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KNOWLEDGE COMPETENCIES

  1. Describe the mechanisms of traumatic injury and relate them to accurate assessment of overt and covert injuries.

  2. Discuss the common physiologic and psychosocial effects on the patient and family because of major traumatic injury.

  3. Identify the unique needs of the trauma patient in critical and progressive care units.

  4. Integrate selected management principles to treat trauma patients with thoracic, abdominal, and musculoskeletal injuries.

INTRODUCTION

Trauma is a leading cause of mortality worldwide and an increasing healthcare problem in the United States. In 2016, the World Health Organization (WHO) identified trauma as the leading cause of death in young adults accounting for 10% of all deaths among men and women. Although the death rate is high for this patient population, the disability rate is even greater. In the United States, approximately 30% of all intensive care unit (ICU) admissions are related to traumatic injuries. This chapter focuses on thoracoabdominal, musculoskeletal, and pelvic trauma. Traumatic brain injury (TBI) is the single largest cause of death from injury and is discussed in Chapter 21, Advanced Neurologic Concepts.

SPECIALIZED ASSESSMENT

Trauma patients are unlike other hospitalized patients and require specialized assessment and monitoring. For the trauma victim, admission to the critical care or progressive care setting is sudden and unplanned, without time for psychological preparation or the stabilization of chronic conditions. Trauma patients are often young; however, trauma among older adults is an increasing problem and more complex since they often have additional chronic conditions. Minor injuries can evolve into life-threatening ones if not addressed in initial assessment. Traumatic injuries may be subtle and complications are common. Alcohol or drug use often plays a major role in the cause of the trauma and subsequent treatment. Rehabilitation is frequently needed after injury, and a trauma victim’s quality of life may never return to preinjury status. This is especially true for traumatic brain and spinal cord injuries; however, even in lower extremity trauma, it may take a full year for an individual to return to work. Trauma takes a significant emotional and financial toll on the patient, family, and society.

Management of traumatic injury in the initial phases of care occurs in tandem with assessment; for example, the insertion of an advanced airway, establishing intravenous (IV) access and administration of fluids, and pain control may all be provided before the site of hemorrhage is identified and controlled. Internal bleeding is occult and may be missed on the primary survey. External hemorrhage, in contrast, would be obvious in the survey and would be a priority. One of the most important aspects of assessing the traumatically injured patient is to determine the injury based on the mechanism, whether blunt or penetrating trauma. Based on this information, an “index of suspicion” regarding specific injuries is developed during the primary and secondary survey. The goal is to ensure that no occult injuries are overlooked as the ...

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