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Key Points

  1. Trauma is 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 usually follows the primary survey (the “ABCs”—Airway with cervical spine protection, Breathing, and Circulation), although at times restoring Circulatory volume may proceed active Airway intervention; the goals of the primary survey are to identify and treat conditions that constitute an immediate threat to life.

  3. 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.

  4. Patients with ongoing hemodynamic instability, whether “nonresponders” or “transient responders,” require prompt intervention; one must consider the dominant causes of acute shock, i.e., hemorrhagic, cardiogenic, and neurogenic shock.

  5. Patients with trauma-induced coagulopathy (TIC) are at risk for massive transfusion and need to be identified early.

  6. 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 zones.

  7. The gold standard for determining if there is a blunt descending aortic injury is computed tomography angiography (CTA) scanning; indications are primarily based on injury mechanism.

  8. The abdomen is a diagnostic black box. Physical examination and FAST ultrasound can identify patients requiring emergent laparotomy. Computed tomography (CT) scanning is the mainstay of evaluation in the remaining patients to more precisely identify the site and magnitude of injury.

  9. 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 gastrointestinal spillage.

  10. Blunt injuries to the carotid and vertebral arteries are usually managed with systemic antithrombotic therapy.

  11. 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 visceral edema, retroperitoneal edema, and ascites).


Trauma, or injury, is defined as cellular disruption caused by environmental energy that is beyond the body’s resilience, which is compounded by cell death due to ischemia/reperfusion. Trauma is the most common cause of death for all individuals between the ages of 1 and 44 years, and is the third image most common cause of death regardless of age.1 It is also the leading cause of years of productive life lost. Unintentional injuries account for over 135,000 deaths per year, with homicides, suicides, and other causes are responsible for another 60,000 deaths each year. However, death rate underestimates the magnitude of the societal toll. For example, in 2014 there were almost 200,000 injury-related deaths, but 37.2 million injured patients treated in emergency departments (EDs). Injury-related medical expenditures ...

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