Epidemiology and Management of Trauma in Australia

What is the global impact of trauma in terms of annual injury care and deaths?

Approximately 970 million people require care for injuries, and 4.8 million die annually.

What is the leading cause of death for Australians aged 1-44?

Trauma, particularly from road traffic injuries.

Which demographic in Australia has higher rates of injury-related deaths?

Indigenous Australians, especially those aged 25-44, often due to violence and poisoning.

What are the leading causes of death in Australia for individuals?

Suicide, accidental poisoning, and land transport accidents.

What are the components of a trauma system?

Prevention, prehospital care, hospital care, rehabilitation, and recovery/disability.

Why is rapid identification and transport critical in major trauma cases?

It is crucial to transport patients to the highest-level trauma service within 60-90 minutes.

What does the kinetic energy formula?

KE = ½mv²

Which groups are considered high-risk for injury even with low-energy mechanisms?

Children and the elderly.

What are the types of bleeding and their characteristics?

Arterial (bright red, spurting), venous (dark red, steady flow), capillary (oozing).

What is the significance of uncontrolled bleeding in trauma?

It is a leading cause of preventable death.

What is shock in the context of trauma?

Inadequate tissue perfusion due to failure of the heart, vessels, or blood volume.

What are the types of shock?

Hypovolemic, Obstructive, cardiogenic, and distributive shock (septic, neurogenic, anaphylactic).

What is the difference between compensated and decompensated shock? Irreversible?

Compensated shock with compensatory mechanisms to maintain blood pressure through tachycardia and vasoconstriction, LOC may change; decompensated shock results in dropped blood pressure and organ failure. Increasing lactic acid levels result from anaerobic metabolism result in metabolic acidosis. Irreversible occurs when tissues and cells throughout the body become ischemic and necrotic, resulting in multiple organ dysfunction.

What are the types of soft-tissue injuries?

Closed (contusions) and open (lacerations, abrasions, avulsions, punctures).

What is the care for closed soft-tissue injuries?

Rest, ice, compression, and elevation.

What are the agents that can cause burn injuries?

Thermal, chemical, electrical, and radiation.

How are burn injuries classified by depth?

Superficial (red, painful), partial-thickness (blisters, moist, painful), full-thickness (dry, leathery, painless).

What are the types of chest injuries?

Closed (blunt), open (penetrating), pneumothorax, tension pneumothorax, hemothorax, haemopneumothorax.

What is the care for abdominal injuries?

Minimize movement, cover eviscerations, and ensure rapid transport.

What are the types of musculoskeletal injuries?

Fractures, dislocations, sprains, and strains.

What are the complications associated with musculoskeletal injuries?

Bleeding, infection, and compartment syndrome.

What are the types of brain injuries?

Concussion, contusion, hemorrhage, and diffuse axonal injury.

What are the different types of head haemorrhage and the difference?

An epidural hematoma (EDH) occurs between your skull and the outermost layer of meninges, the dura mater. A subdural haematoma occurs in the space between the dura mater and the second meninges layer, the arachnoid layer.

What are the common mechanisms that lead to spinal cord injury?

Falls, motor vehicle collisions (MVCs), and penetrating trauma.

What assessments are crucial for evaluating spinal cord injury?

Glasgow Coma Scale (GCS), neurological checks, and NEXUS criteria for spinal immobilization.

What are the primary care priorities for a patient with spinal cord injury?

Airway and breathing support, spinal motion restriction, and rapid transport.

What risks are associated with face, jaw, and neck injuries?

Airway compromise, severe bleeding, and associated brain/spine injuries.

What is the approach to managing multisystem trauma?

Rapid assessment, prioritizing life threats, teamwork, and early transport to a trauma center.

What tools are used for the assessment of multisystem trauma?

GCS, mechanism of injury, and anatomical and physiological priorities.

What types of environmental emergencies are recognized?

Hypothermia, heat stroke, frostbite, drowning, and poisoning.

How does the body regulate thermoregulation?

It produces/conserves heat via metabolism and shivering, and loses heat through radiation, conduction, convection, and evaporation.

What are the differences between local and general cold injuries?

Local cold injuries refer to frostbite, while general cold injuries refer to hypothermia.

What types of heat emergencies exist?

Heat cramps, heat exhaustion, and heat stroke.

What are the care priorities for environmental emergencies?

Remove from the environment, rewarm or cool as appropriate, monitor ABCs.

What is hypovolemic shock and its primary cause?

Hypovolemic shock occurs due to significant loss of circulating blood volume, most commonly from trauma-induced hemorrhage.

What compensatory mechanisms does the body employ during hypovolemic shock?

Tachycardia, vasoconstriction, and increased respiratory rate to maintain perfusion to vital organs.

What are the consequences of uncorrected hypovolemic shock?

Hypotension, organ dysfunction, metabolic acidosis, and multi-organ failure.

What are the management priorities for a patient in hypovolemic shock?

Control external bleeding, restore blood volume with IV fluids, provide oxygen therapy, minimize scene time, and monitor for ongoing bleeding.

What is the C-ABCDE approach in trauma primary survey?

Catastrophic Hemorrhage, Airway, Breathing, Circulation, Disability, Exposure/Environment.

What is the first step in the primary survey for trauma?

Immediately control life-threatening external bleeding.

How should the airway be assessed in trauma patients?

Assess airway patency while protecting the cervical spine and clear obstructions.

What should be assessed during the Breathing step of the primary survey?

Adequate ventilation, chest movement, and lung auscultation.

What is involved in the Circulation assessment during the primary survey?

Assess pulse, skin color, capillary refill, control bleeding, and initiate IV access.

What is the purpose of the Disability step in the primary survey?

To perform a rapid neurological assessment using AVPU and Glasgow Coma Scale.

What should be done during the Exposure/Environment step of the primary survey?

Fully expose the patient to identify all injuries while preventing hypothermia.

What are the key components of assessing a patient with suspected spinal injury?

Mechanism of injury, symptoms like neck/back pain, neurological assessment, and NEXUS criteria.

What management steps should be taken for a patient with suspected spinal injury?

Call for ambulance, instruct the patient to remain still, prioritize airway management, immobilize spine, and monitor ABCs.

What is the primary goal when exposing a patient in trauma assessment?

To identify all injuries and prevent hypothermia.

What are the key symptoms indicating a suspected spinal injury?

Neck/back pain, numbness, weakness, paralysis, loss of bladder/bowel control, priapism.

What is the NEXUS criteria used for?

To determine the need for spinal immobilization. It considers Neurological deficit, high risk factors such as age, MOI, Midline tenderness, Altered Mental Status, Intoxication, Pain or Distracting Injuries.

What should be prioritized in unconscious patients with suspected spinal injury?

Airway management, using jaw thrust/chin lift to open the airway.

What is the immediate priority in managing a multi-trauma patient with uncontrolled bleeding?

Control catastrophic external hemorrhage using direct pressure, tourniquet, or hemostatic agents.

What are the steps in the initial management of a multi-trauma patient?

Control bleeding, maintain airway, provide high-flow oxygen, assess for life-threatening injuries, initiate IV access, and minimize scene time.

What are the epidemiological differences in trauma outcomes between Indigenous and non-Indigenous Australians?

Indigenous Australians have higher injury-related deaths, particularly in ages 25-44, and greater risk of death from interpersonal violence and PTSD. Indigenous Australians experience a higher proportion of injury-related deaths, particularly in ages 25-44 (46% men, 32% women) compared to non-Indigenous Australians (25% men, 12% women).

What is the purpose of trauma scoring systems in prehospital care?

To quantify injury severity, guide triage, predict outcomes, and determine appropriate destination for care.

What does the RTS (Revised Trauma Score) include?

It uses Glasgow Coma Scale, systolic blood pressure, and respiratory rate.

How does the body regulate temperature?

Through mechanisms such as shivering, hormonal thermogenesis, vasoconstriction, sweating, and vasodilation.

What role does the hypothalamus play in thermoregulation?

It acts as the body's thermostat, integrating signals from temperature sensors.

What factors can disrupt thermoregulation in environmental emergencies?

Hypothermia from exposure to cold, wet clothing, wind, or immersion.

What is the significance of rapid transport to a trauma center?

It minimises scene time and ensures timely definitive care for the patient.

What are the risks associated with hypothermia?

Exposure to cold can overwhelm heat production and conservation mechanisms, increasing risk in the elderly, infants, and those with impaired mobility.

What are the mechanisms of heat loss from the body?

Sweating, vasodilation, radiation, conduction, convection, and evaporation.

What should be done for a patient with a compromised airway and uncontrolled bleeding?

Simultaneously control bleeding and maintain the airway while providing high-flow oxygen.

What is hyperthermia/heat stroke?

A dangerous rise in core temperature due to excess heat or impaired sweating/vasodilation, which can lead to cellular damage, shock, and organ failure.

What factors can impair heat loss leading to hyperthermia?

Dehydration, certain medications, or illnesses.

What is ventilation in the context of respiratory physiology?

The mechanical movement of air in and out of the lungs, enabling gas exchange between the body and the environment.

What is external ventilation (external respiration)?

The exchange of gases (O₂ and CO₂) between the alveoli in the lungs and the pulmonary capillaries.

What occurs during inhalation in external ventilation?

The diaphragm and intercostal muscles contract, increasing thoracic volume and creating negative pressure to draw air into the lungs.

Where does external ventilation occur?

At the alveolocapillary membrane in the lungs.

What is the purpose of external ventilation?

To supply oxygen to the blood and remove carbon dioxide from the body.

What is internal ventilation (internal respiration)?

The exchange of gases between the systemic capillaries and the body's tissues.

What happens to oxygen during internal respiration?

Oxygen-rich blood is delivered to tissues, where oxygen diffuses from the blood into the cells.

What happens to carbon dioxide during internal respiration?

Carbon dioxide diffuses from the cells into the blood to be transported back to the lungs.

Where does internal respiration occur?

At the tissue capillary level throughout the body.

What is the purpose of internal respiration?

To deliver oxygen for cellular metabolism and remove carbon dioxide, a byproduct of cellular respiration.

How many vertebrae are in the human spine?

33 vertebrae

What are the types of vertebrae in the spine and their counts?

Cervical: 7, Thoracic: 12, Lumbar: 5, Sacral: 5 fused, Coccygeal: 4 fused.

How many pairs of spinal nerves emerge from the spinal cord?

31 pairs of spinal nerves.

What is end-tidal CO₂ (ETCO₂)?

The partial pressure or concentration of carbon dioxide measured at the end of exhalation, indicating a patient's ventilatory status.

What are normal values for ETCO₂ in healthy adults?

35-45 mmHg

What is Cushing's triad?

A set of three clinical signs: Hypertension (increased systolic blood pressure with widened pulse pressure), Bradycardia (abnormally slow heart rate), Irregular or abnormal respirations (such as Cheyne-Stokes breathing).

What does Cushing's reflex respond to?

Increased intracranial pressure (ICP), often due to severe traumatic brain injury or other causes.

What is the Monro-Kellie Doctrine?

A principle stating that the skull is a rigid compartment containing brain tissue, blood, and cerebrospinal fluid, where the total volume remains constant.

What is the relationship described by the Monro-Kellie Doctrine?

If the volume of one component increases, there must be a compensatory decrease in the volume of one or both of the other components to maintain normal ICP. The total volume of these three elements remains constant. Therefore, if the volume of one component increases there must be a compensatory decrease in the volume of one or both.

What is the formula for calculating Cerebral Perfusion Pressure (CPP)?

CPP = MAP - ICP.

What do the components of the CPP calculation represent?

CPP (Cerebral Perfusion Pressure) is the effective pressure driving blood to brain tissue. MAP is the average pressure in arteries throughout one cardiac cycle, which is a single heartbeat.

What is considered a normal range for Cerebral Perfusion Pressure (CPP)?

60-100 mmHg.

What is the significance of a Cerebral Perfusion Pressure (CPP) less than 60 mmHg?

It risks brain ischemia from a lack of perfusion over the ICP.

What CPP value is associated with poor outcomes and brain injury?

CPP less than 50 mmHg.

What is the formula for Kinetic Energy (KE)?

KE = ½ x M x V², where M is mass and V is velocity.

How does velocity affect injury severity in trauma?

Higher velocity results in more severe injury.

What are the mechanisms of injury associated with blunt trauma?

Acceleration, deceleration, compression, shearing, and direct forces.

What factors characterise penetrating trauma?

Profile, tumble, fragmentation, and energy level; high-velocity causes more tissue disruption.

What are the five types of blast injuries?

Primary (blast wave), secondary (debris), tertiary (thrown), quaternary (other injuries), quinary (post-detonation effects).

Which groups are considered high-risk for trauma?

Children, elderly, Indigenous Australians, and those under the influence of alcohol/drugs.

What defines shock in a medical context?

A systemic reduction in tissue perfusion and decreased oxygen delivery.

What are the five types of shock?

Hypovolaemic, cardiogenic, distributive, obstructive, and dissociative.

What are the stages of shock?

Compensated, decompensated, and irreversible.

What is the Lethal Triad in shock management?

Hypothermia, acidosis, coagulopathy, hypocalcaemia.

What is the management strategy for shock?

Control bleeding, provide oxygenation, administer IV fluids, and ensure rapid transport.