MANAGEMENT OF

TRAUMA VICTIM

Dr Sanju Sharma, MD
Associate Professor, Anaesthesia & Critical Care
Instructor, Advanced Trauma Life Support
(ATLS), India
Introduction
• Trauma is a physical, cognitive, and emotional response
caused by a traumatic event, series of events, or set of
circumstances that is experienced as harmful or life-
threatening. (CDC, USA)

• The "Golden Hour" refers to the first 60 minutes

following traumatic injury. It is a critical period during
which rapid assessment, resuscitation, and treatment
significantly improve survival rates.
Problem Statement
• 5.8 million people die every
year from unintentional
injury and violence -- more
than nine people every
minute.
• Injury accounts for 18% of
the world’s burden of Road traffic
disease. Other
17%
injuries
25%

• Motor vehicle crashes alone Self-inflicted

cause more than 1 million violence
16%
Fires 5%

deaths annually and 20 to Poisoning 6%

50 million significant Interpersonal
violence Falls 6%
Drowning War
injuries. 10%
9% 6%
Components of a Trauma System

• Emergency Medical Services (EMS): The first responders

who provide initial care at the scene of the incident.
(Prehospital care)

• Trauma Centers: Specialized hospitals equipped to provide

comprehensive trauma care. They are categorized into different
levels (Level I, II, III, IV) based on their capabilities and
resources
 Prehospital care (EMS)
Role of Prehospital Care in Trauma Systems:

• Initial Stabilization: Prehospital care aims to stabilize the

patient’s condition to prevent deterioration during
transport.
• Rapid Transport: Ensuring quick and safe transport to the
appropriate trauma center is crucial.
• Communication and Coordination: Effective
communication between EMS and trauma centers ensures
that the receiving facility is prepared for the patient’s
arrival and can provide immediate care
Objectives of Pre-Hospital Trauma Care

• Primary Goals

• Rapid assessment of injuries.

• Stabilization of life-threatening conditions.

• Safe and timely transport to an appropriate facility.

• Minimize further injury during transport.

Components of Pre-Hospital Care
• Key Components:
• Scene Safety: Ensuring the scene is safe for rescuers and victims.

• Initial Assessment: ABCDE (Airway, Breathing, Circulation,

Disability, Exposure).
• Emergency Interventions: Managing airway, controlling bleeding,
stabilizing fractures.
• Triage: Prioritizing patients based on severity of injuries.

• Transport: Safe and efficient transport to the nearest trauma centre

Principles of Triage
• Triage is the process of quickly assessing and
categorizing patients in an emergency based on the
severity of their injuries or medical conditions.

• The goal is to prioritize care for those who need it most

urgently, ensuring that limited medical resources—such
as personnel, equipment, and time—are allocated
effectively
 Principles of Triage
1.Rapid Assessment: Quickly evaluate the patient’s condition to
determine the urgency of their needs.
2.Prioritization: Categorize patients based on the severity of their
condition.
1.Immediate (Red): Life-threatening conditions
2.Delayed (Yellow): Serious but not immediately life-threatening
injuries.
3.Minor (Green): Minor injuries that can wait for treatment.
4.Expectant (Black): Injuries so severe that survival is unlikely
despite intervention.
3.Resource Allocation
4.Continuous Reassessment
5.Communication
6.Ethical Considerations
Triage strategy
Advanced trauma life support
(ATLS)
• Advanced Trauma Life Support (ATLS) is a training
program developed by the American College of Surgeons
(ACS) to teach medical providers a systematic approach to
the management of acute trauma cases.

• Benefits:
• Ensures that no life-threatening injuries are missed.

• Promotes timely decision-making during the critical Golden Hour

History of ATLS
ATLS Concept
• Follow ABCDE approach to
evaluation and treatment.

• Treat the greatest threat to life

first.

• Recognize the definitive diagnosis

is not immediately important.

• Understand that time is of the

essence.

• Do no further harm.
ATLS Concept

• Airway with restriction of cervical

spine motion

• Breathing and ventilation

• Circulation with hemorrhage control
• Disability: Neurological status
• Exposure / Environmental control
Initial Assessment and Management
Airway with Cervical Spine Protection (A)

• Objective: Ensure the patient has a clear airway while

simultaneously protecting the cervical spine.

• Key Steps:
• Check responsiveness
• Look for obstruction
• Airway maneuvers: Chin lift or jaw thrust
• Airway adjunct: Oropharyngeal airway (OPA)
Nasopharyngeal airway (NPA)
• Cervical spine protection: Always assume a cervical
spine injury in trauma patients.
Chin Lift
Jaw Thrust
Oropharyngeal airway Laryngeal
mask airway
Example of C-spine immobilisation
Breathing and Ventilation (B)
• Objective: Ensure adequate oxygenation and ventilation
• Key Steps:
• Inspect chest movement: Check for symmetric chest rise and
fall
• Auscultate: Listen to breath sounds on both sides of the chest.
• Palpate: Feel for rib fractures or subcutaneous emphysema
• Interventions:
• Supplemental oxygen: Administer oxygen via a non-rebreather
mask or bag-valve mask (BVM)
• Needle decompression or chest tube: In cases of tension
pneumothorax an emergency needle decompression may be
necessary, followed by chest tube placement.
Circulation with Hemorrhage Control (C)

• Objective: Assess and support circulation while

controlling any major external or internal bleeding.
• Key Steps:
• Check for a central pulse: A weak or absent pulse
may indicate shock or cardiac arrest.
• Inspect for external bleeding: Active, uncontrolled
hemorrhage is a primary cause of death.
• Skin assessment: Look for signs of shock like cold,
clammy skin, pale or cyanotic appearance
• Capillary refill: Assess for delayed capillary refill
(>2 seconds), indicating poor perfusion.
Circulation with Hemorrhage Control (C)
• Interventions
• Direct pressure: Apply direct pressure to control external bleeding.

• IV access: Establish two large-bore intravenous (IV) lines for fluid resuscitation.

• Fluid or blood products: Begin fluid resuscitation with isotonic fluids or blood
products if hemorrhagic shock is suspected.
• Hemostatic agents or tourniquet: Use these for severe bleeding when direct
pressure is ineffective
• Rapid assessment for internal bleeding: Hypotension or a distended
abdomen, warranting immediate imaging (e.g., FAST scan) or surgical
intervention
 Disability (Neurological Status)
(D)
Objective: Rapidly assess the patient’s neurological status to identify
head or spinal cord injuries.
•Key Steps:
•Glasgow Coma Scale (GCS): Use the GCS to quickly determine the
level of consciousness.
•Mild: GCS 13-15
•Moderate: GCS 9-12
•Severe: GCS 3-8
•Pupil assessment: Check pupil size and reaction to light
•Motor and sensory function: Quickly assess the ability to move
limbs and the presence of sensation.
Disability (Neurological Status)
(D)
•Interventions:
•Immediate airway protection may be required if the
patient has a severely altered level of consciousness
(GCS < 8).
•Immobilization: Maintain cervical spine immobilization
if a spinal cord injury is suspected.
•Elevate head: If there's concern for increased
intracranial pressure
Glasgow Coma Scale (GCS)
Exposure and Environmental Control (E)

Objective: Completely expose the patient to identify all injuries

while preventing hypothermia.
•Key Steps:
•Remove all clothing: This allows for a thorough visual
inspection of the entire
•Log roll: Carefully roll the patient to examine the back
•Environmental Control:
•Prevent hypothermia: Cover the patient with warm
blankets or use external warming devices.
•Warm IV fluids or blood products may be needed .
Case Scenario
18-year-old male , unrestrained
driver in MVC vs. tree
None reported
Vitals not reported
Prolonged extrication;
transported to ED by
ambulance; O2 by mask; fluids
via single IV; spinal motion
restricted on long spine board
Case Scenario

Case Scenario Progression

• EMS report: patient is

lethargic, mumbling
unintelligibly
• Patient has facial injuries
• Vital signs: HR 120; BP
90/40; RR 24, O2 sat 89%,
temp 36°C
Case Scenario
• Discussion Questions:
• EMS report:
1. Based on this information, what patient is
interventions can be done in the lethargic,
prehospital setting? mumbling
unintelligibly
2. Which patients should be • Patient has
immediately transported to the facial injuries
trauma center based on their field
• Vital signs: HR
presentation?
120; BP 90/40;
RR 24, O2 sat
89%, temp
36°C
Case Scenario
• Case Scenario Progression

• Patient arrives at hospital

• Vital signs: HR 120; BP
90/palp; RR 20; O2 sat 82%,
temp 35.5°C
Case Scenario
• Discussion Questions:

Case Details
1. What are your clinical concerns?
• Patient
2. What are your management priorities? arrives at
hospital
• Vital signs:
HR 120; BP
90/palp; RR
20; O2 sat
82%, temp
35.5°C.
 Case Scenario
Case Scenario Progression
Primary survey reveals:
A: Obvious facial trauma and mumbling incoherently.
B: Decreased breath sounds, L chest; no visible neck
veins
C: Minimal bleeding; open L femur fracture; L chest
bruising; possible pelvic fracture
D: Localizes to pain with upper extremities; moans to
painful stimuli; does not open eyes
Case Scenario
Case Scenario Progression

• Patient intubated
• Femur fracture reduced and immobilized; pelvic
stabilizing device applied
• 500 mL warmed crystalloid and 1 unit unmatched
pRBCs IV
• Vital signs: HR 97; BP 110/64; RR 24; O2 sat 96%
• Patient begins to respond to verbal stimuli, opens eyes,
and tries to brush away your hands
Case Scenario
Case Details
Discussion Questions:
• Patient intubated
• Femur fracture reduced
1. What additional adjuncts and and immobilized; pelvic
stabilizing device
treatments would you order at applied
this time? • 500 mL warmed
crystalloid and 1 unit
2. When should the transfer occur unmatched pRBCs IV
and what tests are necessary • Vital signs: HR 97; BP
110/64; RR 24; O2 sat
before transferring the patient? 96%
• Patient begins to
respond to verbal
stimuli, opens eyes, and
tries to brush away your
hands
Secondary Survey

• Discussion Question:

• When does the secondary survey occur, and how is it

conducted?
Secondary Survey
• Definition: A comprehensive head-to-toe evaluation
after stabilizing the patient.
• The secondary survey occurs after the primary survey is
complete
• Components:
• History (AMPLE: Allergies, Medications, Past medical history,
Last meal, Events leading to injury).
• Full physical exam

• imaging studies
Case Scenario

• Case Scenario
Conclusion

• The patient is transferred

to a trauma centre via air,
and goes to surgery for
evacuation of an
intracranial hematoma.
Any Questions?

?
Thank you all for your attention