Trauma and Surgical Emergencies
Domain focus
The Trauma and Surgical Emergencies domain tests the primary survey, hemorrhage control, damage-control resuscitation, and recognition of injuries that need immediate operation.
Core rules
- Primary survey ABCDE with cervical spine protection; treat life threats as found.
- External hemorrhage: direct pressure, tourniquet for junctional or limb bleeding, pelvic binder for suspected pelvic fracture.
- Hypotension after trauma is hemorrhagic until proven otherwise. Activate massive transfusion protocol with balanced 1:1:1 red cells, plasma, platelets; give tranexamic acid within 3 hours of injury.
- Permissive hypotension until hemorrhage control in penetrating trauma without TBI; avoid large crystalloid boluses.
- eFAST looks for pericardial, pleural, and intraperitoneal fluid; a positive FAST in an unstable patient prompts laparotomy.
- Tension pneumothorax is clinical: needle decompression then chest tube.
Worked example
A 30-year-old unrestrained driver is hypotensive after a high-speed crash. eFAST shows fluid in Morison's pouch. The patient remains at 80/50 after 1 L blood. Reasoning: positive FAST plus instability means intra-abdominal hemorrhage; do not send to CT. Activate MTP, give TXA, and go to the operating room for laparotomy.
Traps
A normal FAST does not exclude retroperitoneal or hollow-viscus injury. Do not remove an impaled object. Avoid over-resuscitation with crystalloid, and do not miss tension pneumothorax because breath sounds are hard to hear in a noisy bay.