Clinical Trauma Care Across the Continuum
Think continuum, not single encounter
TCRN questions test trauma as a chain: injury prevention, prehospital care, acute resuscitation, rehabilitation, and reintegration. For prevention, know Haddon's matrix, which pairs host, agent, and environment with pre-event, event, and post-event phases. Primary prevention prevents the event (e.g., speed-limit enforcement); secondary prevention limits injury (e.g., airbags, helmets); tertiary prevention is rehabilitation. Prehospital priorities include field triage using physiologic, anatomic, mechanism, and EMS-judgment criteria, plus hemorrhage control, airway management, spinal motion restriction, and transport destination.
Acute care essentials
In the ED, the primary survey is a rapid ABCDE assessment with simultaneous resuscitation. Do not proceed to the secondary survey until immediate threats are addressed. Reassess after every intervention. Key traps include trusting a normal blood pressure in a compensating young adult, missing hypothermia and coagulopathy during damage-control resuscitation, omitting tetanus and analgesia, and delaying rehabilitation referral. The secondary survey is a head-to-toe examination with history (MIST or AMPLE), repeated vital signs, and indicated diagnostics.
Rehabilitation and reintegration
Early mobilization, nutrition, pain control, venous thromboembolism prophylaxis, pressure-injury prevention, and psychosocial screening reduce complications. Screen for PTSD, depression, and substance use. Plan return to work, school, driving, and community participation with the patient and family.
Worked rule of thumb
A restrained driver has heart rate 130, blood pressure 110/70, and pale skin. Treat tachycardia as early shock, not anxiety; hypotension is a late sign. Start blood products early for hemorrhagic shock and reassess.
Trap to avoid
Stopping at the first abnormality. Complete the primary survey, reassess, then move on.