Evolving frontiers in severe polytrauma management - refining the essential principles.

This editorial aims to refine the severe polytrauma management principles. While keeping ABCDE priorities, the termination of futile resuscitation and the early use of tourniquet to stop exsanguinating limb bleeding are crucial. Difficult-airway-management (DAM) is by a structured 5-level approach. The computerised tomography (CT) scanner is the tunnel to death for hemodynamically unstable patients. Focused Abdominal Sonography for Trauma-Ultrasonography (FAST USG) has replaced diagnostic peritoneal lavage (DPL) and is expanding to USG life support. Direct whole-body multidetector-row computed tomography (MDCT) expedites diagnosis & treatment. Non-operative management is a viable option in rapid responders in shock. Damage control resuscitation comprising of permissive hypotension, hemostatic resuscitation & damage control surgery (DCS) help prevent the lethal triad of trauma. Massive transfusion protocol reduces mortality and decreases the blood requirement. DCS attains rapid correction of the deranged physiology. Mortality reduction in major pelvic disruption requires a multi-disciplinary protocol, the novel pre-peritoneal pelvic packing and the angio-embolization. When operation is the definitive treatment for injury, prevention is best therapy.

A preliminary survey of Hong Kong snake shops and the potential snake bite risks for the healthcare system.

Consumption of snakes is a traditional part of Chinese life. Snake shops, which provide both the food products and live snakes to the public, are believed by the medical community to stock only local species. The medical risk posed by these live snakes is therefore regarded as manageable as they are indigenous and thus effective anti-snake venom (ASV) is believed to be available. This study visited four snake shops, reviewed the snakes present and interviewed the vendors regarding the snakes' likely geographical origin. Snakes species were definitively identified and, in addition, the current stocking of ASV by hospitals in terms of amount and species covered was determined. Snakes were also examined to determine whether they had been de-fanged and thus rendered unable to inflict a venomous bite. The study identified that non-indigenous species are being imported, capable of delivering a venomous bite, which provide a tangible medical risk as ASV is not available to deal with envenomations.