Trauma is a significant global health issue, being the third leading cause of death, and requires a systematic approach for effective assessment, triage, and resuscitation. The document outlines the triage process, primary and secondary surveys, and critical aspects of trauma management including airway, breathing, circulation, and disability assessments. Timely intervention and preventive measures are emphasized as essential for improving trauma outcomes.

1. Trauma: Triage,
Resuscitation and
Monitoring
Dr. P. M. Mshelbwala,
Department of Surgery,
College of Health Sciences,
University of Abuja

2. Trauma
• One of the leading cause of disability & death
– 3rd most common cause of death worldwide
– More than 5 million deaths annually
– 12% of world burden of disease
– Considered a major public health issue
• The study of medical problems associated
with physical injury i.e. adverse effect of
physical force
Dr. P. M. Mshelbwala 2

3. Trauma
• Has a very wide spectrum
– from minor injuries to life & limb threatening
injuries
• Severity of injury and time of intervention are
key in determining outcome
• A systematic method of assessment and
intervention is necessary
Dr. P. M. Mshelbwala 3

4. Trimodal Death Distribution
• Death occurs due to injuries in one of 3 peaks
• 1st peak: within seconds or minutes
– Apnoea due to severe brain injury, heart rupture
– Prevention is the main modality to reduce deaths
• 2nd peak: within minutes to several hours
– Subdural or epidural haemorrhage,
haemopneumothorax, pelvic injuries
• 3rd peak: several days to weeks
– Sepsis, multiple organ system dysfunction
Dr. P. M. Mshelbwala 4

5. Triage
• French word ‘triager’ – to sort
• Objective method of assessing patients
• Applied at site of injury field
– i.e. pre-hospital care
– Stay & play or scoop & run
• Applied in hospital
– On arrival at A&E
– In radiology department
– Operating theatre
Dr. P. M. Mshelbwala 5

6. Triage
• Sorting of patients based on their need for
treatment & available resources
– Critical: within seconds e.g. airway obstruction
– Immediate: within minutes e.g. major vascular
injury or tension pneumothorax
– Urgent: within the golden hour or period e.g.
multiplied injuries
– Deferred: as soon as practical e.g. non life-
threatening injuries or beyond recovery
Dr. P. M. Mshelbwala 6

7. Assessment of the Trauma Patient
Primary Survey
A, B, C, D, E
Dr. P. M. Mshelbwala 7

8. Assessment of the Trauma Patient
• A: airway with cervical spine protection
• B: breathing & ventilation
• C: circulation & haemorrhage control
• D: disability (neurologic evaluation)
• E: exposure/environmental control
– Based upon the Advanced Trauma Life Support
(ATLS) system developed in the USA
Dr. P. M. Mshelbwala 8

9. Airway Maintenance with Cervical
Spine Protection
• Assess airway for patency
– Look for foreign bodies, facial & mandibular
fractures, dentures etc
– If patient can communicate verbally, the airway is
likely to be patent
– Do chin-lift or jaw thrust maneuver, don’t
hyperextend, rotate nor hyperflex neck
• Use cervical collar until cervical injury is
excluded
Dr. P. M. Mshelbwala 9

10. Breathing & Ventilation
• If airway is patent, ensure breathing or assist
ventilation for adequate gas exchange
– Ambu bag
– ? Mouth to mouth resuscitation
• Expose chest to assess chest wall excursion
• Look out for tension pneumothorax
Dr. P. M. Mshelbwala 10

11. Circulation with Control of
Haemorrhage
• Consider
– Blood volume
– Cardiac output
– Bleeding
• Assess
– Level of consciousness
– Skin colour
– Pulse
– External haemorrhage
Dr. P. M. Mshelbwala 11

12. Disability (Neurologic Evaluation)
• Perform at the end of primary survey
• Assess
– Level of consciousness
• Use Glasgow Coma Scale (GCS)
– Pupillary size & reaction
– Lateralizing signs
– Spinal cord injury level
Dr. P. M. Mshelbwala 12

13. Exposure/Environmental Control
• Adequately undress the patient
– Cutting off garments & clothes may be best
• Ensure warmth
– Cover patient with blankets
– Use external warming devices
– Warm all fluids to be infused
Dr. P. M. Mshelbwala 13

14. Resuscitation
• Airway
– Protect at all times with chin-lift or jaw-thrust
– Intubate if necessary
• Breathing
– Provide oxygen by mask-reservoir device to maintain
oxygenation
• Circulation
– Ensure 2 wide bore IV lines, infuse fluids in bolus,
obtain blood for transfusion
– Avoid hypothermia
Dr. P. M. Mshelbwala 14

15. Monitoring
• Electrocardiographic monitoring
• Urinary catheters
• Nasogastric tubes
• Arterial blood gases levels
• Pulse oximetry
• X-ray, ultrasound scan other diagnostic studies
Dr. P. M. Mshelbwala 15

16. Secondary Survey
• Performed after primary survey (ABCDE) is
completed and resuscitation is underway
• Complete History – iSAMPLE
Dr. P. M. Mshelbwala 16

17. iSAMPLE
• i – Immunization or Tetanus Status
• S – Social History. Available social support
• A- Allergies
• M- Medications patient is currently on
• P – Past medical illness
• L – Last meal
• E – Events related to the injury
Dr. P. M. Mshelbwala 17

18. Secondary Survey
• Head-to-toe evaluation of the trauma patient
• Physical examination
• Look out for missed injuries
• Reassessment of all vital signs
• Continue monitoring
Dr. P. M. Mshelbwala 18

19. Adjuncts to Secondary Survey
• Reevaluate the patient
• Decide definitive care
• Keep records for medico-legal purposes
• Prevention of trauma is the best ‘treatment’
Dr. P. M. Mshelbwala 19

20. Conclusion
• Trauma is a leading cause of death
• It is a global health issue
• Timely & systematic intervention improves
outcome
• Preventive measures are the best ‘treatment’
Dr. P. M. Mshelbwala 20

21. References
• Bailey & Love’s Short Practice of Surgery. 25th
edition
• WHO Guidelines for Essential trauma care
• Advanced Trauma Life Support for Doctors. 8th
edition
Dr. P. M. Mshelbwala 21