Physical Injury Information

Physical trauma refers to a physical injury, generally of a considerable degree. A trauma patient is someone who has suffered serious and life-threatening physical injury, with the potential for secondary complications such as shock, respiratory failure and death.

Definition

Trauma is defined as any body wound or shock produced by sudden physical injury, as from accident, injury, or impact.

Signs and symptoms

There are a wide variety of symptoms that are associated with physical trauma; for example, unconsciousness, internal bleeding, disorientation, shock, or death.

Causes

Comprehensive table of injury-related deaths in the United States is found at: [1]

Prognosis

Death from trauma often occurs during three different peaks: immediately, early, and late. The immediate deaths are often due to apnea, severe brain or high spinal cord injury, or rupture of the heart or large blood vessels. The early deaths occur within minutes to hours and are often due to a subdural hematoma, epidural hematoma, hemothorax, pneumothorax, ruptured spleen, liver laceration, or pelvic fractures. This is known as the Golden hour. The late deaths occur days or weeks after the injury.^[2]

Management

People who have suffered trauma may require specialized care, including surgery and blood transfusion. Outcomes are better if this occurs as quickly as possible thus the so called golden hour of trauma. This is not a strict deadline, but recognizes that many deaths which could have been prevented by appropriate care occur in a relatively short time after injury. In many places organized trauma referral systems have been set up to provide rapid care for injured people. Research has shown that deaths from physical trauma decline where there are organized trauma systems.

Techniques

In the prehospital setting, emergency medical technicians, firefighters and other trained as first responders, use stabilization techniques to improve the chances of a person surviving the transport to the nearest hospital. After ensuring their own safety and taking isolation precautions, a primary survey is performed, consisting of checking and treating airway, breathing, and circulation (called the ABC's) than an assessment of the level of consciousness.

The purpose of the primary survey is to identify life-threatening problems. Ensuring that the injured person is not disabled by unnecessary movement of the spine. Frequently the neck is secured with a cervical collar, and the back is secured to a long spine board with head supports, or other medical transport device such as a Kendrick extrication device, before moving the person. Unless the person is in imminent danger of death, first responders in the Anglo-American emergency medical system will "load and go," transporting immediately to the nearest appropriate trauma-equipped hospital.

Upon completion of the primary survey, the secondary survey is begun. This may occur during transport or upon arrival at the hospital. The secondary survey consists of a systematic assessment of the abdominal, pelvic and thoracic area, complete inspection of the body surface to find all injuries, and a neurological exam. The purpose of the secondary survey is to identify all injuries so that they may be treated. A missed injury is one which is not found during the initial assessment (for example, as a patient is brought into a hospital's emergency department), but rather manifests itself at a later point in time.

Intravenous fluids

Traditionally high volume intravenous fluids were given in people with hemodynamic instability due to trauma. Current evidence however supports limiting the use of fluids for penetrating thorax and abdominal injuries allowing mild hypotension to persist.^[3]

See also

• Anaesthesia Trauma and Critical Care
• Advanced Trauma Life Support
• Blunt force trauma
• Emergency Medical Services
• Emergency medicine
• Fluid replacement
• Penetrating trauma
• Polytrauma
• Shock
• Surgery
• Trauma surgery
• Runner's toe, repetitive traumatic injury seen in runners

References

1. ^ Page 27 in: Trauma. By Ernest Eugene Moore, David V. Feliciano, Kenneth L. Mattox. Publisher: McGraw-Hill Medical; 5 edition (1 Nov 2003). ISBN-10: 0071370692 ISBN-13: 978-0071370691
2. ^ American College of Surgeons (2008). Atls, Advanced Trauma Life Support Program for Doctors. Amer College of Surgeons. ISBN 1-880696-31-6.
3. ^ Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. 2467. ISBN 9780323054720.

Further reading

• American College of Surgeons (2008). Atls, Advanced Trauma Life Support Program for Doctors. Amer College of Surgeons. ISBN 1-880696-31-6.

External links

• Trauma.org (trauma resources for medical professionals)
• Emergency Medicine Research and Perspectives (emergency medicine procedure videos)
• American Trauma Society
• Society of Trauma Nurses
• Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (Akuttjournalen (in Norwegian language))
• Definitive Surgical Trauma Skills
• After the Injury- Children's Hospital Of Philadelphia

Categories: Medical emergencies | Traumatology | Causes of death

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See Also:

• Avulsion Injury
• Physical Abuse
• Physical Urticaria