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CME

Major Trauma - Emergency Management

General Information

General InformationGeneral Information

Background

  • Major trauma involves more than 1 organ system, also termed multisystem trauma
  • A significant cause of death and disability worldwide with large socioeconomic costs

Anatomy

  • See sections based on specific injury

Etiology

  • Blunt trauma represents the majority of trauma with significant examples including1,2
    • Motor vehicle collision
    • Pedestrian struck by car
    • Bicycle struck by car
    • Fall from height
    • Assault
  • Penetrating injury is less common with significant examples including1,2
    • Gunshot wound
    • Stab wound

Epidemiology

  • Trauma is the leading cause of death for persons aged 1-44 years1,2
  • Globally, trauma from motor vehicle collisions are responsible for over 1 million deaths annually and up to 50 million injuries1,2,3
  • Patients with serious traumatic injuries have significantly lower likelihood of mortality or morbidity if treated at a designated trauma center4
  • There is a trimodal pattern to traumatic death: immediate, early, and late1,2
    • Immediate deaths (seconds to minutes)
      • Due to apnea from severe brain or spinal cord injury
      • Due to rupture of the heart or aorta
      • Prevention is the only method to reduce these deaths
    • Early deaths (minutes to hours)
      • Typical injuries: epidural or subdural hematoma, hemopneumothorax, liver injury, splenic rupture, pelvic fracture
      • These deaths can be decreased by rapid assessment and treatment
    • Late deaths (days to weeks): often due to sepsis or multiorgan failure

References

References

General References Used

  1. ACS Committee on Trauma, Advanced Trauma Life Support Manual. American College of Surgeons; 2012
  2. Brunicardi, FC, Andersen DK, Billiar TR, Hunter JG. Schwartz's Principles of Surgery. McGraw-Hill; 2009
  3. World Health Organization (WHO). Global Status Report on Road Safety 2015. WHO 2015
  4. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006 Jan 26;354(4):366-78full-text
  5. Parks JK, Elliott AC, Gentilello LM, Shafi S. Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample. Am J Surg. 2006 Dec;192(6):727-31
  6. Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg. 2006 Jan;41(1):92-8
  7. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989 May;29(5):623-9
  8. Paydar S, Fazelzadeh A, Abbasi H, Bolandparvaz S. Base deficit: a better indicator for diagnosis and treatment of shock in trauma patients. J Trauma. 2011 Jun;70(6):1580-1
  9. Odom SR, Howell MD, Silva GS, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013 Apr;74(4):999-1004
  10. Smith KA, High K, Collins SP, Self WH. A preprocedural checklist improves the safety of emergency department intubation of trauma patients. Acad Emerg Med. 2015 Aug;22(8):989-92
  11. Green RS, Butler MB, Erdogan M. Increased mortality in trauma patients who develop postintubation hypotension. J Trauma Acute Care Surg. 2017 Oct;83(4):569-574
  12. Mowery NT, Gunter OL, Collier BR, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma. 2011 Feb;70(2):510-8
  13. Holcomb JB. Damage control resuscitation. J Trauma. 2007 Jun;62(6 Suppl):S36-7
  14. Brenner M, Teeter W, Hoehn M, et al. Use of Resuscitative Endovascular Balloon Occlusion of the Aorta for Proximal Aortic Control in Patients With Severe Hemorrhage and Arrest. JAMA Surg. 2018 Feb 1;153(2):130-135

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T906321, Major Trauma - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T906321. Registration and login required.

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