Stabilising a Trauma Patient

Trauma patient usually refer to someone who has suffered serious and life-threatening physical injury which has the potential to result in secondary complications such as shock, respiratory failure and death. Trauma patients require specialized care within the so-called golden hour of emergency medicine, the first sixty minutes after trauma occurs.

When a trauma patient is brought to the hospital, a primary survey should have already been conducted by the ambulance officers. Any problems related to the ABCs (Airway, Breathing, and Circulation) that are highlighted by the officers should be dealt with immediately.

Any obstruction in the airway would probably have been removed by the ambulance officers. However, if the trauma patient still has an obstructed airway, the cause of the obstruction should be removed immediately.

In the case of breathing difficulties, the trauma patient may have to be intubated and undergo positive pressure ventilation.

In a trauma patient with falling blood pressure, for example, in someone who is suffering from hypovolaemic shock caused by bleeding, it is necessary to immediately control the bleeding and restore the victim's blood volume by giving infusions of balanced salt solutions. Blood transfusions are necessary for loss of large amounts of blood (e.g. greater than 20% of blood volume). Sodium is essential to keep the fluid infused in the extracellular and intravascular space whilst preventing water intoxication and brain swelling. Metabolic acidosis (mainly due to lactic acid) accumulates as a result of poor delivery of oxygen to the tissues, and mirrors the severity of the shock. It is best treated by rapidly restoring intravascular volume and perfusion. Inotropic and vasoconstrictive drugs should be avoided, as they may prevent us from accurately assessing the blood volume.

Regardless of the cause, the restoration of the circulating volume is priority. As soon as the airway is maintained and oxygen administered the next step is to commence replacement of fluids via the intravenous route.

Once the ABCs have been stabilized, a secondary survey consists of a systematic assessment of the abdominal, pelvic and thoracic viscera, complete inspection of the body surface to find all injuries, and neurological exam. Priority should be given to regions of the body that are suspected to be damaged after considering the history given by the ambulance officers. The purpose of the secondary survey is to identify all injuries so that they may be treated

In this PCL case, a haemothorax was identified and an attempt was made to remove the blood by the insertion of a chest tube.

Contributed by John Lee