Lecture on Trauma

• Severe Trauma


  Leading cause of death in < 40 yrs
• Initial management with team approach


  Primary survey followed by secondary survey
• Aim of primary survey


  To stabilize the patient and assess the most severe injuries. To ensure a patient's Airway is clear, their Breathing is adequate, and their Circulation (Bloodflow) is stable.
• Once the patient's in a stable condition


  You can perform a secondary survey to diagnose further injuries
• Primary Survey


  1. A - Airway with C-Spine

  2. B - Breathing and ventilation

  3. C - Circulation and hemorrhage control

  4. D - Disability

  5. E - Exposure
• Airway


  • Patent vs compromised
  • Jaw thrust if cervical spine injury suspected
  • Use adjuncts like guedel if needed
  • C-collar
  • Intubate if needed/ surgical airway
• Life-threatening airway problem


  Airway obstruction
• Breathing and ventilation

  • Assess effort and effectiveness
  • Trachea position
  • Listen for breath sounds
  • Provide oxygen as needed
  • Treat if any tension pneumothorax/ hemothorax with needle thoracotomy and chest drain
• Life-threatening chest injuries


  • Tension Pneumothorax
  • Hemothorax
  • Open Pneumothorax
  • Penetrating Trauma
  • Cardiac Tamponade
• How to manage life-threatening chest injuries

  1. Tension pneumothorax = emergency chest decompression

  2. Hemothorax = blood drained

  3. Open Pneumothorax = stuffed with bandages to keep the chest wound open

  4. Penetrating chest trauma = surgery on the damaged organ

  5. Cardiac tamponade = emergency pericardiocentesis
• Circulation and hemorrhage control


  • Assess for peripheral pulse, BP, HR, visible hemorrhage
  • 2 IV cannulae
  • X-match blood, FBC
  • IV NS bolus 20mls/kg repeat if needed, transfuse blood
  • Control any external bleeding
• Sources of severe bleeding

  • Arteries
  • Veins
  • Capillaries
• How to manage severe bleeding

  Tourniquets should be applied
• Disability


  • GCS vs AVPU
  • Intubation indicated for GCS<8
  • Check pupils
• Exposure


  • Remove clothes
  • Keep patient warm