Trauma and Musculoskeletal Injuries
Mechanism, hemorrhage, and the lethal triad
Candidates must connect mechanism of injury to expected injuries and recognize that exsanguinating hemorrhage is the leading early cause of preventable trauma death. Control external bleeding with direct pressure and tourniquets when indicated, and remember that a tourniquet is not a last resort for life-threatening extremity bleeding. The lethal triad is hypothermia, acidosis, and coagulopathy; prevention means warming, restoring perfusion, and avoiding crystalloid overload. Massive transfusion protocols with balanced ratios are examinable.
Regional injuries
Head and cervical spine: immobilize based on mechanism and findings, and know that spinal precautions can be cleared by validated criteria. Chest: rib fractures, flail chest, hemothorax, and aortic injury. Abdomen: solid organ injury from blunt trauma, hollow viscus injury from penetrating trauma; a seat-belt sign suggests bowel injury. Pelvis: unstable pelvic fracture can bleed massively; a binder is a temporizing measure. Extremities: check pulses, sensation, and motor function before and after splinting; compartment syndrome presents with pain out of proportion, especially on passive stretch, and is a clinical diagnosis.
Burns and special populations
Estimate burn size, and remember inhalation injury signs: facial burns, singed nares, soot, hoarseness, and enclosed-space fire. Pregnancy, older age, and anticoagulation change trauma priorities.
Traps in questions
- A normal initial blood pressure does not exclude significant hemorrhage in young patients.
- Do not remove an impaled object; stabilize it.
- Compartment syndrome is not diagnosed by pulselessness, which is a late finding.
- Log-roll and inspect the back; missed posterior wounds are a classic error.
Rule of thumb
Address catastrophic bleeding before airway in the exsanguinating patient. Worked example: a patient with an amputated forearm and spurting bleeding gets direct pressure and a tourniquet first, then airway and breathing assessment.