Trauma (main): Difference between revisions
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**[[Post-concussive syndrome]] | **[[Post-concussive syndrome]] | ||
**[[Clinical decision rules for head CT in trauma]] | **[[Clinical decision rules for head CT in trauma]] | ||
**[[Elevated intracranial pressure]] | |||
*[[Orbital trauma]] | *[[Orbital trauma]] | ||
*[[Maxillofacial trauma]] | *[[Maxillofacial trauma]] |
Revision as of 19:43, 21 November 2017
Background
Initial evaluation objectives
- Rapidly identify life-threatening injuries
- Initiate supportive therapy
- Organize definitive therapy
Locations of Possible Life-Threatening Bleeding
- External
- Internal
- Thoracic cavity
- Peritoneal cavity
- Retroperitoneal space (i.e. pelvic fracture)
- Femur fracture (into muscle/subcutaneous tissue)
Lethal Triad of Major Trauma
Clinical Features
Classes of hemorrhagic shock[1]
Class | I | II | III | IV |
---|---|---|---|---|
Approximate blood loss | <15% | 15-30% | 30-40% | >40% |
Heart rate | ↔ | ↔/↑ | ↑ | ↑↑ |
Blood pressure | ↔ | ↔ | ↔/↓ | ↓ |
Pulse Pressure (mmHg) | ↔ | ↓ | ↓ | ↓ |
Respiratory Rate (per min) | ↔ | ↔ | ↔/↑ | ↑ |
Urine Output (mL/hr) | ↔ | ↔ | ↓ | ↓↓ |
Glasgow coma scale score | ↔ | ↔ | ↓ | ↓ |
Base deficit^ | 0 to -2 mEq/L | -2 to -6 mEq/L | -6 to -10 mEq/L | -10 or less mEq/L |
Need for blood products | Monitor | Possible | Yes | Massive transfusion protocol |
^Base excess is the quantity of base (HCO3-, in mEq/L) that is above or below the normal range in the body. A negative number is called a base deficit and indicates metabolic acidosis.
Differential Diagnosis
Head trauma
- Traumatic brain injury
- Orbital trauma
- Maxillofacial trauma
- Pediatric head trauma
Neck trauma
Torso Trauma
Extremity trauma
Pediatric trauma
Evaluation
- Consider FAST
- Consider CT
Management
Complications
- Hypothermia
- Acidosis
- (Dilutional) coagulopathy
- Hypocalcemia
Disposition
- Depends on underlying injury
See Also
External Links
References
- ↑ American College of Surgeons Committee on Trauma. Shock: in Advanced Trauma Life Support: Student Course Manual, ed 10. 2018. Ch 3:62-81