Emergency - Major trauma

From CambridgeNotes

ABC

  • Primary survey as per ATLS

History and Examination

  • AMPLE history as per ATLS
  • Inspection: color, perfusion, deformities, swelling or discoloration, wounds or amputations, foreign bodies
  • Palpation: sensation, tenderness, crepitation, pulse, capillary refill, temperature
  • Vascular injury: hemorrhage, expanding hematoma, diminished or absent pulses, bruit or thrill, diminished distal perfusion, decreased sensation, increasing pain
  • Compartment syndrome (increased pressure in fascial compartment compromising blood flow): severe pain, paresthesia, paralysis; compare with ischaemic limb (which is also pale, cold, and pulseless)

Investigations

  • AP and lateral films confirm fracture; air in the joint space?
  • Doppler may assist in determining pulses.
  • Ankle Brachial Index: <0.9 assume arterial injury

Definitive Treatment

  • Priorities to save life > save limb > preserve functionality
  • Life-threatening
    • Blood loss: see primary survey
    • Rhabdomyolysis: continue fluids and consider alkalinizing urine, osmotic diuretics
  • Limb-threatening:
    • Open fractures: see fracture management
    • Major nerve or vascular injury: immediate surgery
    • Compartment syndrome: remove constricting layers; consider manometer to confirm (>40mmHg); treat with fasciotomy (4 compartments in leg – 2 cuts)

References

  1. ATLS
MediaWiki