Trauma

SUGGESTED READINGS TRAUMA

Current Surgical Diagnosis & Treatment, 12th Edition, Ch. 13.

OBJECTIVES

1. Identify the correct sequence of priorities of emergency medical care to be followed in assessing the multiply-injured patient.
2. Outline the primary and secondary evaluation surveys to be used in assessing the multiply-injured patient.
3. Explain the treatment guidelines and techniques to be used in the initial resuscitation of the trauma patient and in the definitive care phase of treatment.
4. Understand how to perform an initial assessment and management survey on a mulitply-injured patient, using the correct sequence of priorities; explain the management techniques for primary treatment and stabilization.
5. Define shock and discuss the four classifications of hemorrhagic shock.
6. Discuss the basic principles of emergency treatment of hemorrhagic shock; outline the steps to be taken in fluid therapy of victims of hemorrhagic shock.
7. Identify each of the following common life threatening chest injuries and discuss their pathophysiologic mechanisms:

a. tension pneumothorax
b. open pneumothorax
c. massive hemothorax
d. flail chest
e. cardiac tamponade

8. Recognize the following potentially life threatening chest injuries and discuss their initial management:

a. pulmonary contusion
b. aortic disruption
c. tracheobronchial disruption
d. esophageal disruption
e. diaphragmatic disruption
f. myocardial contusion

9. Outline supportive diagnosis and therapeutic actions for abdomininal trauma, including the indications and contraindications for diagnostic peritoneal lavage and abdominal CT scan.
10. Review the anatomy and physiology of the head as related to head injuries.
11. Discuss the general management of the unconscious traumatized patient and describe the delayed complications that can follow head injury.
12. Describe the Glasgow Coma Scale and discuss its value in predicting mortality and neurologic recovery.
13. Describe the associated pathophysiologic mechanisms and effects of increased intracranial pressure.
14. Outline the therapeutic interventions which, when initiated in the early phases of management, can help reverse or delay undesirable effects of increased intracranial pressure.
15. Identify the principles of management of the patient with spine or spinal cord injury.
16. Given a patient with spine or spinal cord injury, assess the injury by applying appropriate immobilization techniques.
17. Outline general principles of management in the transportation and/or transfer of the trauma patient.
18. Describe the early metabolic responses to major traumatic injury.
19. Describe the pathophysiology of shock.

CASE HISTORIES

1. A 29-year-old white male is involved in a motor vehicle accident. He was not wearing a seat belt at the time of the accident and was thrown 30 feet from the automobile. At the scene the paramedics find the patient unresponsive with an initial blood pressure of 80/40 and a pulse of 150. They note shallow respirations at a rate of 40. At the scene the pneumatic antishock garment (PASG) is applied the patient is placed on a backboard and a cervical collar is applied. The paramedic also manages to start a 16 gauge IV in the left arm. The patient is transported to the emergency room with transport time of five minutes. On arrival in the emergency room the patient remains unresponsive with a blood pressure of 90/60, pulse 130, and shallow respirations at a rate of 45.

2. A 49-year-old white male involved in an MVA sustained blunt chest trauma from the steering wheel. Blood pressure was initially stable but in the emergency room falls to 90/60 and does not respond to IV fluids. It is noted that the patient's neck veins are distended.

3. A 54-year-old white male sustains a dislocation of the right knee during a MVA. Pulses in the right foot are absent at the scene. On arrival in the emergency room the knee is reduced and pulses return. X-rays reveal a comminuted fracture of the distal femur and proximal tibia.

4. A 49-year-old male falls 20 feet from scaffolding and presents to the emergency room with stable vital signs but 4+ blood on urine dipstick. Urinalysis reveals 70 red cells per high-powered field. He has no other apparent injuries.

5. A 24-year-old male is involved in a motor vehicle accident in which he was thrown twenty feet from the automobile. The patient presents in the emergency room unresponsive except for eye opening to painful stimulus and some intermittent decorticate posturing. Blood pressure is 180/100, pulse is 70, respiratory rate 14. Physical examination reveals a normally reacting left pupil, but a dilated non reactive right scalp over the right parietal area with a palpable linear skull fracture. The remainder of the physical examination is unremarkable.

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