Major Trauma & Multiple Injuries Cheat Sheet

Major trauma involves severe injuries that can lead to death, requiring rapid assessment and management. Understanding the causes, immediate threats, and systematic approach is crucial for survival.

Core Principles

• Trauma is a leading cause of mortality, especially in younger age groups (1-44 years).
• Injuries are classified as penetrating (low or high velocity) or blunt.
• Major trauma can cause immediate, early, or late death, depending on the severity and type of injury.
• Management follows a structured approach, starting with primary survey (ABCDE) and resuscitation.
• The 'Triad of Death' (hypothermia, coagulopathy, acidosis) must be prevented.
• Early detection and management of life-threatening conditions like airway obstruction and severe bleeding are paramount.

Action Steps

• Perform primary survey (Airway, Breathing, Circulation, Disability, Exposure).
• Control external bleeding using compression, pressure bandages, or tourniquets.
• Establish large-bore IV access and administer fluids and blood products.
• Assess and manage airway obstruction using maneuvers, tubes, or intubation.
• Stabilize cervical spine immediately.
• Conduct secondary survey (history and head-to-toe examination) once primary survey is complete.
• Obtain necessary radiological assessments (X-rays, FAST exam).
• Administer antibiotics and tetanus prophylaxis.
• Prioritize treatment based on severity: airway, circulation, severe bleeding, head injuries, then others.

Key Terms

• Penetrating Injury: Injury caused by sharp objects or projectiles (e.g., stab wounds, gunshot).
• Blunt Injury: Injury caused by impact, deceleration, or direct blow (e.g., falls, car accidents).
• ATLS: Advanced Trauma Life Support protocol, a systematic approach to trauma care.
• ABCDE: Primary survey steps: Airway, Breathing, Circulation, Disability, Exposure.
• FAST Exam: Focused Assessment with Sonography in Trauma, used to detect free fluid.
• Triad of Death: Hypothermia, Coagulopathy, and Acidosis, a lethal combination in trauma patients.

Pro Tips

• In mass casualty, triage critically injured patients first if resources are limited.
• Nasotracheal intubation is safer if cervical spine fracture is suspected.
• A patent airway is indicated by the patient's ability to speak unstrained.
• For open pneumothorax, initial treatment is an occlusive dressing taped on three sides.
• The nipple is a landmark for the 5th intercostal space for chest tube insertion.
• Monitor urine output (0.5-1 ml/kg/hour) to assess resuscitation effectiveness.
• Prolapsed viscera or bones are covered, not reduced, with sterile dressing.
• Meticulous examination is crucial as multiple injuries are common.

Pitfalls to Avoid

• Delaying airway management.
• Inadequate control of external or internal bleeding.
• Failure to recognize and manage tension pneumothorax promptly.
• Missing occult severe internal bleeding sites (thoracic, abdominal, pelvic, femur).
• Not preventing or treating hypothermia.
• Reducing prolapsed organs or bones.
• Losing time on investigations when urgent surgery is needed.

Real World Examples

• Pedestrian struck by a vehicle.: Suffers direct trauma and acceleration injury.
• Car occupant not wearing a seat belt.: Body strikes car interior upon impact.
• Car occupant wearing a seat belt.: May sustain seat belt injuries (skin marks, clavicle fracture, etc.).

Statistics

• Commonest cause of death (age 1-44): Trauma
• 3rd common cause of death (all ages): Trauma
• Urine output for normal resuscitation (adults): 0.5 -1 ml/kg/hour