Polytrauma Cases – When to Cut and When to Wait

Introduction:
It is fair to say that the optimal timing of definitive surgical intervention for veterinary patients following extensive trauma has yet to be defined. Although ample research has been carried out in people, the extrapolation of the evidence and protocols to the care of veterinary patients should be done with great care. Differences are not simply related to the patient factors (eg, distinct types of injuries, physiological differences) but also due to the organization of pre-hospital care, and dedicated organized hospital care (eg Trauma Centres) available in human healthcare.

Trauma patients requiring surgery can be categorized into three groups: 1) Those that require immediate surgical intervention to prevent imminent death, 2) Those with varying degree of haemodynamic instability and with injuries that merit urgent surgical intervention, and 3) Those that are hemodynamically stable and can be operated on a semi-elective basis as resources allow. In terms of when to perform surgery, there is little doubt with patients in categories 1 or 3, however for patients in category 2, who have suffered severe but not immediately life-threatening injuries such as long bone fractures, pelvic ring fractures and severe soft tissue wounds from polytrauma, there is great uncertainty of the best approach.  [...]