Trauma and Surgical Emergencies
This domain tests the primary survey, haemorrhage control, shock recognition, torso and head injury, and indications for urgent surgery. The exam emphasises treating lethal problems before completing history or imaging.
Core rules
- Primary survey: catastrophic haemorrhage control, airway with cervical spine protection, breathing, circulation, disability, exposure.
- Hypotension after trauma is haemorrhagic until proven otherwise. Stop external bleeding, apply pelvic binder for suspected pelvic fracture, and activate massive transfusion for major haemorrhage.
- Give tranexamic acid within 3 hours for major trauma with suspected bleeding.
- FAST detects haemoperitoneum but does not exclude retroperitoneal or pelvic bleeding.
- In traumatic brain injury, avoid hypotension and hypoxia; maintain cerebral perfusion. Permissive hypotension is unsafe with suspected TBI.
Worked example
A motorcyclist has BP 78/40, tachycardia, and a unstable pelvis on examination. Apply a pelvic binder, start blood products and tranexamic acid, and arrange urgent transfer. Do not give large volumes of crystalloid, which worsen dilutional coagulopathy and clot disruption.
Traps
- Do not remove impaled objects; stabilise them.
- Do not perform a digital rectal examination as a routine trauma step.
- Do not miss distracting injuries or tension pneumothorax during airway manoeuvres.
- Do not interpret a normal FAST as excluding all bleeding.
- Avoid excessive crystalloid; use balanced resuscitation and blood products.