Trauma and Emergency Surgery
Core concepts
Apply damage-control principles: hemorrhage control, contamination control, temporary closure, and ICU resuscitation before definitive repair. Know indications for laparotomy in blunt and penetrating trauma, and the role of CT in stable patients. Understand colorectal injury management by grade: primary repair for low-grade, resection with diversion for destructive injuries. Recognize the septic abdomen, perforated diverticulitis (Hinchey classification), and the choice of resection with or without anastomosis. Know when to use a temporary stoma.
Traps
Questions test whether you avoid anastomosis in the unstable, contaminated, or hypotensive patient. Another trap: choosing CT in an unstable patient-unstable patients go to the operating room. Watch for over-reliance on antibiotics for perforated viscus. Also know that colostomy is not mandatory for all left-sided trauma.
Worked example
A hypotensive patient with a gunshot wound to the sigmoid and gross contamination: damage-control laparotomy, resection without primary anastomosis, and temporary end colostomy. Rule of thumb: the unstable patient gets the fastest safe operation-control contamination, avoid a fresh anastomosis under shock.