Operational Critical Care. Intensive Care and Trauma

Abstract

Trauma management involves good prehospital, emergency, surgical, anaesthetic and intensive care decision-making. Optimal outcome depends on keeping abreast of the latest thinking in an ever-changing and increasingly technology-rich environment. The intensive care unit needs to represented as early as possible in the damage-control resuscitation phase. Improved trauma system care has resulted in an increasing number of multiply injured military patients surviving their initial trauma. These patients require intensive care and are at risk from sepsis and multiple organ failure. Attention to detail is important, preservation of organ function, infection control and nutrition to maintain muscle strength allowing normal metabolic function to return. Multiply injured patients often require lengthy periods of mechanical ventilation and a variety of therapeutic interventions may have to be considered during management of the disease process. As we are now seeing more survivors in the military trauma system the focus now needs to be morbidity reduction in order for these survivors to be best prepared for their rehabilitation phase of care.

Critical Care at Role 4

“…Unless the patient has specific localised injuries indicating a need for ongoing neurosurgical or cardiothoracic surgery, the default plan is to admit to Area B. Repatriation to the UK is carried out by the Critical Care Air Support Team (CCAST) normally within 24-48 hours, via a seamless continuation of Role 3 critical care through to UHB. Further description of this process is beyond the scope of this article [1,2] …”

Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine

“…During the recent conflicts in Iraq and Afghanistan, advances in medical care, along with improved personal protective equipment, increased survivability from significant complex trauma,1 thus presenting a myriad of challenges for early rehabilitation.…”