Musculoskeletal and Trauma
Core concepts
Trauma care follows a primary survey with hemorrhage control as a priority. Understand tourniquet application, wound packing, pelvic binder placement, traction splinting, spinal motion restriction, and fracture stabilization. Recognize compartment syndrome, crush injury, open fractures, and major pelvic or femoral hemorrhage. Permissive hypotension may be appropriate in selected trauma before hemorrhage control, but traumatic brain injury requires adequate perfusion and oxygenation. Tranexamic acid and blood products may be part of hemorrhage management per protocol.
Traps
Questions often test tourniquet timing and tightening: a tourniquet may be painful and should not be loosened once effective. Pelvic binders belong at the level of the greater trochanters, not the iliac crests. Traction splints are contraindicated with certain pelvic or lower-extremity injuries. Do not prioritize splinting over hemorrhage control. Spinal precautions should not delay airway or lifesaving interventions.
Rule of thumb
Life before limb: control catastrophic hemorrhage, then airway and breathing, then stabilize fractures. For suspected pelvic fracture with instability, place a pelvic binder at the greater trochanters and reassess.
Worked example
A patient with a femur fracture is hypotensive and tachycardic. The femur can bleed significantly. Prioritize hemorrhage control, consider a traction splint if appropriate, monitor for compartment syndrome, and initiate resuscitation and transport. Do not let splinting delay treatment of shock.