1. Trauma remains the most common cause of death for
all individuals between the ages of 1 and 44 years and is the third
most common cause of death regardless of age.
2. The initial management of seriously injured patients consists
of performing the primary survey (the “ABCs”—Airway
with cervical spine protection, Breathing, and Circulation);
the goals of the primary survey are to identify and treat conditions
that constitute an immediate threat to life.
3. Patients with ongoing hemodynamic instability, whether “nonresponders” or “transient
responders,” require prompt intervention; one must consider
the four categories of shock that may represent the underlying pathophysiology:
hemorrhagic, cardiogenic, neurogenic, and septic.
4. All patients with blunt injury should be assumed to have unstable
cervical spine injuries until proven otherwise; one must maintain
cervical spine precautions and in-line stabilization.
5. Indications for immediate operative intervention for penetrating
cervical injury include hemodynamic instability and significant
external arterial hemorrhage; the management algorithm for hemodynamically
stable patients is based on the presenting symptoms and anatomic
location of injury, with the neck being divided into three distinct
6. Blunt injuries to the carotid and vertebral arteries are usually
managed with systemic antithrombotic therapy.
7. The abdomen is a diagnostic black box. However, physical examination
and ultrasound can rapidly identify patients requiring emergent
laparotomy. Computed tomographic (CT) scanning is the mainstay of
evaluation in the remaining patients to more precisely identify
the site and magnitude of injury.
8. Manifestation of the “bloody vicious cycle” (the lethal
combination of coagulopathy, hypothermia, and metabolic acidosis)
is the most common indication for damage control surgery. The primary
objectives of damage control laparotomy are to control bleeding
and limit GI spillage.
9. The abdominal compartment syndrome may be primary (i.e., due
to the injury of abdominal organs, bleeding, and packing) or secondary
(i.e., due to reperfusion gut edema and ascites).
10. The gold standard for determining if there is a blunt descending
torn aorta injury is CT scanning; indications are primarily based
on injury mechanisms.
Trauma, or injury, is defined as cellular disruption
caused by an exchange with environmental energy that is beyond the
body’s resilience. Trauma remains the most common cause
of death for all individuals between the ages of 1 and 44 years
and is the third most common cause of death regardless of age.1 It
is also the number one cause of years of productive life lost. The
U.S. government classifies injury-related death into the following
categories: accidents (unintentional injuries), intentional self-harm
(suicide), assault (homicide), legal intervention or war, and undetermined
causes. Unintentional injuries account for over 110,000 deaths per
year, with motor vehicle collisions accounting for over 40%.
Homicides, suicides, and other causes are responsible for another
50,000 deaths each year. However, death is a poor indicator of the
magnitude of ...