Trauma (main)

Background

Initial evaluation objectives

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

Locations of Possible Life-Threatening Bleeding

• External
• Internal
  • Thoracic cavity
  • Peritoneal cavity
  • Retroperitoneal space (i.e. pelvic fracture)
  • Femur fracture (into muscle/subcutaneous tissue)

Lethal Triad of Major Trauma

1. Hypothermia
2. Coagulopathy
3. Acidosis

Clinical Features

Classes of hemorrhagic shock

Class	I	II	III	IV
Blood Loss (mL)	<750	750-1000	1500-2000	>2000
Blood Loss (%)	<15	15-30	30-40	>40
Pulse rate (per min)	<100	100-120	120-140	>140
Blood Pressure	Normal	Normal	Decreased	Decreased
Pulse Pressure (mmHg)	Normal or Increased	Decreased	Decreased	Decreased
Respiratory Rate (per min)	14-20	20-30	30-40	>35
Urine Output (mL/hr)	>30	20-30		Negligible
Mental Status	Slightly Anxious	Mildly Anxious	Anxious, Confused	Confused, Lethargic
Fluids	Crystalloid	Crystalloid	Crystalloid and blood	Crystalloid and blood

Differential Diagnosis

• Head trauma
• Maxillofacial trauma
• Neck trauma
  • Spinal cord trauma
  • Blunt neck trauma
• Thoracic trauma
  • Cardiac trauma
  • Thoracic and lumbar spine trauma
• Abdominal trauma
• Genitourinary trauma
• Penile trauma
• Extremity trauma
  • Fractures (main)
• Pediatric trauma
  • Pediatric head trauma

Evaluation

• Consider FAST
• Consider CT

Management

• Massive transfusion protocol

Complications

• Hypothermia
• Acidosis
• (Dilutional) coagulopathy
• Hypocalcemia

Disposition

• Depends on underlying injury

See Also

• Trauma Sedation
• Trauma in pregnancy
• Trauma center levels
• Hemorrhagic shock

References

Authors

Ross Donaldson, Neil Young, Kenn Ghaffarian, Robert Granata