fractures, hydrothorax, and pulmonary contusion when compared to the chest x-ray. CT scans of the pelvis, head, abdomen, or chest are enough to guide the surgeons as to which areas of the body need to be treated surgically. CT scans of the pelvis and abdomen are usually done together using oral and intravenous contrast. Abdominal and pelvic organ damage can be identified along with retroperitoneal and pelvic injuries. This eliminates the need for angiographic study of these areas; however, angiographic interventions may still be necessary. CT scanning is a good replacement for plain radiographs in evaluating patients with spinal trauma. While CT scanning of the spine is being done, there can be simultaneous evaluation of the chest, pelvis, and abdomen. If these studies aren’t done by the emergency room staff, they are often done by the consulting orthopedist or neurosurgeon. If CT scanning is unavailable, plain films of the spine may be helpful. If the patient is at low risk for spinal injury, this evaluation can be undertaken at a later time. If there is an urgent need to rule out a cervical spine injury, a portable x-ray of the lateral cervical spine can be undertaken in the emergency department during resuscitation. Eventually, a full spinal series needs to take place to evaluate the entire spine. If a cervical fracture is found, there is a ten percent chance that the patient has another spinal injury. Magnetic resonance imagery can be done to rule out injuries to the ligaments and muscles around the spine. Nerve root injury can be found on an MRI scan. Angiography can be both a diagnostic test and a therapeutic test. The most common reason why an angiography is ordered in the emergency department is to identify and control bleeding from an arterial source in blood vessels supplying the pelvis or retroperitoneum. Angiographic embolization is the preferred method of treating these types of hemorrhages and helps avoid surgery to treat these things. Angiography can be done after CT scan with contrast reveals a major bleed in the abdomen or pelvis. The most important lab test to do in the early stages of trauma management is the type and crossmatch, which is usually available in twenty minutes. Arterial blood gases can also be done in this period; however, continuous pulse oximetry may be just as valuable and less invasive. A baseline hemoglobin can be done but may not reflect a major hemorrhage in the early stages. This may need to be repeated after fluid resuscitation to fully evaluate the patient for hemorrhaging. Urine drug screens for illicit drugs and an alcohol screen are often done at major trauma centers to see if these things are interfering with the resuscitation process. Blood alcohol and glucose testing can help identify possibly correctable reasons for a low level of consciousness. Assessments of coagulation, electrolytes, and cell counts are not very useful in trauma patients.
Key Takeaways •
The most common cause of multiple organ dysfunction syndrome is bacterial sepsis.
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Patients decompensate because of poor oxygenation that leads to cardiac dysfunction and poor end organ perfusion.
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Resuscitation with fluids is the treatment of choice in sepsis; however, vasopressors and albumin can be used to restore volume.
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