Trauma (main)

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Background

Initial evaluation objectives

  1. Rapidly identify life-threatening injuries
  2. Initiate supportive therapy
  3. Organize definitive therapy

Locations of Possible Life-Threatening Bleeding

Lethal Triad of Major Trauma

  1. Hypothermia
  2. Coagulopathy
  3. Acidosis

Clinical Features

Classes of hemorrhagic shock[1]

Class I II III IV
Blood Loss (mL) <750 750-1000 1500-2000 >2000
Blood Loss (%) <15 15-30 30-40 >40
Pulse rate (per min) <100 100-120 120-140 >140
Blood Pressure Normal Normal Decreased Decreased
Pulse Pressure (mmHg) Normal or Increased Decreased Decreased Decreased
Respiratory Rate (per min) 14-20 20-30 30-40 >35
Urine Output (mL/hr) >30 20-30 Negligible
Mental Status Slightly Anxious Mildly Anxious Anxious, Confused Confused, Lethargic
Fluids Crystalloid Crystalloid Crystalloid and blood Crystalloid and blood

Differential Diagnosis

Head trauma

Neck Trauma

Torso Trauma

Extremity trauma

Pediatric trauma

Evaluation

  • Consider FAST
  • Consider CT

Management

Complications

Disposition

  • Depends on underlying injury

See Also

External Links

References

  1. American College of Surgeons Committee on Trauma. Shock: in Advanced Trauma Life Support: Student Course Manual, ed 9. 2012. Ch 3:62-81