Trauma and Orthopaedic Emergencies
Core concepts
Understand the primary survey (ABCDE) with cervical spine protection, and the concept of damage-control resuscitation with permissive hypotension in penetrating trauma and balanced transfusion. Know the lethal triad (hypothermia, acidosis, coagulopathy) and how to prevent it. Cover the recognition and management of tension pneumothorax, massive haemothorax, cardiac tamponade, and pelvic fracture with haemodynamic instability (binder, not traction). Learn the Ottawa rules for ankle and knee imaging, and the assessment of compartment syndrome (pain out of proportion, pain on passive stretch). Cover head injury with GCS-based imaging decisions and the anticoagulated head injury patient.
Traps
Questions test giving too much crystalloid in haemorrhagic shock. A pelvic binder is a lifesaver but a distractor may suggest repeated log-rolling. In compartment syndrome, pulselessness is a late sign - do not wait for it. In the anticoagulated patient with head injury, a normal CT does not exclude delayed bleeding.
Rule of thumb
In major trauma, treat catastrophic haemorrhage before airway only if it is immediately life-threatening (the C-ABC sequence). For compartment syndrome, the earliest and most reliable sign is disproportionate pain on passive stretch.
Worked example
A motorcyclist with pelvic pain, BP 80/50, and a stable chest: apply a pelvic binder, activate massive transfusion, and avoid repeated pelvic examination - transfer for definitive haemorrhage control.