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
care
Level 1 (I) trauma center • provides leadership in education,
research, and system planning
• providers are immediately
available
• provides comprehensive trauma
care
Level 2 (II) trauma center • meets same provider expectation
as level 1
• not required to participate in
education and research
• provides prompt immediate
emergency care and stabilization
Level 3 (III) trauma center but transfer patient to higher
level center
• serve a community that doesn’t
have access to level 1 or 2
• provide advance life support
before transfer
Level 4 (IV) trauma center • 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 shock waves that change the air
pressure resulting in tissue damage
when the air pass by the body
Secondary injuries occur from
Secondary category increased negative pressure from the
shock wave causing debris to impale the
body creating organ and tissue damage
Tertiary blast injuries are the result
Tertiary category from the body being thrown by the
force of the explosion
Quaternary blast injuries occur from
Quaternary category 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
• Prepare for intubation and
mechanical ventilation
• Computed tomography scan
Massive hemothorax • Chest tube insertion on
affected side
• Prepare emergency open
thoracotomy
Resuscitation in maintaining circulation:
• 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
