ATLS y trauma facial. ¿Un solo tamaño sirve para todo? Parte 1: dilemas en el manejo de pacientes con lesiones múltiples coexistiendo con lesiones faciales
Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 1: dilemmas in the management of the multiply injured patient with coexisting facial injuries.
Perry M.
Regional and Maxillofacial Trauma Units, Belfast, UK.mikepmaxfax@yahoo.com
Int J Oral Maxillofac Surg. 2008 Mar;37(3):209-14. Epub 2008 Feb 21.
Abstract
Maxillofacial trauma is without doubt still a very challenging area, especially in the early stages of care when other injuries may be present. Craniofacial trauma, with or without life and/or sight-threatening complications, may be associated with significant injuries elsewhere. Both general trauma and facial trauma management have evolved considerably over the last 20 years and on occasion clinical priorities may seemingly conflict, suddenly change or be hidden. In these circumstances a number of clinical dilemmas may arise, which this and three further reviews will discuss. These are based on review of the current literature, supplemented where appropriate by the collective experiences of the co-authors. Facial injuries can be broadly placed into one of four groups, which can aid determination of the urgency for treatment. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems.
http://download.journals.elsevierhealth.com/pdfs/journals/0901-5027/PIIS0901502707010314.pdf
ATLS y trauma facial:¿Un tamaño sirve para todos? Parte 2: ATLS, lesiones maxilofaciales y dilemas en el manejo de la vía aérea
Advanced trauma life support (ATLS) and facial trauma: can one size fit all? Part 2: ATLS, maxillofacial injuries and airway management dilemmas.
Perry M, Morris C.
Regional and Maxillofacial Trauma Units, Belfast, UK.mikepmaxfax@yahoo.com <mikepmaxfax@yahoo.com>
Int J Oral Maxillofac Surg. 2008 Apr;37(4):309-20. Epub 2008 Jan 18.
Abstract
Maxillofacial trauma poses an obvious threat to the patient's airway, which may not be immediately evident. In the multiply injured patient, the co-existence of actual or potential injuries elsewhere may complicate airway management, notably in the presence of full spinal immobilization. Following high-velocity trauma, injuries to the cervical spine must be assumed to be present. They also need to be ruled out in an appropriate and timely manner, as patients may wish to sit up. Assessment and management of the airway in maxillofacial trauma can be difficult, requiring a senior anaesthetist or other individual appropriately trained in emergency airway care. A number of management options may exist to protect the airway, each with advantages and drawbacks. Agitation and vomiting can occur unexpectedly and need to be managed safely with due consideration to the spine. Oral and maxillofacial surgeons need to be aware of these dilemmas and their early warning signs, and be skilled in emergency surgical airway procedures, especially if involved as part of the trauma team. Prolonged immobilization is associated with significant morbidity and mortality. A number of protocols currently exist for 'clearing' the spine. Imaging now plays a greater role, especially in the obtunded, unconscious or intubated patient, and this is discussed.
http://download.journals.elsevierhealth.com/pdfs/journals/0901-5027/PIIS0901502707010326.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 1: dilemmas in the management of the multiply injured patient with coexisting facial injuries.
Perry M.
Regional and Maxillofacial Trauma Units, Belfast, UK.mikepmaxfax@yahoo.com
Int J Oral Maxillofac Surg. 2008 Mar;37(3):209-14. Epub 2008 Feb 21.
Abstract
Maxillofacial trauma is without doubt still a very challenging area, especially in the early stages of care when other injuries may be present. Craniofacial trauma, with or without life and/or sight-threatening complications, may be associated with significant injuries elsewhere. Both general trauma and facial trauma management have evolved considerably over the last 20 years and on occasion clinical priorities may seemingly conflict, suddenly change or be hidden. In these circumstances a number of clinical dilemmas may arise, which this and three further reviews will discuss. These are based on review of the current literature, supplemented where appropriate by the collective experiences of the co-authors. Facial injuries can be broadly placed into one of four groups, which can aid determination of the urgency for treatment. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems.
http://download.journals.elsevierhealth.com/pdfs/journals/0901-5027/PIIS0901502707010314.pdf
ATLS y trauma facial:¿Un tamaño sirve para todos? Parte 2: ATLS, lesiones maxilofaciales y dilemas en el manejo de la vía aérea
Advanced trauma life support (ATLS) and facial trauma: can one size fit all? Part 2: ATLS, maxillofacial injuries and airway management dilemmas.
Perry M, Morris C.
Regional and Maxillofacial Trauma Units, Belfast, UK.mikepmaxfax@yahoo.com <mikepmaxfax@yahoo.com>
Int J Oral Maxillofac Surg. 2008 Apr;37(4):309-20. Epub 2008 Jan 18.
Abstract
Maxillofacial trauma poses an obvious threat to the patient's airway, which may not be immediately evident. In the multiply injured patient, the co-existence of actual or potential injuries elsewhere may complicate airway management, notably in the presence of full spinal immobilization. Following high-velocity trauma, injuries to the cervical spine must be assumed to be present. They also need to be ruled out in an appropriate and timely manner, as patients may wish to sit up. Assessment and management of the airway in maxillofacial trauma can be difficult, requiring a senior anaesthetist or other individual appropriately trained in emergency airway care. A number of management options may exist to protect the airway, each with advantages and drawbacks. Agitation and vomiting can occur unexpectedly and need to be managed safely with due consideration to the spine. Oral and maxillofacial surgeons need to be aware of these dilemmas and their early warning signs, and be skilled in emergency surgical airway procedures, especially if involved as part of the trauma team. Prolonged immobilization is associated with significant morbidity and mortality. A number of protocols currently exist for 'clearing' the spine. Imaging now plays a greater role, especially in the obtunded, unconscious or intubated patient, and this is discussed.
http://download.journals.elsevierhealth.com/pdfs/journals/0901-5027/PIIS0901502707010326.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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