Trauma, Burns, and Surgical Critical Care
Core concepts
Apply ATLS priorities: airway with cervical spine protection, breathing, circulation, disability, exposure. Recognize life-threatening injuries: tension pneumothorax, massive hemothorax, cardiac tamponade, and airway obstruction. Understand damage-control resuscitation with balanced blood products and permissive hypotension in hemorrhage. In burns, use the Parkland or modified Brooke formula for initial fluid resuscitation and recognize inhalation injury and compartment syndrome. Know abdominal compartment syndrome and the open abdomen. Understand postoperative complications such as anastomotic leak and sepsis.
Traps
Permissive hypotension is inappropriate in traumatic brain injury - maintain cerebral perfusion. Fluid resuscitation formulas are starting points; titrate to urine output and clinical response. Do not miss inhalation injury in a patient with facial burns, soot, or hoarseness. Abdominal compartment syndrome is diagnosed by bladder pressure and organ dysfunction, not by exam alone. In hemorrhage, avoid large-volume crystalloid, which worsens coagulopathy.
Worked example
A 70-kg patient with a 40% total body surface area burn: Parkland formula gives 4 mL × 70 kg × 40% = 11,200 mL over 24 hours, with half in the first 8 hours from the time of injury. Titrate to urine output of 0.5–1 mL/kg/h. Rule of thumb: the formula is a starting point; clinical endpoints guide ongoing resuscitation.