[Major] trauma is any injury that has the potential to cause prolonged disability or death.
Cause
Blunt and penetrating
Falls, MVA's, and gunshot wounds
Classification
Classified by body area:
Polytrauma (aka multiple trauma) (40%), injuries affecting multiple areas
Head injuries (30%)
Chest trauma (20%)
Abdominal trauma (10%)
Extremity trauma (2%)
Ix
Trauma series, including x-rays of the:
Cervical spine
Chest
Pelvis
FAST exam (focused assessment w/ sonography for trauma), depending on the mechanism of injury and presentation, to check for internal bleeding
CT scans, are useful, for those w/ relatively stable BP, HR, and sufficient oxygenation
Tx
ATLS (advanced trauma life support) includes:
Primary survey, which includes:
Airway maintenance w/ C-spine protection
Breathing and ventilation
Circulation w/ hemorrhagic control
Disability/neurologic assessment
Exposure and environmental control
Secondary survey, which is begun when the primary survey is completed, resus efforts are well established, and vitals are normalizing. It is a head-to-toe evaluation of the trauma Pt, including a complete Hx and O/E, including the reassessment of all vital signs. Each region of the body must be fully examined. X-rays indicated by exam are obtained. If at any time the Pt deteriorates, another primary survey is carried out as a potential life threat may be present
Tertiary survey, where a careful/complete exam followed by serial assessments help recognize missed injuries and related problems, allowing a definitive care Mx. The rate of delayed Dx can be as high as 10%
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