Major Trauma & Multiple Injuries Cheat Sheet

Major trauma involves severe injuries that can lead to death, requiring immediate and systematic management. This cheat sheet outlines the incidence, causes, mortality, and management principles of major trauma, focusing on the ABCDE approach.

Core Principles

• Trauma is a leading cause of mortality, particularly in younger age groups (1-44 years).
• Injuries are categorized into penetrating (low and high velocity) and blunt trauma.
• Mortality after major trauma occurs in immediate, early, and late phases, each with distinct causes.
• Management follows the Advanced Trauma Life Support (ATLS) protocol, starting with a primary survey (ABCDE).
• The primary survey addresses Airway, Breathing, Circulation, Disability, and Exposure/Environment.
• Secondary survey involves a detailed history and head-to-toe examination to identify all injuries.

Action Steps

• Perform immediate manual immobilization of the head and cervical spine.
• Assess airway patency and protect it, clearing any obstructions.
• Evaluate breathing by inspecting for chest rise, listening for breath sounds, and checking oxygen saturation.
• Control external bleeding using compression, direct pressure, or tourniquets if necessary.
• Establish large-bore IV access for fluid and blood resuscitation.
• Conduct a head-to-toe examination to identify all injuries.
• Administer antibiotics and tetanus prophylaxis as indicated.
• Prioritize treatment based on the severity of injuries, starting with airway, breathing, and circulation.

Key Terms

• Penetrating Injury: Injury caused by sharp objects or projectiles (e.g., stabs, bullets).
• Blunt Injury: Injury caused by impact, falls, or collisions without penetration.
• ATLS: Advanced Trauma Life Support protocol for managing trauma patients.
• ABCDE: Primary survey steps: Airway, Breathing, Circulation, Disability, Exposure.
• Triage: Sorting patients based on injury severity and resource availability.
• EFAST: Extended Focused Assessment with Sonography in Trauma; used to identify internal injuries.
• Triad of Death: Hypothermia, Coagulopathy, and Acidosis, which worsen outcomes in trauma.

Pro Tips

• In mass casualty incidents, triage patients based on clinical diagnosis and available resources.
• Prioritize critically injured patients if resources are limited.
• Recognize that multiple, associated injuries are very common in trauma patients.
• Never reduce prolapsed viscera or bones; cover them with sterile dressing.
• Monitor urine output closely (0.5-1 ml/kg/hour) as an indicator of adequate resuscitation.
• Be aware of the 'Triad of Death' in trauma: Hypothermia, Coagulopathy, and Acidosis.

Pitfalls to Avoid

• Delaying airway management can lead to rapid deterioration.
• Failing to control external hemorrhage promptly can result in hypovolemic shock.
• Missing occult internal bleeding (thoracic, abdominal, pelvic, femur) can be fatal.
• Inadequate cervical spine immobilization can cause further neurological damage.
• Overlooking the 'lucid interval' where a patient may appear stable but has a worsening internal injury.
• Dropping the level of medical care during patient transfer.

Real World Examples

• Pedestrian struck by a vehicle.: Suffers direct trauma and acceleration injury.
• Car occupant not wearing a seatbelt.: Body strikes the car interior, causing severe injuries.
• Car occupant wearing a seatbelt.: May sustain seatbelt-related injuries (e.g., clavicle fracture, abdominal injuries).

Statistics

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