Trauma

Surgery

Assumptions

The student understands the basic physiology of the circulatory system and changes that occur due to shock. The student will review the pertinent anatomy of the organ systems discussed in the trauma chapter.

Knowledge Objectives

Through their reading and patient care experiences, at the end of the rotation students should be able to:

Describe the priorities and sequence of a trauma patient evaluation (ABC’s).
Describe the four classes of hemorrhagic shock and how to recognize them.
Describe the appropriate fluid resuscitation of a trauma victim.
Discuss choice of IV access
Discuss the choice of fluid and use of blood components.
Discuss the differences between adult and pediatric resuscitation.
Discuss the types, etiology and prevention of coagulopathies typically found in patients with massive hemorrhage.
Describe the appropriate triage of a patient in a trauma system.
Discuss how the trauma system is organized in your state.
Discuss the importance of mechanism of injury on management and triage decision making.
Describe the diagnostic evaluation, differences between blunt and penetrating mechanisms of injury and the initial management of:
Closed head injury (consider Glasgow Coma Scale, ICP, subdural hematoma, epidural hematoma, diffuse axonal injury, basilar skull fractures & CSF leaks)
Spine injury (consider mechanism of injury, level of injury, use of steroids, immobilization, neuro exam, management of shock)
Thoracic injury (consider hemo / pneumothorax, tension pneumothorax, tamponade, pulmonary contusion, massive air leak, widened mediastinum, flail chest)
Abdominal injury (consider role of physical exam, ultrasound, CT, peritoneal lavage, operative vs. non-operative management of liver and spleen injury, which patients need urgent laparotomy, management of hematomas)
Urinary injury (consider operative vs. non-operative renal injury, ureteral injury, intraperitoneal and extraperitoneal bladder injury, urethral trauma, when not to place a Foley, candidates for cystogram, relationship to pelvic fracture)
Orthopedic injury (consider open vs. closed fractures, compartment syndromes, concepts of immobilization (splinting, internal fixation), treatment of patients with pelvic fractures, hemorrhage control, commonly associated vascular injuries)
Describe the early management of a major burn.
Discuss estimation of total body surface burn and burn depth.
Discuss fluid resuscitation, choice of fluid and monitoring for adequacy of resuscitation (rule of 9’s, differences in pediatric and adult management).
Discuss options for topical antimicrobial therapy.
Discuss inhalation injury, CO poisoning and triage of patients to burn centers.
Discuss the basic principles of wound coverage, skin grafting, and timing.
Discuss the assessment and need for escharotomy.
Describe the effects of trauma on the individuals’ ability to return to full health and employment.
Discuss the role of physical therapy, occupational therapy, speech therapy and other rehabilitation services in the patient’s recovery.
Discuss the economic impact of traumatic injury and disability.
Describe the recognition of suspected child abuse and domestic violence presenting as trauma and the physician’s role in reporting.
Describe the importance of careful documentation in the medical record for traumatic injury and the basic concepts of a "trail of evidence" in victims of assault.
Discuss the importance of passenger and appropriate infant restraints in motor vehicles.
Discuss the role of helmets in preventing head injury in motorcycle, bicycle, and roller blade accidents.
Discuss the significant influence of the use of drugs and alcohol on a large percentage of traumatic injuries including assaults, burns and motor vehicle accidents.
Discuss the value of smoke and carbon monoxide detectors, and evacuation drills in reducing mortality and injury.