Trauma and Musculoskeletal Injuries
Core concepts
Understand the kinematics of trauma and how mechanism predicts injury patterns. Know the primary survey with catastrophic hemorrhage control (direct pressure, tourniquet, wound packing, pelvic binder), airway management with cervical spine precautions, and recognition of tension pneumothorax, hemothorax, flail chest, and pericardial tamponade. Understand spinal immobilization indications, the role of rapid transport versus scene time, and principles of splinting, traction, and neurovascular assessment for musculoskeletal injuries. Burn assessment (rule of nines), hypothermia prevention, and crush injury considerations are also fair game.
Traps in questions
Distractors often emphasize spinal immobilization over airway or hemorrhage control, or suggest removing an impaled object. Be careful with tourniquet questions-modern practice favors early application for life-threatening extremity hemorrhage rather than waiting. Watch for questions that confuse tension pneumothorax (needs needle decompression) with simple pneumothorax. Also note that in trauma, hypotension is hemorrhagic until proven otherwise.
Rule of thumb
In major trauma, follow the sequence: catastrophic hemorrhage control, airway with C-spine precautions, breathing, circulation, disability, exposure. "Scene time is treatment time"-minimize on-scene interventions that do not save life or limb.