Major trauma

Understanding Major Trauma: A Lifesaving Guide

Major trauma is any injury that has the potential to cause prolonged disability or death. It can be caused by falls, motor vehicle collisions, stabbing wounds, and gunshot wounds among other things.

The Initial Assessment: A Race Against Time

Imagine a scene of chaos—ambulances racing, paramedics shouting, and the air thick with adrenaline. The initial assessment is critical in this high-stakes environment. It’s like trying to solve a complex puzzle under pressure, where every second counts.

Classifying Trauma: A Complex Puzzle

Injuries are classified based on severity, location, demographic group, type of force applied, or a combination of these factors. Major trauma can be further classified by body area, with polytrauma affecting 40% of cases. It’s like sorting pieces into different boxes to understand the bigger picture.

Causes and Consequences: A Closer Look

The causes of major trauma are diverse—blunt trauma (leading cause of traumatic death), motor vehicle collisions, falls, penetrating trauma (caused by foreign bodies such as bullets or knives), and blast injury. Penetrating trauma is often caused by firearms in urban areas, while sports injuries may also be a cause of major trauma.

Approximately 2% of those who experience significant trauma have a spinal cord injury. The Injury Severity Score (ISS) is used to define major trauma for research purposes. The body responds to traumatic injury by attempting to protect vital organs, restore homeostasis, and promote healing through inflammation. The healing time depends on various factors such as sex, age, and severity of injury.

Initial Assessment: A Lifesaving Checklist

The initial assessment is critical for determining the extent of injuries and needs to manage them effectively. Physical examination involves identifying life-threatening problems, followed by a systematic assessment of the abdominal, pelvic, and thoracic areas. Imaging studies such as chest and pelvic x-rays, FAST exams, and CT scans may be used to diagnose injuries.

Surgical Techniques: A Lifeline in Crisis

In cases of severe blunt trauma, surgical techniques are often used when signs of shock are present. Prevention strategies involve identifying risk factors within a community, educating the public about specific risks, and developing solutions to decrease the incidence of injury. Trauma care involves bystanders, community members, healthcare professionals, and systems.

Pre-hospital Management: A Race Against Time

Pre-hospital management uses stabilization techniques to improve survival chances. Techniques include spinal motion restriction, control of severe bleeding, intubation for airway obstruction, and rapid transportation. In-hospital management involves multiple healthcare specialists and a primary survey to evaluate the person’s airway, breathing, circulation, and neurologic status.

In-hospital Management: A Team Effort

Intubation is indicated for airway obstruction, inability to protect the airway, and respiratory failure. Helicopter EMS transport improves mortality rates in adult trauma patients. Hospitals with designated trauma centers have improved outcomes compared to those without.

Trauma Resuscitation: A Lifesaving Protocol

Trauma resuscitation includes control of active bleeding, vascular access and blood chemistry tests, chest compressions for cardiac arrest due to trauma, correction of underlying causes such as pneumothorax or pericardial tamponade, FAST exam for internal bleeding assessment, maintenance of airway, breathing, and circulation in maxillofacial trauma.

Intravenous Fluids: A Lifesaving Solution

Intravenous fluids are crucial. Limiting fluid use in certain traumas, allowing mild hypotension to persist, targeting mean arterial pressure 60 mmHg, systolic blood pressure 70–90 mmHg, hypertonic saline has been found to be of little difference from normal saline, and warmed Lactated Ringer’s solution is the solution of choice. Fresh frozen plasma and platelets are recommended for improved survival.

Medications: A Lifesaving Arsenal

Tranexamic acid decreases death in people with ongoing bleeding or traumatic brain injury. Recombinant factor VIIa assists blood clotting in severe bleeding disorders. Positive inotropic medications have a lack of evidence for their use.

Surgery: A Last Resort

The decision to perform surgery is determined by the extent of damage and anatomical location of injury. Bleeding must be controlled before definitive repair can occur. Damage control surgery is used to manage severe trauma that may lead to death if not corrected. Approximately 15% of people with trauma have abdominal injuries, and 25% require exploratory surgery.

Prognosis: A Long Road Ahead

The financial cost of trauma includes treatment costs, lost productivity, and lost wages. The average financial cost for treating traumatic injury in the United States is approximately US$334,000 per person. Citizens of low- and middle-income countries account for 89% of worldwide injury deaths, often due to lack of access to surgical care, trauma systems, and pre-hospital care.

Conclusion: A Lifesaving Mission

Trauma is the sixth leading cause of death worldwide, resulting in five million deaths annually. It is also a significant cause of disability. Trauma affects more males than females and is twice as common in males as it is in females. The primary causes of traumatic death are central nervous system injuries and substantial blood loss.

Understanding major trauma is crucial for saving lives. Every second counts, and every action matters. Whether you’re a healthcare professional or part of the community, your role in preventing and managing trauma can be lifesaving. Remember, in the world of trauma care, every moment counts, and every life saved is a victory.