Trauma (main)

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Background

Initial evaluation objectives

  1. Rapidly identify life-threatening injuries
  2. Initiate supportive therapy
  3. Organize definitive therapy

Locations of Possible Life-Threatening Bleeding

Lethal Triad of Major Trauma

  1. Hypothermia
  2. Coagulopathy
  3. Acidosis

Clinical Features

Primary Survey

Evaluate

  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure (completely expose patient, then prevent hypothermia
  • Theoretically, if derangement in ABCs found, evaluation should stop until life-threatening dysfunction treated. In multiprovider practices, assessment and management often occur simultaneously

Classes of hemorrhagic shock[1]

Class I II III IV
Approximate blood loss <15% 15-30% 30-40% >40%
Heart rate ↔/↑ ↑↑
Blood pressure ↔/↓
Pulse Pressure (mmHg)
Respiratory Rate (per min) ↔/↑
Urine Output (mL/hr) ↓↓
Glasgow coma scale score
Base deficit^ 0 to -2 mEq/L -2 to -6 mEq/L -6 to -10 mEq/L -10 or less mEq/L
Need for blood products Monitor Possible Yes Massive transfusion protocol

^Base excess is the quantity of base (HCO3-, in mEq/L) that is above or below the normal range in the body. A negative number is called a base deficit and indicates metabolic acidosis.

Secondary Survey

  • Head to toe evaluation for additional injuries

Differential Diagnosis

Head trauma

Neck Trauma

Torso Trauma

Extremity trauma

Pediatric trauma

Evaluation

  • Consider FAST
  • Consider CT

Management

Complications

Disposition

  • Depends on underlying injury

See Also

External Links

References

  1. American College of Surgeons Committee on Trauma. Shock: in Advanced Trauma Life Support: Student Course Manual, ed 10. 2018. Ch 3:62-81

Authors:

Ross Donaldson