Trauma and Acute Care Surgery
Core concepts
Trauma care follows a primary survey (airway, breathing, circulation, disability, exposure) with immediate treatment of life threats, then a secondary survey. Understand tension pneumothorax, hemothorax, pericardial tamponade, flail chest, massive hemothorax, and aortic injury. FAST detects pericardial and intraperitoneal fluid but does not rule out retroperitoneal or hollow-viscus injury. Damage-control resuscitation emphasizes hemorrhage control, balanced blood products, prevention of hypothermia, acidosis, and coagulopathy, and permissive hypotension in selected patients without traumatic brain injury. Massive transfusion protocols typically use balanced ratios; tranexamic acid may be given early in trauma with significant bleeding. Pelvic binders, REBOA, and operative or angiographic hemorrhage control are selected by anatomy and physiology.
Traps
Tension pneumothorax is a clinical diagnosis-do not wait for imaging. A negative FAST does not exclude injury, especially in stable patients who can undergo CT. Do not give excessive crystalloid in hemorrhagic shock. In suspected cardiac tamponade, Beck triad is neither sensitive nor specific. Anticoagulated and elderly patients may bleed with minor mechanisms.
Worked example
A hypotensive adult with blunt abdominal trauma, distended abdomen, and positive FAST should go to the operating room after rapid resuscitation; CT is inappropriate if unstable. Rule of thumb: unstable plus positive FAST equals laparotomy; stable plus equivocal findings equals CT with serial examination.