This document defines trauma and discusses the emergency management of traumatic injuries. It begins by defining trauma as an injury to living tissue caused by external forces. It then outlines the emergency management approach of assessing the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Key interventions discussed include controlling hemorrhage, needle decompression for tension pneumothorax, chest tube insertion, and pelvic stabilization. Complications from trauma like respiratory failure, renal failure, and sepsis are also reviewed. The document provides an overview of the initial evaluation and management of traumatic injuries.

1. TRAUMA
Mr. Melvin Jacob MSc (N)
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2. Learning objectives.
The students will be able to:
• define trauma.
• narrate etiology of trauma.
• explain the pathophysiology of trauma.
• enumerate the clinical manifestations of trauma.
• explain the classification , diagnosis and
management of trauma.
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3. Introduction
• Trauma is the Greek word for "wound". Although
the Greeks used the term only for physical
injuries.
• A deeply distressing or disturbing experience
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4. Meaning
An injury (such as a wound) to living tissue
caused by an extrinsic agent
Psychological Trauma
A disordered psychic or behavioural state
resulting from severe mental or emotional stress
or physical injury.
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5. Incidence
• About 5.8 million people die each year as a
result of injuries. This accounts for 10% of the
world's deaths.
• Nearly one third of the 5.8 million deaths from
injuries are the result of violence and nearly one
quarter are the result of road traffic crashes.
• Injuries affect all age groups but have a
particular impact on young people.
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6. Classification of Trauma.
• Major trauma is any injury that has the potential
to cause prolonged disability or death. There are
many causes of major trauma, blunt and
penetrating, including falls, motor vehicle
collisions, stabbing wounds, and gunshot
wounds.
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7. Classification of Trauma.
• A minor trauma is defined both in the Statutory
Accident Benefits Schedule (SABS) and the MIG
as a sprain, strain, whiplash associated disorder,
contusion, abrasion, laceration or subluxation
and any clinically associated sequelae.
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8. Trauma can be Scary
• Keep your cool
• We all set the tone
• Know your role, follow the leader
• Follow an algorithm
• Don’t get distracted
• Traumatic arrest have around 99% mortality
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9. Be Prepared
• Trauma or Monitored bay
• Ensure adequate staff
• Assign roles
• Check equipment
• Wearing lead
• Pain relief/blood products ready
• Is decontamination required?
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10. Shock is the Enemy
Haemorrhagic
Causes
Non-Haemorrhagic
Causes
External bleeding Tension pneumothorax
Intrathoracic bleeding Myocardial contusion
Intra-abdominal
bleeding
Pericardial tamponade
Pelvic fractures Spinal cord transection
Long bone fractures Coincident medical (AMI,
seizure)
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11. The Approach
C :Catastrophic haemorrhage
A: Airway > C-spine
B: Breathing
C: Circulation
D: Disability
E: Exposure
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12. Airway
Assessment Interventions
Can the patient talk? Position (caution of C-
spine)
Is the patients voice
normal?
Jaw thrust
Stridor? Oral airway
Foreign body? Suction
Bleeding and secretions? Definitive airway
Burns (or evidence of) Prepare for difficult airway
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13. Life-threatening airway problems
• Airway obstruction (partial or complete)
• Inhalation injury
• Facial trauma/deformity
• Blunt & penetrating neck trauma
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14. Breathing
Assessment Interventions
Equal chest wall rise and
fall?
BVM
Breath sounds
bilaterally?
Needle decompression
Tracheal deviation or
JVD?
3 sided occlusive dressing
SQ air? Chest tube
Rib fractures/fail chest? Definitive airway
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15. Life-threatening breathing problems
• Tension pneumothorax
• Pneumothorax
• Haemothorax
• Sucking chest wound (open PTX)
• Flail chest
• Full-thick circum burn to thorax
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16. Circulation
Assessment Interventions
Heart sounds? Access, (IV,IO,CVC?)
Pulses? Fluids Vs Blood products?
Vital signs? External direct pressure
External Bleeding? Pelvic binder
Falling Hb, increasing
lactate?
Pericardiocentesis
Shocky? Thoracotomy
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17. Life threatening circulation problems
• External haemorrhage (amputation)
• Penetrating trauma
• Blunt trauma
• Pericardial tamponade
• Traumatic aortic rupture
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18. Massive Transfusion
•Focuses more on blood products than fluids
Predicting who needs M/T
 Penetrating mechanism
 SBP <90mmHg
 HR >120bpm
Positive FAST abdominal views
1:1:1 Ratios (PRBCS, FFP, Platlets)
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19. Trendelenburg Position
• Limited evidence (more harm than good)
•Effects are short lived
Complications
 ^ dyspnea, hypoventilation and atelectasis
 Abdo organs into chest cavity decreasing venous
return to heart
 Risk of aspirating gastric contents
?Leg elevation better than nothing
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20. Cervical Spine
• Try and clear neck early
• Collars cause C-spine pain
• Use decision rule’s (Canadian Vs Nexus)
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21. Life Threatening Disability
• Spinal cord transection
• Intracerebral haemorrhage
• Diffuse axonal injury with cerebral oedema
• Subdural/epidural haematoma
• Blunt cerebrovascular injury
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22. Exposure
• Completely undress, and log roll
• Then keep them warm,
• Blankets, warm fluids, monitor temperature
• Reverse shock and coagulopathy
• Avoids hypothermia prevents= the lethal triad.
• Burn patients
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23. Full set vital signs
• Cardiac monitor
• Pulse oximeter
• BP (invasive vs. non-vasive)
• Urinary catheter, unless contraindicated
• NGT (nasal/oral)
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24. Give comfort measures
• Verbal reassurance
• Therapeutic touch
• Liaise with family
• Pain relief (which drug is best?)
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25. History
AMPLE
• Allergies
• Medications currently used
• Past illnesses/Pregnancy
• Last meal/fluids
• Events leading up to trauma
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26. Head to Toe
Focus on:
• Sites of external bleeding
• External markers of torso injury
• All penetrating wounds
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27. Head Skull & Face
Look for:
• Lacerations (scalp lac’s often underestimated)
• Ecchymosis
• Mid-face instability
• Drainage from nose and ears (CSF)
• Raccoon eyes, battle sign
• Check pupils, (ocular bleeding, swelling)
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28. Head Skull & Face
Interventions:
• Pain relief
• Maintain airway patency
• Remove contact lenses
• Haemorrhage control (difficult)
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29. Cervical Spine & Neck
•Remove anterior portion of collar:
Look for:
• Wounds, bruising, deformities, distended neck
veins
Feel for:
• Tenderness, bony crepitus, deformity, sub-Q
emphysema, tracheal position
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30. Cervical Spine & Neck
Interventions
• Maintain spinal alignment (head hold, tape,
sandbags)
• Consider changing from hard collar to soft
collar (Philadelphia)
• Use direct pressure if haemorrhage control
required
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31. Chest
Look for:
• Breathing rate &depth, wounds, deformities,
bruising, accessory muscle use, paradoxical
movement, expansion and symmetry
Listen to: Breath and heart sounds Feel for:
• Tenderness, bony crepitus, emphysema,
deformity to clavicles and shoulders.
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32. Chest
Interventions:
• Prepare for needle decompression (tension PTX)
• Prepare for chest tube insertion (PTX or
HaemPTX)
• Prepare for pericardiocentesis (pericardial
tamponade)
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33. Abdomen & Flanks
Look for:
• Sounds, distension, ecchymosis, seat-belt sign,
scars
Listen for: Bowel sounds in all 4 quadrants
Feel for:
• Tenderness, rigidity, guarding, masses, femoral
pulses
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34. Abdomen & Flanks
Interventions:
• FAST or EFAST scan
• Insert NGT or IDC
• Anticipate for further imaging AXR CT-abdo
• Maintain high index of suspicion if seat belt sign
present
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35. Pelvis & Perineum
Look for:
• Wounds, deformities, lacerations.
• Bruising, priapism, blood at urinary meatus or
perineal area
Feel for:
• Pelvis instability, anal sphincter tone, prostate
position, rectal/vaginal wall integrity
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36. Pelvis & Perineum
Interventions:
• Apply external pelvic immobilisation (pelvic
binder, sheet)
• Anticipate for suprapubic catheter,
urethrogram
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37. Extremities
Assess all 4 limbs, and hands and feet
Look for:
• Deformity, open wounds, bruising, swelling,
rotation, shortening
Feel for:
• Abnormal bony movement, joint instability, tight
compartments
Assess for:
• Motor & sensory deficits, circulation, capillary
refill
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38. Extremities
Interventions:
• Apply splints/cast
• Assist with radiological interventions
• Dress open wound
• Give analgesia
Compartment Syndrome
•Pulses
•Pain
•Paralysis
•Paresthesia
•Pallor
•Plaintiff
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39. Investigations
• Blood analysis
• ABG vs VBG
• U&E
• Coag studies
• LFT’s
• Group
Blood investigations need to
be done serially, to monitor
effectiveness of interventions
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40. Imaging
•X-rays
•CT scan
•MRI
•PET scan
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41. Interventions
• External- Apply direct pressure, Suture
Lacerations
• Long Bone # - Splint +/- reduce #
• Chest- ICD, Pigtail
• Abdomen- Emergency Laparotomy
• Retroperitoneum
 Externally stabilse pelvis, Emergency Angiogram
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42. Special Considerations
• Elderly
• Athletes
• Pregnancy
• Medication
• Hypothermia
• Pacemaker
• Obesity
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43. Transporting the Trauma Patient
• Experience counts
• Prepare for the worst
• Stabilise before transferring
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44. Complications of Trauma
 The big five complications
• Haemorrhage
• Respiratory failure
• Renal failure
• Sepsis
• Multiorgan failure.
 Post traumatic stress syndrome.
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45. Prevention
• Seat-belts, helmets- RTA
• Modification to prevent falls among the elderly
• Pool fencing to reduce the risk of drowning
• Treatment of depression - suicide
• Educational programmes to prevent intimate
partner violence
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46. Recapitulation
In this class we discussed regarding
meaning, different types of trauma, emergency
management, clinical manifestations, diagnostic
tests and management for trauma.
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47. Conclusion
A traumatic event is an incident that
causes physical, emotional, spiritual, or
psychological harm. The person
experiencing the distressing event may
feel threatened, anxious, or frightened as
a result.
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48. Evaluation
• Define trauma?
• What are the causes of trauma?
• What all are the emergency steps to manage
trauma?
• What are the complications of trauma?
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49. Reference
• Smeltzer – Brunner & Suddharth Textbook of
Medical Surgical Nursing, Wolters kluwer
publishers, 12th edition 2009.
• Black – Medical Surgical Nursing, Elsevier
publishers, 8th edition 2009.
• Nettina – Lippincott manual of Nursing Practice,
Wolters kluwer publishers, 7th edition 2014.
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