, 82 vomiting (during spinal immobilisation), underwater seal chest 36, 112 drainage, 83 uterine contractions, 239 weight estimation in uterine rupture, 240 children, 196 wheeze, 39 vagal nerve stimulation, 110 wound irrigation, 161 vaginal bleeding, 240 writing a statement, 268

283