Contents:

Protocol for paging Trauma team The Trauma Team Primary Survey Secondary Survey Radiology Placement Head injuries Spinal Injuries Chest Injury Blunt abdominal Trauma Penetrating abdominal Trauma Urological Injuries Eye Trauma

Hand Injuries Burns Carbon monoxide poisoning Obstetric Trauma Paediatric Trauma Paediatric resuscitation chart Hypothermia Universal Precautions Blood Alcohol Testing Patient transfers into Liverpool Patient transfers out of Liverpool Telephone numbers Acknowledgments

STAB WOUNDS

( also refer to our abdominal stabbing algorithm and thoraco-abdominal stabbing algorithm)

All stab wounds to the abdomen must be explored in theatre. In the event of peritoneal penetration, a laparotomy should be performed. There may be a role for laparoscopy in stable patients when it is uncertain whether the peritoneum has been breached. If laparoscopy confirms the breach, laparotomy should be performed.

GUNSHOT WOUNDS

All gunshot wounds must be explored and debrided in the operating theatre.

ASSESSMENT

Obvious penetrating wounds of the peritoneal cavity (eg. with evisceration) must be explored under general anaesthesia.

Penetrating wounds situated anterior to the anterior axillary line between the nipples and the pubis which have not obviously penetrated the peritoneal cavity should be explored in the operating theatre.

Penetrating wounds between the anterior axillary line and para-spinous muscles must be explored under general anaesthesia.

Penetrating wounds to the abdomen must be suspected of penetrating the diaphragm, thus examination and chest X-rays are mandatory. Bullet wounds without exit wounds must be investigated by X-ray, as fragments may travel anywhere within the trunk or extremities. Wounds should be identified with radio-opaque markers (eg paperclips).

CT scan should be performed if there is haematuria.

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