Surgery and Traumatology
Surgery and Traumatology tests the ABCDE primary survey, recognition of shock, acute abdomen, wound care, and basic fracture management. In Cambodia, road traffic injury from motorbikes is a common exam scenario, so prioritize hemorrhage control and safe transfer.
Core rules
- Primary survey before history: catastrophic bleeding, airway, breathing, circulation, disability, exposure.
- Unstable patient with suspected abdominal bleeding goes to FAST and surgery, not CT.
- Give tranexamic acid within 3 hours of trauma with significant bleeding; keep the patient warm and give calcium with massive transfusion.
- Open fractures need antibiotics, tetanus prophylaxis, splinting, and urgent debridement.
Worked example
A 25-year-old man after a motorbike crash has HR 130, BP 85/50, cool skin, and a distended abdomen. FAST shows free fluid. This is hemorrhagic shock from likely splenic or liver injury. Activate massive transfusion, give tranexamic acid, and proceed to damage-control laparotomy. Do not send him to CT. Check the pelvis and cervical spine, and document tetanus status.
Traps
- Ordering CT in a hemodynamically unstable patient, delaying hemorrhage control.
- Forgetting that pelvic fracture can cause massive bleeding; examine and bind the pelvis.
- Missing associated injuries because a single wound is obvious.
- Giving too much crystalloid before blood in hemorrhagic shock.