Trauma and Musculoskeletal Injuries
Primary survey in trauma
Use a structured approach - catastrophic haemorrhage control, airway with cervical spine precautions, breathing, circulation, disability, exposure. Control life-threatening external bleeding before moving on; recognise the signs of internal bleeding (tachycardia, delayed capillary refill, altered mental status, hypotension as a late sign). Understand when a pelvic binder, tourniquet, or direct pressure is appropriate.
Fractures and dislocations
Know the classic signs: deformity, swelling, crepitus, pain, loss of function, and neurovascular compromise (pulses, sensation, movement distal to injury). Understand that splinting reduces pain and bleeding and protects soft tissue, and that joints should be immobilised in the position found unless circulation is compromised. Recognise the significance of an open fracture and the need for wound coverage and prompt transport.
Head and spinal injury
Recognise signs of raised intracranial pressure (deteriorating consciousness, unequal pupils, vomiting, headache) and the importance of avoiding hypoxia and hypotension, both of which worsen brain injury. Understand spinal immobilisation principles and that the mechanism of injury plus symptoms guide suspicion.
Traps in questions
Watch for the 'obvious' injury distracting from a life-threatening one - a femur fracture can bleed significantly. Do not remove impaled objects. Do not straighten a deformed limb if it compromises circulation. Beware answers that prioritise splinting over haemorrhage control.
Rule of thumb
Catastrophic bleeding is controlled before airway - a patient can exsanguinate in minutes.