Major Trauma & Multiple Injuries Cheat Sheet

Major trauma involves severe, life-threatening injuries requiring immediate, systematic assessment and management to prioritize life-saving interventions and prevent further deterioration.

Core Principles

• Trauma is a leading cause of death, particularly in younger age groups (1-44 years).
• Injuries are broadly classified into penetrating (low and high velocity) and blunt trauma.
• Mortality in major trauma occurs in three phases: immediate (minutes), early (hours), and late (weeks).
• Management follows a structured approach, starting with a primary survey (ABCDE) and progressing to secondary survey and definitive treatment.
• The Advanced Trauma Life Support (ATLS) protocol provides a standardized framework for managing trauma patients.
• Early recognition and management of life-threatening conditions like airway obstruction, tension pneumothorax, and severe bleeding are critical.

Action Steps

• Perform primary survey (Airway, Breathing, Circulation, Disability, Exposure).
• Control external bleeding using direct pressure, elevation, or tourniquet if necessary.
• Initiate resuscitation with IV fluids and blood products as indicated.
• Conduct a secondary survey, including a head-to-toe examination.
• Obtain necessary radiological assessments and laboratory samples.
• Administer antibiotics and tetanus prophylaxis.
• Plan definitive treatment based on injury severity and type.

Key Terms

• Penetrating Injury: Injury caused by sharp objects or projectiles, categorized by velocity (low vs. high).
• Blunt Injury: Injury caused by direct impact, falls, or deceleration forces.
• ATLS: Advanced Trauma Life Support protocol for standardized trauma care.
• ABCDE: Primary survey components: Airway, Breathing, Circulation, Disability, Exposure.
• Tension Pneumothorax: Air trapped in the pleural space, causing mediastinal shift and hemodynamic compromise.
• Hemorrhagic Shock: Shock caused by significant blood loss.
• Triad of Death: Hypothermia, coagulopathy, and acidosis, a lethal combination in severe trauma.
• EFAST: Extended Focused Assessment with Sonography in Trauma, used for rapid bedside imaging.

Pro Tips

• In mass casualty incidents, triage patients based on clinical diagnosis and available resources.
• For airway management, the ability to speak clearly indicates a patent airway.
• In cases of suspected cervical spine fracture, use jaw thrust rather than head tilt-chin lift.
• For open pneumothorax, use an occlusive dressing taped on three sides to create a flutter valve.
• Recognize the 'Triad of Death' in trauma: hypothermia, coagulopathy, and acidosis.

Pitfalls to Avoid

• Failure to secure the airway can lead to immediate death.
• Delaying treatment for tension pneumothorax can cause rapid deterioration.
• Overlooking occult internal bleeding can result in hemorrhagic shock.
• Inadequate exposure and environmental control can lead to hypothermia.
• Rushing investigations when a patient is critically ill and requires immediate surgery.

Statistics

• Commonest cause of death (age 1-44): Trauma
• 3rd common cause of death (all ages): Trauma

Timeline

• Within minutes: Immediate death (e.g., airway obstruction, major vascular rupture, brain/spinal cord injury).
• Within hours: Early death (e.g., intracranial, intrathoracic, or intra-abdominal hemorrhage, major fractures).
• Within weeks: Late death (e.g., sepsis, multiple organ failure).
• Ongoing: Continuous monitoring of vital signs, oxygen saturation, and urine output.
• Post-resuscitation: Secondary survey and definitive treatment planning.

Quiz

• What are the three main phases of death in major trauma?: Immediate, Early, Late
• Which of the following is NOT a component of the primary survey (ABCDE)?: Diagnosis
• What is the 'Triad of Death' in trauma?: Hypothermia, Coagulopathy, Acidosis