Trauma 101

Here’s an introduction to trauma and the primary survey. Here we talk about the initial management of the patient within the “golden hour” (the hour in which if we resuscitate the patient we may prevent death). So what do we do in that first hour?

Test your knowledge

Bring your answers to class on Friday.

• What is the difference between the European (“stay and play”) and American (“scoop and run”) model of emergency medical transport of trauma patients? Can you name some benefits and disadvantages of each?
• As head of the trauma team resuscitating a patient, would you think it’s better for you to stand at the foot of the bed and direct everyone or to get “down and dirty” and start placing lines and tubes?
• A man got shot in the buttocks and he is pissed off, he is swearing and cussing and can’t answer any questions you ask. He’s taking swings at everyone and trying to kick people at his feet. He’s giving evil glares at any one who comes close to him. How would you rank his disability score?
• What is a flail chest? Is that a breathing problem we need to address in the primary survey?

Test your knowledge

For the following traumatic injuries, (i) describe the trauma (what kind and where), (ii) what injuries you would suspect, and (iii) how would you work it up?

• Gunshot to the abdomen
• Fall off a 2-story ladder on your feet
• Car crash hitting your head on the windshield and knees against the dashboard
• Dove into a shallow pool
• Punched in the gut by Dr. Casey

Test your knowledge

Tell me how you’d work up the following cases of blunt trauma to the chest.

• Punched in the sternum by Mike Tyson
• Punched in the sternum by Rahul Patwari (ie, < 1/4 Mike Tyson)
• Hit in chest with a steering wheel at 40 mph in a Toyota Prius, whose front end has a huge dent – it’s not driveable

Test your knowledge

How would you work up the following cases of penetrating trauma?

• Knife still stuck in the right chest, anterior axillary line, 5th rib space
• While defeating 100 ninjas, you get a throwing star to sternum (penetrates 3-4 mm)
• Two bullet holes seen, one in right flank and the other in left axilla