Emergency eye care in the accident and emergency department.

Abstract

Sir I completed an Advanced Trauma and Life Support (ATLS) court in March this year. The next day I was senior house officer (SHO) on call covering general surgery for the weekend when a call was put out for the trauma team to report to the resuscitation room in the accident and emergency (A&E) department. A helicopter had crashed and a survivor was in the resuscitation room. Following immediate intubation examination revealed that he had a superficial wound to the left upper chest and a flail segment of that same side with poor air entry. I inserted a large chest drain immediately, without radiological confirmation, and the aspiration of air and blood improved his oxygenation. Following rapid infusion of fluid and blood as per ATLS guidelines his blood pressure rose to 110/90ml of mercury and his heart rate was 120 beats min-1. He had a fracture of the left femur and radiographs of the cervical spine, chest and pelvis revealed a fracture of the pelvis and marked shadowing in the left lung field with multiple rib fractures. The case demonstrated clearly to me the value of the ATLS course I had just attended. In a crisis situation it gives a system of working whereby a patient can be managed quickly and in an orderly fashion. I would encourage everyone who deals with trauma to undertake this valuable course.