Delirium in Trauma Patients: Prevalence and Predictors.

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Abstract

[Indexed for MEDLINE] 15. J Clin Orthop Trauma. 2020 Dec 5;13:106-115. doi: 10.1016/j.jcot.2020.12.003. eCollection 2021 Feb. Evaluation and management of haemorrhagic shock in polytrauma: Clinical practice guidelines. Vishwanathan K(1), Chhajwani S(2), Gupta A(3), Vaishya R(4). Author information: (1)Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India. (2)Department of Anaesthesia and Critical Care, Pramukhswami Medical College, Karamsad, India. (3)Division of Trauma Surgery & Critical Care, J.P.N. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India. (4)Department of Orthopaedics & Joint Replacement, Indraprastha Apollo Hospitals, New Delhi, India. Haemorrhagic shock is the most common preventable cause of early mortality in polytrauma patients. Road traffic injuries are the most common cause for polytrauma and most commonly include orthopaedic injuries. Hence, orthopaedic trainees and junior orthopaedic surgeons need to be well aware of evaluation and management of haemorrhagic shock in the multiple injured patient. The present narrative review discusses evaluation and current principles in management of haemorrhagic shock in a polytrauma patient. A classification system for haemorrhagic shock based on ATLS guidelines has been described along with novel use of colour coding to facilitate better and effective use of the classification. A treatment algorithm has also been presented for quick reference. The emphasis is to avoid overloading with crystalloid fluids, replacing with blood and blood products (Balanced resuscitation), permissive hypotension, prevent and acutely treat lethal conditions such as hypothermia, acidosis and coagulopathy. The management of haemorrhagic shock in polytrauma patient is quite challenging and require a detailed knowledge of its management. An arbitrary and haphazard management of these patients may lead to severe complications. We have mentioned the broad principles of management of hypovolemic shock in a polytrauma patient. © 2020 Delhi Orthopedic Association. All rights reserved. DOI: 10.1016/j.jcot.2020.12.003 PMCID: PMC7919934