Refractory shock in trauma is still most likely due to occult ongoing haemorrhage; shock may be due to the underlying cause of trauma e.g. MI leading to car crash
Apply ATLS/APLS protocol: primary survey to exclude life-threatening injuries, secondary survey, re-evaluation and definitive care.
Trauma Literature Summaries: Tranexamic acid (TXA) for traumatic haemorrhage; Steroids for acute spinal injury
Assessment of thoracic trauma requires the identification of immediately life-threatening injuries on primary survey, and delayed life threats on secondary survey.
Finger Thoracostomy: Any pneumothorax in a patient undergoing positive pressure ventilation; Actual or near traumatic cardiac arrest; Shocked state with no apparent cause; Pleural drainage is not indicated in drowning or hangings unless pneumothorax is diagnosed. Remember pleural decompression will reduce the efficiency of the ACD and impedance valve
The most important extremity injuries are those that are either life-threatening or limb-threatening in nature such as Pelvic disruption with massive hemorrhage; Severe arterial hemorrhage; and Crush syndrome
Pelvic stabilization is an important simple intervention in the management of severe pelvic trauma, and has 4 main objectives: Prevent re-injury from pathological pelvic motion (most important clinically); Decrease pelvic volume; Tamponade bleeding pelvic bones and vessels; Decrease pain
Post-splenectomy patients are at increased risk of infection from encapsulated organisms which can (very rarely) lead to overwhelming post-splenectomy sepsis (OPSS); have distinctive findings on full blood count (FBC) and the blood film
Initial Trauma Assessment: ATLS approach
A syndrome caused by systemic embolisation of fat globules released into the circulation following trauma or surgical procedures