Trauma and Surgical Critical Care
Trauma and Surgical Critical Care tests the primary survey, triage, damage control, thoracic and abdominal injury, burns, shock, and resuscitation. Answers must follow ATLS priorities and physiology.
Primary survey and resuscitation
- ABCDE: airway with cervical protection, breathing, circulation, disability, exposure. Treat tension pneumothorax, massive hemothorax, cardiac tamponade, and airway obstruction before imaging.
- Hypotensive trauma: permissive hypotension until hemorrhage control (except traumatic brain injury), balanced blood products, tranexamic acid within 3 h, and early damage-control surgery.
- FAST detects free fluid; it does not exclude retroperitoneal or hollow-viscus injury.
Burns and shock
- Parkland: 4 mL × kg × %TBSA in 24 h, half in the first 8 h from burn time. Use urine output 0.5–1 mL/kg/h as the endpoint, not formula alone.
- Shock classes: tachycardia, narrowed pulse pressure, then hypotension; lactate and base deficit track perfusion.
Worked example: A 70 kg man with 30% TBSA flame burn arrives 2 h after injury. Parkland = 4 × 70 × 30 = 8,400 mL/24 h; first 8 h volume = 4,200 mL, but 2 h have elapsed, so give 4,200 mL over the remaining 6 h (about 700 mL/h) and titrate to urine output. Reasoning: the clock starts at the burn, not at arrival.
Traps: using the rule of nines incorrectly in children; giving colloid first; missing inhalation injury; over-resuscitating burns and causing abdominal compartment syndrome; forgetting tetanus and analgesia.