Categories
Emergency Medicine

Approach To Trauma

Last Updated on July 27, 2022

History Taking

Background

• Premorbid ADL status
Hand dominance
• Occupation
Comorbidities
• Staying with who?

• How patient came? Brought by ambulance? Came alone?

Trauma details

• Date & time of trauma
• Witness
• How trauma occurred?
Type of trauma
• Was patient under alcohol or illicit drug influence?

Motor-vehicle accident
• Type of vehicle
• Patient was the driver / passenger / rider / pillion rider ?
How it happened?
• Speed
• Wearing helmet? Helmet intact?
• Did the vehicle hit anything e.g. divider?

Post-Trauma

• Pain at which site?
• Bleeding at which site?
• Abrasion wound at which site? Laceration wound at which site?
• Able to walk?
• Any headache? Any vomiting?
• Any loss of consciousness? How long it lasted?
• Any retrograde amnesia?

Relevant History

• Co-morbidities e.g. DM, HTN,

Physical Examination

• Trauma survey – [open]

Criteria

(a) High Energy Impact

(i) Falls
• >6 meters (≈double-storey)

(ii) High-risk auto-crash
• Intrusion: >30 cm from occupant site or >46 cm from any site
• Ejection: partial / complete, from vehicle
• Death in the same passenger compartment
• Vehicle telemetry data consistent with high risk injury

(iii) Auto VS pedestrian / bicyclist
(iv) Thrown / run over, or with significant (>30 km/hr) impact
(v) Motorcycle crash >30 km/hr

(b) Canadian CT Head Rule

(c) Nexus criteria for cervical clearance

Investigations

Imaging

Chest X-rays
Pelvic X-rays
CT brain (brain window & bone window)
CT cervical

• Fall [open]
Canadian CT Head Rule [open]

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