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Trauma Scoring

• Abbreviated Injury Score (AIS(


• Injury Severity Score (ISS(
Abbreviated injury scale (AIS)

Injury AIS Score


1 Mild
2 Moderate
3 Serious
4 Severe
5 Critical
6 Unsurvivable
Initial trauma management

Triage

• Sorting of patients based on the need for


treatment and the available resources to
provide that treatment.
• Based on ABC.
• On the field and medical facility.
• Appropriate patient transport.
Glasgow coma score (GCS)

Eye opening Verbal response Motor response

Spontaneous = 4 Oriented = 5 Obeys commands = 6

To voice = 3 Confused = 4 Localizes stimuli = 5

To pain = 2 Inappropriate words = 3 Withdrawal = 4

None = 1 Incomprehensible sounds = Decorticate = 3


2
None = 1 Decerebrate = 2

None = 1
The degree of blood loss
Class I Class II Class III Class IV

Blood loss (mL) Up to 750 750–1500 1500–2000 >2000

Blood loss (%) Up to 15% 15–30% 30–40% >40%

Pulse rate <100 >100 >120 >140

BP Normal Normal Decreased Decreased

RR 14–20 20–30 30–40 >40

Urine output >30 20–30 5–15 Negligible


(mL/hr)

Mental status Slightly Mild anxiety Anxious, Lethargic


anxious confused
grade type Liver Injury Scale
Description
I Hematoma Subcapsular, nonexpanding, < 10% surface area.
Laceration Capsular tear, nonbleeding; < 1 cm deep in parenchyma.

II Hematoma Subcapsular, on expanding, 10– 50% surface area; intraparenchymal,


nonexpanding, < 10 cm
Laceration Capsular tear, active bleeding; 1– 3 cm deep into the parenchyma, < 10
cm long.
III Hematoma Subcapsular, > 50% surface area or expanding or ruptured subcapsular
hematoma with active bleeding intraparenchymal hematoma > 2 cm or
expanding.
Laceration > 3 cm deep into the parenchyma.

IV Hematoma Ruptured intraparenchymal hematoma with active bleeding.


Laceration Parenchymal disruption involving > 50% of hepatic lobe.

V Laceration Parenchymal disruption involving > 50% of hepatic lobe.


Vascular Juxtahepatic venous injuries; ie, retro-hepatic vena cava or major
hepatic veins.
VI Vascular Hepatic avulsion.
 CT scan criteria for staging liver trauma based on the AAST liver injury
scale include the following:

• Grade 1 - Subcapsular hematoma less than 1 cm in maximal thickness,


capsular avulsion, superficial parenchymal laceration less than 1 cm
deep, and isolated periportal blood tracking

• Grade 2 - Parenchymal laceration 1-3 cm deep and
parenchymal/subcapsular hematomas 1-3 cm thick

• Grade 3 - Parenchymal laceration more than 3 cm deep and
parenchymal or subcapsular hematoma more than 3 cm in diameter

• Grade 4 - Parenchymal/subcapsular hematoma more than 10 cm in
diameter, lobar destruction, or devascularization

• Grade 5 - Global destruction or devascularization of the liver

• Grade 6 - Hepatic avulsion

Spleen Trauma
Character Grade
Subcapsular hematoma I
Sub segmental parenchgmal II
injury
Segmental devitalization III
Polar disruption IV
Shattered or devascularized V
organ