Trauma
What this domain tests
Trauma items test hemorrhage control, shock recognition, spinal motion restriction, and burn and chest-injury management. The exam favors fixing immediate threats over completing a full head-to-toe first.
Core rules
- Use XABCDE: control exsanguinating hemorrhage, then airway, breathing, circulation, disability, exposure with hypothermia prevention.
- Tourniquet 5–7 cm above the wound, never over a joint, tightened until bleeding stops, with the time recorded. Pack junctional and deep wounds with hemostatic gauze and apply direct pressure.
- Apply a pelvic binder at the level of the greater trochanters for suspected pelvic fracture with hypotension.
- Spinal motion restriction is selective: mechanism plus distracting injury, neurologic deficit, or altered mental status, not every trauma patient.
- Tension pneumothorax: unilateral absent breath sounds, hypotension, distended neck veins, worsening distress. Needle decompression per protocol at the second intercostal space midclavicular or fourth/fifth anterior axillary line.
- Burns, adult rule of nines: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.
- Stabilize impaled objects in place; never remove them.
Worked example
A motorcyclist is pale, confused, with a heart rate of 132 and systolic pressure of 84 mmHg, and a painful pelvis. You control external bleeding, apply a pelvic binder, keep him warm, and transport rapidly rather than spending time splinting a forearm.
Traps
Splinting before controlling bleeding, removing impaled objects, backboarding everyone, and missing hypothermia in the exposed trauma patient all cost marks.