[Major] trauma is any injury that has the potential to cause prolonged disability or death.

• Blunt and penetrating
• Falls, MVA's, and gunshot wounds

• 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%)

• 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

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%