Investigations
1st investigations to order
ECG
Test
Should be performed immediately on presentation.
Result
non-specific ST-T changes; atrial fibrillation; ventricular fibrillation; asystole
FBC
Test
Ordered as baseline.
Advised if trauma is suspected.
Low haemoglobin suggests internal bleeding.
Result
normal
electrolytes
Test
Ordered as baseline.
Abnormalities such as elevated potassium, creatinine, or urea suggest shock or rhabdomyolysis.
Result
normal
LFTs
Test
Ordered as baseline.
Result
normal
coagulation studies
Test
Ordered as baseline.
Advised if trauma is suspected.
Result
may be normal or abnormal
creatine kinase
Test
If elevated 5 times normal, suggests compartment syndrome with rhabdomyolysis.
Result
normal; or elevated in the presence of muscle lysis or muscle necrosis
urine myoglobin
Test
Rhabdomyolysis results in the precipitation of myoglobin in the renal tubules and subsequent risk of nephropathy.[26]
Result
negative; or positive in the presence of muscle cell lysis or muscle necrosis
cardiac enzymes (CK-MB and troponin)
Test
Need to be interpreted with caution.
Result
may be elevated
toxicology screen
Test
Recommended for all patients admitted with multi-trauma.
Alcohol may have contributed to the cause of the injury.
Cocaine use might increase cardiac vulnerability to ventricular fibrillation.[27]
Result
may be positive for alcohol or cocaine
chest x-ray
Test
Suggests flash pulmonary oedema secondary to cardiac dysfunction.
Result
increased alveolar markings
Investigations to consider
plain x-rays
Test
Usefulness will depend on the index of suspicion of an injury in the affected body part.
Result
confirm suspected bony injuries
head CT
Test
Indicated if head injury is suspected.
Result
intracerebral haemorrhage; skull fracture
head MRI
compartment pressure measurements
Test
Can be measured if compartment syndrome is suspected.
Differential pressure within 20-30 mmHg of the diastolic pressure (delta pressure) is considered a strong indicator for early surgical intervention.[29] Care should be taken when using this criterion for patients who are receiving vasodilatory medications whose diastolic blood pressure is low.
Patients with an intra-abdominal pressure ≥25 mmHg associated with organ dysfunction or failure should be submitted immediately to surgical decompression.[21]
Result
variable
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