By Ian Greaves, Graham S. Johnson
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Extra info for Practical emergency medicine
In an intubated patient monitoring of end-tidal carbon dioxide provides confirmation of successful tracheal intubation and alerts the team to the possibility of the tube being displaced. Many portable and fixed monitors have the capability to monitor carbon dioxide levels in the expired gases, and small disposable colorimetric devices are available which connect to the endotracheal tube. In addition to the urinary catheter, a gastric tube should also be inserted. This provides diagnostic information on the presence of bleeding in the stomach.
Therefore the airway is opened and protected whilst immobilizing the cervical spine. Major lifethreatening breathing abnormalities are identified and corrected. The presence of shock is sought, any bleeding controlled and intravenous fluid infusions started. A brief assessment of neurological status is performed and the patient is fully exposed but protected from hypothermia. 3). The primary survey is regularly revisited to ensure that any interventions performed have corrected the problem and that there has been no deterioration.
It is usually available in 10-15 min. Fully cross-matched blood usually takes 40-60 min to be available. The diagnosis of non-haemorrhagic shock is based on a failure of the patient to respond to intravenous fluid infusion and the absence of an injury causing significant haemorrhage. In practice, it is not uncommon for shock in a multiply injured patient to have both haemorrhagic and non-haemorrhagic aetiology. A search should be made for an injury that might be associated with non-haemorrhagic shock, such as a cervical spinal cord injury or a precordial penetrating injury, which might be associated with a cardiac tamponade.