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 (direct blow, fall, RTA).
• Causes of death post-trauma occur immediately, early (hours), or late (weeks), linked to airway, hemorrhage, or sepsis.
• Management follows the ATLS protocol, starting with a primary survey (ABCDE) and resuscitation.
• Secondary survey involves a head-to-toe examination to identify all injuries, prioritizing life-threatening conditions.
• The 'Triad of Death' (hypothermia, coagulopathy, acidosis) must be prevented and managed.

Action Steps

• Perform primary survey (ABCDE): Airway, Breathing, Circulation, Disability, Exposure.
• Control external bleeding using compression, direct pressure, elevation, or tourniquet.
• Insert large-bore IV lines and administer crystalloids and blood as needed.
• Conduct a secondary survey, gathering history (SAMPLE) and performing a head-to-toe examination.
• Identify and manage life-threatening conditions like airway obstruction, pneumothorax, hemothorax, flail chest, and cardiac tamponade.
• Monitor vital signs, urine output, and neurological status throughout care.
• Administer antibiotics and tetanus prophylaxis as indicated.
• Plan definitive treatment based on injury severity and type.

Key Terms

• Major Trauma: Severe injury that threatens life or limb, requiring a systematic approach.
• Penetrating Injury: Injury caused by a sharp object or projectile (e.g., stab, gunshot).
• Blunt Injury: Injury caused by impact, deceleration, or crushing forces (e.g., falls, RTA).
• ATLS: Advanced Trauma Life Support protocol for systematic trauma management.
• ABCDE: Primary survey components: Airway, Breathing, Circulation, Disability, Exposure.
• Triage: Sorting patients based on severity and available resources in mass casualty incidents.
• Triad of Death: Hypothermia, coagulopathy, and acidosis, which worsen outcomes in trauma.
• EFAST: Extended Focused Assessment with Sonography in Trauma; used to identify internal injuries.
• SAMPLE: History mnemonic: Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading to injury.

Pro Tips

• In mass casualty, prioritize critically injured patients who are most likely to survive.
• Maintain cervical spine control throughout airway management.
• Recognize the 5 main features of respiratory distress.
• For open pneumothorax, use an occlusive dressing taped on three sides.
• For tension pneumothorax, immediate needle decompression is a temporary measure.
• The 'nipple' is a landmark for the 5th intercostal space for chest tube insertion.
• Control of external bleeding is paramount; ABC for bleeding (Alert, Bleeding, Compression).
• Crystaloid needed is 3 times the estimated blood loss.
• Prolapsed viscera or bones are covered, not reduced.
• Meticulous examination during the secondary survey is key, as multiple injuries are common.

Pitfalls to Avoid

• Delaying airway management.
• Failing to control external hemorrhage promptly.
• Missing occult internal bleeding.
• Inadequate resuscitation with fluids and blood.
• Overlooking associated injuries during examination.
• Failing to prevent or manage hypothermia, coagulopathy, and acidosis.
• Reducing prolapsed organs or bones.
• Delaying investigations when urgent surgery is needed.

Real World Examples

• Pedestrian struck by a vehicle.: Blunt injury with acceleration/deceleration forces, direct impact trauma.
• Car occupant not wearing a seatbelt in a collision.: Body strikes car interior, leading to various injuries.
• Car occupant wearing a seatbelt in a collision.: Seatbelt injuries (skin marks, clavicle fractures, thoracic/abdominal injuries).
• Patient with severe bleeding from a limb.: Requires immediate control of external bleeding via compression or tourniquet.
• Patient with respiratory distress after chest trauma.: Requires assessment for open pneumothorax, tension pneumothorax, hemothorax, or flail chest.

Statistics

• Commonest cause of death (age 1-44): Trauma
• 3rd common cause of death (all ages): Trauma
• Crystaloid needed: 3 times estimated blood loss
• Normal urine output (adults): 0.5-1 ml/kg/hour