Trauma Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Understand the principles of trauma assessment and management.

2. Define key trauma terms and concepts.

3. Recognize life-threatening injuries.

4. Apply ABCDE approach in trauma patients.

5. Understand indications for damage control surgery and emergency interventions.

 Key Glossary Terms

1. Trauma

• Definition: Physical injury caused by external force (blunt, penetrating, or thermal).

• Clinical Relevance: Major cause of morbidity and mortality; early recognition and management are critical.

2. Primary Survey

• Definition: Rapid assessment to identify life-threatening conditions.

• Mnemonic: ABCDE

  • A – Airway (with cervical spine protection)

  • B – Breathing (ventilation, oxygenation)

  • C – Circulation (hemorrhage control, IV access)

  • D – Disability (neurological status, GCS)

  • E – Exposure (complete undressing, prevent hypothermia)

3. Secondary Survey

• Definition: Full head-to-toe assessment after stabilization.

• Includes: Detailed history (AMPLE – Allergies, Medications, Past history, Last meal, Events), complete physical exam, diagnostic tests.

4. Glasgow Coma Scale (GCS)

• Definition: Neurological scale to assess consciousness.

• Components:

  • Eye opening (1–4)

  • Verbal response (1–5)

  • Motor response (1–6)

• Score Interpretation:

  • 13–15: Mild

  • 9–12: Moderate

  • ≤8: Severe → often requires airway protection/intubation

5. FAST Scan

• Definition: Focused Assessment with Sonography for Trauma.

• Purpose: Detect free fluid in peritoneal, pericardial, or pleural spaces.

• Clinical Relevance: Rapid bedside tool to identify internal bleeding.

6. Compartment Syndrome

• Definition: Increased pressure within a closed muscle compartment → decreased perfusion.

• Signs (Mnemonic “6 Ps”): Pain, Pallor, Paresthesia, Pulselessness, Poikilothermia, Paralysis.

• Management: Emergent fasciotomy to relieve pressure.

7. Damage Control Surgery

• Definition: Temporary surgical intervention to control bleeding and contamination in unstable patients.

• Steps:

  1. Control hemorrhage.

  2. Control contamination.

  3. Temporary closure.

• Goal: Stabilize patient for ICU resuscitation before definitive surgery.

8. Hemorrhagic Shock in Trauma

• Definition: Shock due to acute blood loss.

• Management: Rapid IV access, fluid resuscitation, blood transfusion, identify source of bleeding.

9. Airway Management in Trauma

• Cervical Spine Precautions: Always maintain inline stabilization.

• Methods: Endotracheal intubation, surgical airway (cricothyrotomy) if obstruction present.

10. Trauma Mnemonics

• AMPLE History: Allergies, Medications, Past medical history, Last meal, Events/Environment.

• ABCDE: Airway, Breathing, Circulation, Disability, Exposure.

• 6 Ps of Compartment Syndrome: Pain, Pallor, Paresthesia, Pulselessness, Poikilothermia, Paralysis.

 Tables

Table 1: Primary Survey Priorities

Table 2: FAST Scan Zones

Table 3: Compartment Syndrome Features