21. Trauma resuscitation

Airway

Breathing

Circulation

Disability (neuro status)

Exposure

ABCDE of the primary survey

GCS ≤ 8

GCS giving indication to intubate

endotracheal intubation

gold standard airway control

End-tidal CO₂ ⭐

Bilateral breath sounds

confirm ET intubation with

cricothyroidotomy

next step when intubation fails, can't ventilate

-faster than tracheostomy

simple pneumothorax

is commonly caused by blunt chest trauma.

Small → O₂ + observe

Large → chest tube

treatment of simple pneumothorax

Hypotension

Tracheal deviation

JVD

Absent breath sounds

what are the signs of a tension pneumothorax

👉 Immediate needle decompression → chest tube ⭐DO NOT wait for imaging

treatment for tension pneumothorax

Chest tube

Massive (>1500 mL) → thoracotomy

treatment for hemothorax

flail chest

≥2 fractures in ≥2 ribs → free-floating segment

Paradoxical movement

Paradoxical movement

a section of the chest that moves in the opposite direction to the rest of the chest during the phases of respiration. Typically seen with a flail segment

Pain control

Oxygen

Positive pressure ventilation if severe

treatment of flail chest

Hemodynamically stable patients ONLY

when to use CT in trauma setting

DO NOT CT if unstable

👉 Go straight to OR or FAST exam

do you go to CT in an unstable patient?

shock index

Heart rate divided by systolic blood pressure.

urine output

Adults: ≥0.5 mL/kg/hr

what is the best indicator of end organ perfusion

Direct pressure ⭐ (first-line for all bleeding)

Pressure dressing / compression bandage

Wound packing (junctional areas: groin, axilla, neck)

Tourniquet ⭐ (life-threatening extremity bleeding)

Place proximal to wound

Tighten until bleeding stops

Hemostatic agents (e.g., combat gauze)

stepwise approach to stop an external bleed

Peripheral IV (2 large-bore) ⭐

Intraosseous (IO)

Central venous access

options for emergent vascular access (in order of urgency)

can't get IV quickly

indication for interosseous access

Proximal tibia ⭐

Humeral head

sites of interosseous access

Seldinger technique

Placement of a central line by first placing a wire in the vein, followed by placing the catheter over the wire

internal jugular, subclavian, femoral

sites to place central lines

1-4

4: spontaneous

3: to sound

2: to pressure

1: none

scores for eye response in GCS

1-5

5: oriented

4: confused

3: words

2: sounds

1: none

scores for verbal response in GCS

1-6

6: obey commands

5: localizing

4: normal flexion

3: abnormal flexion

2: extension

1: none

scores for motor response in GCS

13-15

mild GCS score

9-12

moderate GCS score

3-8

severe GCS score

A = Alert

V = responds to Voice

P = responds to Pain

U = Unresponsive

What is the AVPU scale?

Rectal tone → spinal cord injury

Gross blood → GI injury

DRE in the trauma setting is used to determine

triad of death

-Acidosis

- Hypothermia

- Coagulopathy

secondary survey

Head-to-toe detailed exam AFTER primary survey is complete

-only do after ABCs are stabilized