Major trauma

Understanding Major Trauma

Major trauma is any injury that has the potential to cause prolonged disability or death. Think about it—how many times have you seen a car accident on the news where someone’s life hangs in the balance? That’s major trauma at its most visible. But what exactly does this mean, and how widespread is it?

The Scope of Major Trauma

In 2002, unintentional and intentional injuries were the fifth and seventh leading causes of deaths worldwide, accounting for a significant portion—6.23% and 2.84%, respectively—of all deaths. These numbers are staggering, but they only scratch the surface of what major trauma entails.

Classifying Trauma

Injuries can be classified by severity, location of damage, demographic group, or type of force applied to the body. The Injury Severity Score (ISS) is often used as a definition for major trauma, with scores greater than 15 indicating significant injury.

Common Causes and Consequences

The leading causes of traumatic death include blunt trauma, motor vehicle collisions, and falls, followed by penetrating trauma such as stab wounds or impaled objects. These injuries can be caused by any combination of external forces that act physically against the body. The most common cause of penetrating trauma is firearms, while blast injuries often involve both blunt and penetrating trauma and may also include burn injuries.

Spinal Cord Injuries

Around 2% of those who experience significant trauma have a spinal cord injury. These injuries can be life-altering, affecting mobility and quality of life in profound ways. Imagine the impact on someone’s life if they were to lose their ability to walk or move freely.

The Body’s Response

When the body experiences traumatic injury, it responds with systemic and local responses attempting to protect vital organs, maintain homeostasis, and initiate healing. Symptoms of injury may include altered mental status, fever, and increased heart rate. These symptoms are like the body’s SOS signals, alerting us that something is seriously wrong.

Diagnosis and Treatment

Diagnosis involves a primary and secondary examination, imaging studies such as x-rays and CT scans, and surgical intervention in cases of severe trauma or signs of shock. In-hospital management requires cooperation among healthcare specialists. The primary survey evaluates airway, breathing, circulation, and neurologic status.

Trauma Resuscitation

Control of active bleeding, vital sign checks, ECG, vascular access, baseline blood chemistry tests, chest compressions for cardiac arrest due to trauma, FAST exam for internal bleeding assessment, airway, breathing, and circulation maintenance in maxillofacial trauma—these are just some of the critical steps in managing a trauma patient. It’s like putting out multiple fires simultaneously, each one requiring immediate attention.

Prevention and Public Health

Prevention focuses on identifying risk factors and developing community-based solutions to reduce the incidence of injury. Injury prevention strategies involve educating the public about specific risk factors and developing strategies to avoid or reduce injuries, particularly for high-risk populations such as children. Legislation to prevent injury includes seatbelts, child car-seats, helmets, alcohol control, and enforcement.

Pre-Hospital Care

Pre-hospital care involves stabilization techniques to improve survival chances. Emergency services provide primary stabilization, assessing airway, breathing, circulation, and disabilities. Rapid transportation of severely injured patients improves outcomes. Helicopter EMS transport reduces mortality in adult trauma patients. Pre-hospital intravenous fluid resuscitation’s effectiveness is inconclusive.

Post-Injury Care

Hospitals with designated trauma centers have improved outcomes, and direct transfer to a trauma center may improve outcomes for trauma patients. In-hospital management requires cooperation among healthcare specialists. The primary survey evaluates airway, breathing, circulation, and neurologic status.

Medications and Surgery

Medications such as tranexamic acid and recombinant factor VIIa are used to manage severe bleeding. Surgery is based on the extent of damage and anatomical location of injury. Damage control surgery is used to manage severe trauma with metabolic acidosis, hypothermia, and hypotension.

Prognosis and Long-Term Impact

The prognosis for trauma patients varies depending on access to care, with better outcomes in countries with dedicated trauma systems. Long-term prognosis often involves pain, reduced quality of life, and disability. Trauma is the sixth leading cause of death worldwide, resulting in five million deaths annually.

Financial Costs

The financial cost of trauma includes medical treatment costs and lost wages, amounting to approximately $693 billion in the United States in 2009. This figure underscores the immense economic burden that trauma places on societies worldwide.

Conclusion

Trauma is a complex issue with far-reaching consequences. From the immediate life-threatening injuries to the long-term impacts, it’s clear that addressing this global health challenge requires a multifaceted approach. By understanding and implementing effective prevention strategies, improving access to quality care, and supporting research into new treatments, we can make significant strides in reducing the burden of trauma on individuals and communities.