Traumatic Disorders
Core approach
Trauma care follows a primary survey with catastrophic hemorrhage and airway control first, then a secondary survey. Understand hemorrhagic shock, tension pneumothorax, hemothorax, cardiac tamponade, traumatic brain injury, abdominal solid-organ and hollow-viscus injury, pelvic and long-bone fractures, and compartment syndrome. Use FAST, plain films, and CT selectively; unstable patients should not leave the resuscitation area for prolonged imaging. Activate massive transfusion protocols when indicated and remember damage-control resuscitation: hemorrhage control, balanced blood products, warming, and correction of calcium and coagulopathy.
Traps
A normal FAST does not exclude retroperitoneal or hollow-viscus injury. Hypotension in a pregnant trauma patient may be fetal distress before maternal signs. Elderly and anticoagulated patients may bleed with minor mechanisms. Do not miss distracting injuries or assume intoxication explains altered mental status. In suspected tension pneumothorax, decompress before chest radiography. In TBI, avoid hypotension and hypoxia, which worsen outcomes.
Worked example
A penetrating chest trauma patient is hypotensive with distended neck veins and muffled heart sounds. Bedside ultrasound shows pericardial fluid. Treat cardiac tamponade with emergency pericardial decompression and surgical consultation, not large-volume fluids alone. Rule of thumb: in trauma, hypotension is hemorrhage until proven otherwise; find and control the bleeding source.
Key concepts
Permissive hypotension may be used in hemorrhagic shock without TBI, but avoid prolonged hypotension. Give tranexamic acid early when indicated. Open fractures need antibiotics and early debridement.