Makindo Medical Notes

Trauma is one of the leading causes of morbidity and mortality worldwide, particularly in young adults. It encompasses a spectrum from minor injuries to life-threatening polytrauma. For clinicians, the priority is early recognition, systematic assessment, and timely intervention — always focusing on airway, breathing, circulation.

🌍 Epidemiology

• 🚗 Road traffic collisions (RTCs) = most common global cause.
• 🤾 Sports, falls, assaults, industrial accidents also key contributors.
• ⚠️ Trauma is the leading cause of death under 40 in many countries.

⚙️ Pathophysiology

• 🔴 Primary injury: Direct tissue damage from mechanical force (fractures, lacerations, internal bleeding).
• 🌀 Secondary injury: Physiological derangements — hypoxia, hypovolaemia, shock, acidosis → worsen outcomes if not corrected quickly.
• 🧠 Systemic response: Catecholamine surge, coagulopathy, systemic inflammatory response → may lead to multi-organ dysfunction.

🚑 Initial Approach – ABCDE Framework

• 🅰️ Airway + C-spine protection: Assess patency, consider cervical collar if trauma to head/neck suspected.
• 🅱️ Breathing: Look, listen, feel → oxygen, chest drain for pneumothorax, support ventilation if needed.
• 🅲 Circulation: Control external bleeding (direct pressure, tourniquet if severe). 2 large-bore IV cannulae, fluids (balanced crystalloids), blood products if haemorrhagic shock.
• 🅳 Disability (Neuro): Assess GCS, pupils, blood glucose.
• 🅴 Exposure: Fully expose patient for hidden injuries, but prevent hypothermia (warm blankets, fluids).

🧪 Investigations

• 🔬 Bloods: FBC, U&E, LFTs, clotting, group & save, crossmatch.
• 🩻 Imaging: Trauma series X-rays (C-spine, chest, pelvis), FAST scan (for free intraperitoneal fluid), CT whole body (if polytrauma and stable).
• 🧠 Specialist scans: CT head if GCS <13 or suspected head injury.

🛠️ Principles of Management

• 🔍 Primary survey: Identify life-threatening conditions (e.g. airway obstruction, tension pneumothorax, massive haemorrhage).
• 📋 Secondary survey: Head-to-toe exam once patient is stabilised.
• 💉 Definitive management: Surgery (e.g. laparotomy for bleeding, fixation of fractures), ICU support if needed.
• 🧑‍🤝‍🧑 Multidisciplinary care: Trauma surgeons, orthopaedics, neurosurgery, anaesthetics, ICU, rehab teams.

🚨 Common Life-Threatening Traumas to Recognise

• 🫁 Tension pneumothorax → needle decompression then chest drain.
• 🩸 Massive haemorrhage → haemostatic resuscitation, early blood products.
• 🧠 Traumatic brain injury → early neurosurgical input.
• 🦴 Unstable pelvic fracture → pelvic binder + early IR/ortho involvement.
• 💔 Cardiac tamponade → pericardiocentesis/thoracotomy in extremis.

📚 Case Scenarios — Major Trauma

✅ Conclusion

Trauma care relies on rapid, systematic, team-based intervention. Medical students should focus on recognising life-threatening conditions, applying the ABCDE approach, and calling for senior help early. Early stabilisation saves lives, and every second counts. ⏱️