Trauma and Orthopedic Emergencies
Core concepts
Master the primary survey (ABCDE) and the concept of the "lethal triad" (hypothermia, acidosis, coagulopathy) in massive hemorrhage. Understand damage-control resuscitation, massive transfusion protocols, and the role of tranexamic acid. Know the indications for FAST, CT, and immediate operative intervention.
For orthopedic emergencies, recognize compartment syndrome (pain out of proportion, pain on passive stretch, paresthesia), open fractures, and neurovascular injury. Know the principles of fracture immobilization and the assessment of the "6 Ps." Understand spinal injury precautions and the clearance of the cervical spine. Recognize the potentially missed injuries: posterior shoulder dislocation, hip fracture in the elderly, and vascular injury with knee dislocation.
Traps
Compartment syndrome is a clinical diagnosis - do not wait for absent pulses or late signs. Another trap is missing a second injury (the "distracting injury"). Questions test whether you prioritize hemorrhage control over imaging and whether you know that permissive hypotension is inappropriate in traumatic brain injury.
Worked example / rule of thumb
A patient with a tibial fracture and severe pain worsened by passive toe extension: emergent fasciotomy after removing constricting casts. Rule of thumb: "Life before limb - control the bleeding, then image the bone; and never miss compartment syndrome waiting for a pulse deficit."