Chapter 29 Torso and Pelvic Trauma

Injury seldom respects anatomical boundaries, hence the division of the body into the abdomen and the thorax is artificial. Therefore, injury to the torso with its associated physiological consequences is more appropriate. Injury consistently traverses different anatomical zones of the body, affecting structures on both sides of traditional anatomical zones. These zones are known as junctional zones. The pelvis contains a large plexus of vessels, both venous and arterial. Should injury occur, control of haemorrhage can prove to be exceptionally difficult and may require control of both arterial inflow and venous outflow. Angioembolisation can be a very useful adjunct to treatment, especially with deep pelvic injuries. Thoracic injury accounts for 25% of all severe injuries. In a further 25%, it may be a significant contributor to the subsequent death of the patient. Ultrasound can be used to differentiate between contusion and the actual presence of blood.

Multiple Choice Questions
Weblinks

In view of the complexities of managing trauma, world accepted guidelines and algorithms have been developed, based on best available evidence, that will provide guidance to those faced with managing major physical trauma, but sometimes with limited experience of management of the injury sustained.

Websites

https://www.wsacs.org/foam-resources/ (requires a login, but membership is free)

Free membership and resources from an international society.

https://www.wses.org.uk/ (free)

Free membership and resources from an international society focusing on all aspects of emergency surgery.

https://jevtm.com (free)

Free membership and resources from an international society focusing on haemorrhage control.

https://www.east.org/education-career-development/practice-management-guidelines

Eastern Association for the Surgery of Trauma: Practice Management Guidelines.

https://www.wses.org.uk/guidelines

World Society of Emergency Surgery.

https://www.westerntrauma.org/western-trauma-association-algorithms/

Western Trauma Association.

Guidelines

https://www.aast.org/resources-detail/injury-scoring-scale (free)

Educational resource providing current guidelines and a grading system for solid organ injury.

https://www.east.org/education-career-development/practice-management-guidelines/ (free)

Extensive practice management guidelines and educational resources related to the field of trauma.

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