FROM MARIO RUGNA, MEDEST118 –  Injury is a major cause of premature death and disability worldwide. Most existing injury control strategies focus on primary prevention – that is, avoiding the occurrence of injuries or minimizing their severity – or on secondary prevention – providing adequate medical response to enhance treatment and thereby minimize harm following an injury. Before approaching specific arguments about trauma here are 5 fundamental articles to read about new emerging concepts in trauma care. Those are the clinical and physiological bases to understand what is happening in the actual trauma management scene.

And now let’s go to specific area of interest:

• Spine immobilization

Spine immobilization in trauma is changing. After years of dogmatic approach to strict spine immobilization for all trauma patients regardless any other factor, is now pretty clear that not all the trauma patients benefits from this all or nothing way of thinking. MEDEST already faced the argument in previous posts (The Death of the Cervical Collar?) as also did some prehospital consensus guidelines (Faculty of Pre-Hospital Care Consensus Statements). In 2014 many articles treated this topic in a critical and modern way of re-thinking spinal immobilization, in particular the widespread use of cervical collar. The lessons we learned is that Widespread use of cervical collar in neck trauma has to be carefully evaluated (and even avoided) due to the low incidence of unstable spinal lesions. And routine use of cervical collar is of unclear benefit and supported by weak evidences. A new selective approach has to be implemented based on prehospital clearance protocols.

• Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma

• Learning the lessons from conflict: Pre-hospital cervical spine stabilisation following ballistic neck trauma

• Prehospital Use of Cervical Collars in Trauma Patients- A Critical Review

• Comparison of Three Prehospital Cervical Spine Protocols  for Missed Injuries

• Fluids and blood products

What is “revolution” in clinical practice? We don’t have the answer to this dilemma, but what is happening in fluid resuscitation for trauma patients seems likely to be revolutionary. Restrictive strategies and new blood products are the future for the treatment of trauma patients (read also Fluid resuscitation in bleeding trauma patient: are you aware of wich is the right fluid and the right strategy?).

• Liberal Versus Restricted Fluid Resuscitation Strategies in Trauma Patients

• Fluid resuscitation in trauma patients- what should we know

• Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

• The Ongoing Debate Between Crystalloid and Colloid

• Fluid Resuscitation for Trauma Patients: Crystalloids Versus Colloids

• Hypotensive Resuscitation

• Trauma and Massive Blood Transfusions

• Is early transfusion of plasma and platelets in higher ratios associated with decreased in-hospital mortality in bleeding patients?

• The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study

But much more happened in 2014 about trauma….

Resuscitative throacotomy is now a reality not only “in” but even “out” of hospital, so read all about it

• Resuscitative thoracotomy an update

An evergreen topic is TBI but new concepts are arousing so read here the latest updates

• Critical care management of severe traumatic brain injury in adults

New drugs and new protocols for airway and pain management: a rationale guide to choose the right drug for the right patient.

• Choice of General Anesthetics for Trauma Patients

• Pain   management   in   trauma   patients   in   (pre)hospital   based emergency   care:   Current   practice   versus new guideline

DISCLOSURE: MEDEST strongly encourage AWARNESS reading the propoused articles.
Abstracts are often misleading and articles potentially biased. Even this selection is not immune from potential bias (just human factors not commercial interests).
So download the full text and read it carefully to have a clear and complete opinion of the related topics.