Major Trauma

Abstract

In the UK, trauma is currently the commonest cause of death in people <40 years and its incidence is predicted to rise over the next 20 years. So you have an important role in the assessment and management of this group of patients. Doctors of the ED perform a vital role in the early stages of management of trauma patients. In patients with multiple injuries, the care is delivered by a trauma team constituted by middle-grade doctors from various specialties. A senior doctor, usually from the ED and with training in dealing with trauma, leads the team. The trauma team is often requested by the prehospital ambulance personnel, but this is not always the case. Although in your first few days you would not be expected to manage such situations on your own, you may come across a patient with serious trauma behind the curtains in a cubicle. Recognizing the seriousness of the situation and calling for help in the form of a trauma team may make all the difference to that patient in terms of recovery. The principles of assessment and management of trauma patients are discussed in the first answer of this chapter. The ATLS course introduces you to the principles of early management of trauma victims and this can be applied to any trauma patient whom you will see in the ED. The skills you learn on the ATLS course are applicable in many situations. It is advisable to attend this training course while you are working in the ED. You should suspect major trauma in the following situations: • Related to vehicles: high-speed collisions, victim’s ejection from the vehicle (partial or total), rollover, prolonged extrication, etc. • Death of a co-passenger • Pedestrians run over or thrown away to a distance, or with a significant impact (>20mph/32kph) • Falls from a height of >6m in adults and >3m in children or two to three times the height of the child. Resuscitation in the first hour in the resuscitation room has been proved to reduce mortality and morbidity among trauma patients, and so it might be you who will have saved the life of an individual.