Module 6: Trauma Management

Section 1: Principles of Trauma Care

1.1 The Trauma System

• Trauma Centers:

  • Level I: Comprehensive care for all trauma types; 24/7 availability of surgical specialists

  • Level II: Provides definitive care but may transfer to Level I for certain specialties

  • Level III: Stabilization and transfer to higher-level facilities

• Prehospital Role:

  • Rapid identification and treatment of life-threatening injuries

  • Minimize scene time to ensure early definitive care

1.2 Golden Principles of Trauma Care

• Golden Hour: Early intervention within the first 60 minutes significantly improves survival rates

• Primary Goals:

  • Control hemorrhage

  • Protect the airway

  • Support breathing and circulation

  • Rapid transport to the appropriate facility

Section 2: Trauma Assessment

2.1 Initial Assessment

• Scene Size-Up:

  1. Ensure scene safety (environmental and situational hazards)

  2. Determine mechanism of injury (MOI): Blunt, penetrating, or burns

  3. Number of patients and need for additional resources

• Primary Survey (ABCDE):

  1. A – Airway:

     • Assess for patency

     • Protect cervical spine with manual stabilization or a cervical collar

     • Interventions: Suction, NPA/OPA insertion, or endotracheal intubation

  2. B – Breathing:

     • Assess chest rise, respiratory rate, and effort

     • Interventions: Provide oxygen, assist ventilation with a BVM, or needle decompression for tension pneumothorax

  3. C – Circulation:

     • Assess for major bleeding and perfusion (skin color, capillary refill)

     • Interventions: Direct pressure, tourniquets, fluid resuscitation

  4. D – Disability:

     • Neurological status using the Glasgow Coma Scale (GCS)

     • Pupil size and reactivity

  5. E – Exposure/Environmental Control:

     • Expose injuries but prevent hypothermia using blankets or warmed fluids

2.2 Secondary Survey

• Full head-to-toe examination to identify non-life-threatening injuries

• AMPLE History:

  • Allergies, Medications, Past medical history, Last meal, Events leading to injury

Section 3: Hemorrhage Control

3.1 Types of Bleeding

• Arterial: Bright red, spurting; difficult to control

• Venous: Dark red, steady flow

• Capillary: Oozing; often self-limiting

3.2 Hemorrhage Management

• Direct Pressure:

  • Apply gauze and maintain firm pressure

• Tourniquet Use:

  • Apply 2-3 inches above the wound; note the time of application

  • Indicated for uncontrolled extremity bleeding

• Hemostatic Agents:

  • Impregnated gauze for junctional wounds (ex., groin, axilla)

Section 4: Shock Management

4.1 Types of Shock

• Hypovolemic Shock:

  • Cause: Blood loss (hemorrhage) or dehydration

  • Signs: Tachycardia, hypotension, cold/clammy skin, delayed capillary refill

  • Treatment:

    • Control bleeding

    • Administer IV fluids (20 mL/kg bolus of normal saline)

• Obstructive Shock:

  • Cause: Tension pneumothorax, cardiac tamponade

  • Signs: Jugular vein distension (JVD), hypotension, absent breath sounds (tension pneumothorax)

  • Treatment: Needle decompression or pericardiocentesis

• Neurogenic Shock:

  • Cause: Spinal cord injury leading to loss of sympathetic tone

  • Signs: Hypotension, bradycardia, warm/dry skin

  • Treatment: Maintain spinal immobilization and provide IV fluids

Section 5: Specific Traumatic Injuries

5.1 Head Injuries

• Types:

  • Concussion: Temporary loss of neurological function

  • Contusion: Bruising of the brain tissue

  • Intracranial Hemorrhage: Subdural, epidural, or intracerebral bleeding

• Signs and Symptoms:

  • AMS, vomiting, unequal pupils, posturing

• Prehospital Care:

  • Ensure adequate ventilation and oxygenation

  • Elevate head of the stretcher to 30 degrees if ICP is suspected

  • Monitor for changes in GCS

5.2 Chest Injuries

• Tension Pneumothorax:

  • Signs: Absent breath sounds, tracheal deviation, hypotension

  • Treatment: Needle decompression in the 2nd intercostal space, midclavicular line

• Flail Chest:

  • Signs: Paradoxical chest wall movement

  • Treatment: Stabilize with bulky dressing and provide oxygen

5.3 Abdominal Injuries

• Evisceration:

  • Treatment: Cover with a moist sterile dressing and do not attempt to reinsert

• Blunt Trauma:

  • Signs: Abdominal distension, guarding, hypotension

  • Treatment: Rapid transport and monitoring

5.4 Spinal Injuries

• Assessment:

  • Midline tenderness, step-offs, neurological deficits

• Prehospital Care:

  • Spinal motion restriction using a backboard and cervical collar