ABC of Resuscitation

Resuscitation of the injured patient is often an Herculean task for the untrained health workers. Similarly, some students find it difficult answering questions on the initial care of the acutely injured patient. In this entry I have tried to summarise, in simple language, the essential components of resuscitation, specifically for use in head injury, but with wide-ranging applications in other trauma cases. This information is also useful to the members of the public who may at one time or the other find themselves at accident scenes and have to provide initial care for the injured.

The components are:

• Airway and cervical spine control: check for, and maintain airway patency. Remove debris or food particles which may occupy the mouth and the upper airway thereby preventing adequate air entry. Jaw thrust and/or traction on the tongue might be needed to keep the airway patent. Insertion of oropharyngeal airways, and when indicated/available, oro- or nasotracheal intubation are essential in keeping the airways open. The patient may die rapidly from asphyxia if this initial step is not quickly and meticulously carried out. In doing all these, it is essential to protect the cervical spine which must be assumed to have been injured in all unconscious patients and in those who have sustained significant impact to the cranium, face, neck and upper chest as well as those involved in high-velocity impacts and falls from height.

C-spine protection can be achieved with:

o Rigid neck collars
o Head strappings
o Supportive sand bags placed on each side of the neck

• Breathing: If there is no spontaneous breathing, assisted breathing is essential once airway patency is confirmed. Mouth-to-mouth breathing (Kiss of life; through an handkerchief), ambu-bagging and mechanical ventilation are done as necessary

• Circulation: a quick assessment of the patient’s circulation is done; radial pulse is palpated and BP measurement carried out. Maintenance of the circulation is done using intravenous fluids (crystalloids and colloids) as necessary. This is particularly important in the poly-traumatized patients with haemorrhage. If the initial circulation is not optimal, a search must be made for extracranial bleeding sites as intracranial bleed is not sufficient to cause circulatory collapse except in infants and very young children.

• Drugs may need to be administered. Commonly used drugs in head injury includes mannitol, analgesics, H2-receptor blockers/proton pump inhibitors, inotropic agents, anaesthetic agents, tetanus prophylaxis, etc. Watch-out for a review of these drugs. It is important to also adequately assess the dysfunction of the nervous system

• Environment: it is important to ensure that the environment in which care of the patient is done is safe to prevent further injuries to the patient as well as the care givers

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