TRAUMA

 Trauma is the study of medical problems associated

with physical injury.
 Trauma can refer to any bodily injury but in the
context of surgery normally refers to a patient with
major isolated or multiple injuries.
 Trauma is the leading cause of death in the first
four decades of life, the majority from road traffic
accidents.
The Advanced Trauma Life Support
(ATLS) program and the Golden Hour

 This system prioritizes interventions so that

life threatening injuries are treated first.
 This can be remembered simply as ‘ABCDE’
and is summarized
 The golden hour is the first hour after injury
and it is during this period a number of
treatable complications of trauma manifest
clinically
 Airway

 Lack of oxygenated blood delivered to the brain and other major organs
causes rapid death in the injured patient.
 A protected, unobstructed airway is a priority in order to avoid hypoxia.
 A patient’s airway can be compromised with: A decreased level of
consciousness (head injury,hypoxia hypovolaemia, drugs).
• Facial trauma.
• Neck trauma.
• Aspiration of vomit or teeth.
• Swelling of subcutaneous tissues associated with burns or
smoke inhalation.
 Assessment of airway patency should be rapid.
 All trauma patients should receive oxygen initially.
 Breathing

 Adequate ventilation is required in order to oxygenate blood and

therefore major organs such as the brain.
 Causes of ventilatory compromise include:
Central nervous system depression (head injury, alcohol,
drugs, cervical spine injury).
Tension pneumothorax (needs immediate decompression
before a chest X-ray!).
Open pneumothorax
Rib fractures.
Haemothorax.
Flail chest
 Circulation

 Shock is defined as inadequate organ perfusion and tissue

oxygenation.
 The most common cause of this in the trauma patient is
hypovolaemia secondary to haemorrhage.
 It is important to recognize hypovolaemic shock so that
treatment is not delayed.
 The patient should have capillary refill, pulse rate, blood
pressure, urinary output and conscious level closely
monitored.
 Clinical findings allow the doctor to estimate
 the circulating blood volume (approximately 5 L in
adults).
 Blood pressure can be normal with up to 30%
blood loss, but as the patient decompensates,
 there is tachycardia, hypotension and confusion.
 There are five areas to look at for potential blood loss
—chest, abdomen, pelvis, long bones And on the
floor (e.g. arterial bleeding).
 Conscious level
 This is based on the Glasgow Coma Scale (GCS) and
ranges from 3 to 15.
 This should be monitored regularly to observe for
deterioration in the patient’s condition.
 A simpler method to determine conscious level is AVPU .
 A -Alert
 V- Responds to Verbal Stimuli
 P -Responds to Pain
 U- Unresponsive
 C spine control

 All trauma patients should be assumed to have

unstable neck injuries until proven otherwise,
especially in those with an altered conscious level
or with injuries above the level of the clavicle.
 The cervical spine can be immobilized manually or
with an appropriately sized hard collar, sandbags
and tape across the patient’s forehead.
 Exposure and secondary survey

 Look from head to toe for other injuries.

 This includes log-rolling the patient (with C spine
control) to assess for trauma to the back and spine
The importance of time
 Time pressure shapes our management of trauma
 There is a finite time to assess
 There is a finite time to respond
 For success these must fit into the available time
before irretrievable damage or death.
 Management
INVESTIGATIONS
 A trauma series of X-rays (performed in the
resuscitation area) should include at least chest and
pelvis films, and if indicated C spine films.
 Blood tests include full blood count, urea and
creatinine, clotting and blood should be grouped
and saved in case the patient needs a blood
transfusion.
 Treatment
 Treat life threatening conditions first, in the order of
ABCDE.
 It is then important to identify all other injuries through
the secondary survey so that they can be managed by the
relevant surgical specialties