Trauma

Can be caused by many types of injury, where the intentional or unintentional.

Injuries and violence resulting from trauma related motor vehicle collisions, falls, drowning, extreme heat, and cold exposure, suicide, overdose, and suicide comprise nearly 8% of the deaths worlwide, affecting approximately 4.5 million people annually.

It may be due to an emotionally distressing experience or physical injury.

Firearm injuries, motor vehicle collisions, and falls are the most common types of trauma.

Young children are more likely to be affected by drowning, while older patients are more likely to have falls.

Injury remains the leading cause of death among persons between ages 1 and 44 years.

Trauma is largely a condition of young people, and is the leading cause of life years lost between one and 75 years of age, and costs in the US are estimated at $4.2 trillion a year.

In 2010, trauma what was the leading cause of death worldwide among individuals younger than 45 years.

Estimated 150,000 Americans die after traumatic injuries and thousands are rendered permanently disabled each year.

More than 60% of men and more than 60% of women experience, at least one traumatic event in their life.

Accounts for more than 41 million Emergency Department visits and 2.3 million hospitalizations in the US annually.

The four most common types of trauma worldwide are traffic injuries, falls, interpersonal violence, and burns.

Trauma precipitates a team of emergency department physicians, surgeons, nurses, and technicians to provide care to the injured patient.

Trauma effects people of all ages and its impact on life-years lost is equal to the life-years lost from malignancies, cardiovascular disease, and HIV combined.Leading cause of death of Americans between ages of one and forty-four years.

The leading cause of death among trauma patients remains uncontrolled hemorrhage and accounts for approximately 30–40% of trauma related deaths.

Traumatic hemorrhage accounts for approximately 2 million deaths each year worldwide.

Most deaths from truncal hemorrhage occur within 30 minutes after injury.

Most preventable deaths are related to bleeding, which can be exacerbated by trauma induced coagulopathy involving plasmin mediated fibrinolysis, resulting from tissue injury and hemorrhagic shock.

From the moment of injury focus is on achieving surgical hemorrhage control.

Major trauma is defined as when more than one body system is injured or an isolated limb has been subjected to severe trauma.

85% of patients with major trauma sustain serious limb injuries, most commonly fractured bones.

More than 345,000 traumatic lower extremity injuries were reported to the National Trauma Data Bank in 2016, more than any of the body region.

Soft tissue injury in association with lower extremity fracture increases complication rate, including limb loss.

Wound complications involving infection of the bone or soft tissue are the most common complications following operative management of severe traumatic lower extremity injury and can result in wound failure or exposure of bone or vascular implants.

The overall mortality of injured patients admitted to a level I trauma center has been reduced to 3-4%.

The interval between injury and surgical intervention determines the outcome.

Traumatic injuries include orthopedic, vascular, and skin injuries, burns, massive upper G.I. hemorrhage, G.I. perforation and rectal bleeding.

Intra-abdominal injuries following blunt trauma or penetrating trauma cause 80%, 20% of traumatic deaths, respectively.

Uncontrolled hemorrhage is the single most preventable cause of death following a traumatic injury.

Motor vehicle collisions and falls are the most common causes of blunt trauma,Whereas gunshot and stab wounds to the most common causes of penetrating trauma.

Evaluating penetrating abdominal trauma is straightforward, but blunt abdominal trauma frequently provide diagnostic difficulties.

Systolic blood pressure between 80 and 90 mmHg.

The use of intravenous fluids as a resuscitation medium worsens the outcome.

Whole blood should be used for resuscitation with simultaneous initiation of hemorrhage control maneuvers.

Component therapy, within the context of massive transfusion protocol, emphasizes a high ratio of packed red cells to plasma.

Blood products should be warmed to body temperature because transfusion of cool blood products in a patient with trauma and hemorrhage will contribute to hypothermia and coagulopathy.

Blood products should be arministered at the highest rate possible often as fast as 500 mL per minute to obey the principles of hypotensive resuscitation, with the target systolic blood pressure of 80 mmHg during damage control surgery.

Resuscitation is not a substitute for hemorrhage control, and if initiated, then a hemorrhage control maneuver, including damage control surgery should be initiated simultaneously.

The widespread use of permissive hypotension is safe and provides a substantial survival benefit for patients with penetrating or blunt trauma.

The practice of administering 2 L of crystalloid fluid in hypotensive trauma patients worsens coagulopathy and acidosis and should be abandoned

That administration of large volume intravenous fluids before surgical control of hemorrhage is dangerous and should not be performed unless circumstances, such as coexisting Traumatic brain injury, dictate otherwise.

Severely injured patients have a higher cumulative mortality in the years following admission to a level 1 trauma center.

The elderly have the highest mortality after trauma as well as higher complication rates, especially for pulmonary and infectious complications.

An estimated 10 to 25% of vertebral fractures will result in injury to the spinal cord.

5 to 15% of trauma patients have fractures that initially go undiagnosed.

In a retrospective cohort study of 124,421 injured adult patients in the Washington State Trauma Registry indicated a three-year cumulative mortality of 16% and 9.9% in the first year (Davidson GH et al).

Discharge from a level I trauma center to a skilled nursing facility at any age following trauma is associated with a higher risk of subsequent mortality.

Post-traumatic pneumonia has an incidence of 40-60%, mainly in traumatic brain injury patients.

In ventilated trauma patients intravenous stress-dose hydrocortisone, compared with placebo, decreased risk of hospital acquired pneumonia within 28 days (Roquilly A et al).

Hydrocortisone, at stress doses, increases neutropil activity, increases dendritic homing function, preserves monocyte anf IL-12 function and attenuates inflammatory response that leads to sepsis in trauma patients.

Factors on admission to a level 1 trauma center for death in the year following injury include advanced age, male sex, hypotension and Glasgow coma scale score of less than nine.

In patients sustaining severe trauma ultrasound examination of the abdominal cavity and pericardium during the discovery phase of care is essential as the measurement of vital signs in the initial triage and surgical decision-making, particularly in the patient with hypotension.

The use of incisional negative pressure wound therapy for surgical wounds associated with lower limb fractures from major trauma did not result in any significant difference from standard wound dressing (Whilst trial).

Tranexamic acid administered within three hours after traumatic injury reduces 28 day mortality among patients with suspected bleeding among patients with mild to moderate traumatic brain injury. (CRASH trial).

Among patients with major trauma and suspected trauma induced coagulopathy being treated advanced trauma systems, prehospital administration of tranexamic acid, followed by infusion over eight hours, did not result in greater number of patients surviving with a functional favorable outcome at six months, than placebo.