Taghreed Alqarni

Trauma Management

What is trauma? Physical injury caused by external forces or violence

What is the priority goal in trauma care? Prevention

What is the priority goal after trauma happens? Early and aggressive interventions
to save life and limb.

Direct economic costs in traumatic injuries?

• Actual expense of acute hospitalization and rehabilitative care

Indirect economic costs in traumatic injuries?

• Lost work
• Physical disability
• Psychological disability
• Lost productivity

• Provide comprehensive trauma

Level 1 (I) trauma center
Level 2 (II) trauma center
Level 3 (III) trauma center
care
• provides leadership in education,
research, and system planning
• providers are immediately
available
• provides comprehensive trauma
care
• meets same provider expectation
as level 1
• not required to participate in
education and research
• provides prompt immediate
emergency care and stabilization
but transfer patient to higher
level center
• serve a community that doesn’t
have access to level 1 or 2

Level 4 (IV) trauma center
• provide advance life support
before transfer
• primary goal is to resuscitate
and stabilize patient and arrange
for immediate transfer to higher
level center

The 1st peak of death occurs within seconds to minutes from injury

The 2nd peak of death occurs within minutes to several hours from injury

The 3rd peak of death occurs within several days to weeks from injury

What is the “golden hour” in trauma care? The first hour

Who is usually the leader in trauma teams? The trauma surgeon

What to ensure at the scene of the injury?

• Full attention to AIRWAY

• Administer CERVICAL COLLAR to immobilize cervical spin
• Breathing
• Circulation
• Stabilizing fracture
• Ensure patent IV access
• Avoid large volume of fluids for resuscitation to be administered IV
Transporting patient depends on? Travel time, terrain, availability of air or ground
units, capabilities of transport personnel, weather conditions

What is a minor trauma? Single system injury that doesn’t pose a threat to life or
limb

What is a major trauma? Serious multiple-system injuries that require immediate

intervention to prevent disability, loss of limbs, or death

What is a disaster? Sudden event in which local EMS, hospitals, and community
resources are overwhelmed by the demands placed on them

Multiple patient incident: fewer than 10 victims

Multiple casualty incident: 10 to 100 victims

Mass casualty incident: more than 100 victims

Victims are triaged based on the severity of the injury as:

RED indicates emergent life threatening injuries

YELLOW indicates urgent major illness requiring care within an hour

GREEN indicates nonurgent injuries that the patient can self treat

BLACK means the patient is dead or near death

Define mechanism of injury: refers to how a traumatic event occurred, the injuring
agent, and information about the type and amount of energy exchanged during the
event

Type of injuries:

• Blunt trauma
• Penetrating trauma
• Blast injuries

Blunt trauma: the most common mechanism of injury, results from MVCs, assault
with blunt objects, falls from heights and sport related activities.

Penetrating trauma: results from implement of foreign objects into the body such
as knives and bullets.
Blast injuries: forms of blunt and penetrating trauma and it has 4 categories

The primary explosive blast generates

Primary category
Secondary category
Tertiary category
Quaternary category
shock waves that change the air
pressure resulting in tissue damage
when the air pass by the body
Secondary injuries occur from
increased negative pressure from the
shock wave causing debris to impale the
body creating organ and tissue damage
Tertiary blast injuries are the result
from the body being thrown by the
force of the explosion
Quaternary blast injuries occur from
chemical, thermal, and biological
exposure

Primary survey: most crucial assessment tool takes 1-2 minutes to identify life
threatening injuries, establish priorities and provide care. (ABCDE)

Secondary survey: methodical head to toe assessment by observation, palpation,

percussion, and auscultation to identify all injuries.
Resuscitation in maintaining airway:

• Most common cause of airway obstruction is the tongue

• Maintain open airway by haw thrust or chin lift
• Nasopharyngeal and oropharyngeal airway maintenance are the 2nd choice
• If the patient has facial fractures, was hard to intubate, has facial or upper
airway burns, or oropharyngeal hemorrhage USE Cricothyrotomy

Resuscitation in maintaining breathing effectively:

• Apply supplementary oxygen with ventilatory assistance if needed

• Assess patient frequently for O2 saturation, RR, and respiratory effort
• Assess patient’s ABG
• Remove secretion if needed

Tension pneumothorax • Needle compression

• Chest tube insertion on
affected side
Pneumothorax • Chest tube insertion on
affected side
• Seal wound with occlusive
Open chest wound dressing and tape on 3 sides
• Chest tube insertion on
affected side
Pulmonary contusion • Early intubation and mechanical
ventilation
Flail chest • Early intubation and mechanical
ventilation
• Administer analgesics
Spinal cord injury • Avoid hyperextension or
rotation of the neck
• Observe ventilatory effort and
use of accessory muscles
• Complete spinal immobilization
• Monitor for signs of disruptive
or neurogenic shock
Decreased LOC • Position the head midline with
the head of the bed elevated
• Prevent aspiration

Massive hemothorax
Resuscitation in maintaining circulation:
• Prepare for intubation and
mechanical ventilation
• Computed tomography scan
• Chest tube insertion on
affected side
• Prepare emergency open
thoracotomy

• Monitor vital signs for hypovolemia or hypovolemic shock

• Monitor urine output, mental status
• Rapid identification of the cause (external-internal hemorrhage) and
eliminate it
• Signs and symptoms of shock: tachycardia and tachypnea, narrow pulse
pressure, PaO2 fall, decrease urine output, decrease hematocrit

To treat hypovolemia:

• find the cause and stop the bleeding

• find venous access to administer fluids
• find intraosseous access if IV is not available
• central line access
• Administer lactated ringer (crystalloids)
• Administer blood products based on needs and response

In case of no response to treatment: surgical interventions are needed

Complications to massive fluid resuscitation: fluid electrolyte imbalance,

hypothermia, coagulopathies, organ dysfunction

What is a compartment syndrome? Occurs when a fascia closed muscle

compartment such as an extremity experiences increased pressure form internal
and external sources. If not resolved results in ischemia

Late signs of compartment syndrome: paresthesia, pulselessness, and paralysis.

Management:

• Elevate the extremity to heart level to promote venous outflow, in case of

deterioration do fasciotomy