Trauma Surgery

B

• Blast Injuries — Initial Approach

  Recognize primary (barotrauma), secondary (fragmentation), tertiary (displacement), and quaternary effects. Protect providers, manage hemorrhage and airway, and screen for occult pulmonary, ear, and eye injuries.
• Blunt Cardiac Injury — Diagnosis & Monitoring

  Screen with ECG and troponin in blunt chest trauma. If both normal at ~8 hours, significant BCI is unlikely; admit with telemetry if abnormal. Echo for hypotension, arrhythmia, or elevated troponin.

C

• Cervical Spine Clearance in Obtunded Adult Trauma - CT Based Protocols

  High quality CT can clear the cervical spine in many obtunded adults without neurologic deficit per institutional protocols; maintain collar until clearance is documented.
• Crush Injury & Crush Syndrome — Prevention & Treatment

  Prevent and treat crush syndrome (rhabdomyolysis with hyperkalemia/AKI) with early aggressive fluids, electrolyte management, and careful extrication strategies; monitor for compartment syndrome.

D

• Damage Control Laparotomy - Indications and Staging

  Use staged approach for exsanguinating or physiologically deranged patients with temporary abdominal closure and planned re exploration after resuscitation.

E

• Extremity Vascular Injury - Hard Signs, ABI, and CTA Algorithm

  Control hemorrhage with direct pressure or tourniquet, take hard signs to the operating room, and use ABI and CTA for equivocal cases.

F

• Fat Embolism Syndrome — Recognition & Management

  Clinical diagnosis after long‑bone or pelvic fractures: triad of hypoxemia, neurologic changes, and petechial rash. Manage with supportive care and early fracture fixation; steroids remain controversial.

G

• Geriatric Trauma — Triage and Management

  Lower physiologic reserve, polypharmacy, and frailty increase mortality. Lower thresholds for activation and imaging; reverse anticoagulation; prioritize early mobilization and delirium prevention.

H

• Hand Trauma — Flexor Tendon & Nerve Injuries

  Urgent assessment of vascularity, nerve function, and tendon integrity. Repair flexor tendons with appropriate core/epitendinous sutures and protect with early controlled motion; repair/neurorrhaphy for nerves with tension‑free technique.

M

• Massive Hemothorax - Chest Tube and Operative Indications

  Insert large bore chest tube, resuscitate, and proceed to operative control when output thresholds or instability indicate ongoing bleeding.
• Massive Transfusion Activation in Trauma - Hemorrhage Control and Resuscitation

  Recognize life threatening hemorrhage and activate massive transfusion with balanced components, early calcium, minimal crystalloid, and timely TXA when indicated.
• Massive Transfusion Protocol — Trauma Hemorrhage

  Activate MTP early for life-threatening hemorrhage; use balanced component therapy, tranexamic acid within 3 hours, calcium and temperature management, and viscoelastic-guided adjustments.

N

• Neurogenic Shock in Trauma - Recognition and Vasopressor Strategy

  Differentiate neurogenic from hemorrhagic shock after spinal cord injury; treat with judicious fluids, early vasopressors, and atropine for symptomatic bradycardia.

O

• Open Pelvic Fracture - Contamination Control, Packing, and Diversion

  High mortality injury requiring antibiotics, hemorrhage control, debridement, and fecal or urinary diversion when indicated.

P

• Pediatric Trauma — Differences & Pitfalls

  Children differ anatomically and physiologically: larger head, compliant chest, and limited blood reserve. Use weight‑based dosing, minimize radiation, and involve pediatrics early; permissive hypotension is not appropriate.
• Penetrating Abdominal Trauma - Selective Nonoperative Management

  Stable patients without peritonitis may be managed selectively with CT, serial exams, and labs; operate for instability, peritonitis, or evisceration.
• Penetrating Neck Trauma — Zones & Management

  Modern approach emphasizes 'no‑zone' evaluation with CTA and airway‑first priorities. Hard signs mandate immediate exploration; otherwise selective management guided by imaging and endoscopy.

T

• Tension Pneumothorax - Emergency Decompression in Trauma

  Make a clinical diagnosis and decompress immediately using finger or needle thoracostomy, followed by tube thoracostomy.
• Traumatic Aortic Injury — Imaging & Management

  Deceleration injury graded I–IV by intimal disruption to rupture. CTA is diagnostic; blood pressure/impulse control with beta‑blockers; TEVAR preferred for grade II+ when anatomy suitable.
• Traumatic Diaphragmatic Injury — Recognition & Repair

  Often occult and left‑sided; maintain high suspicion after blunt or penetrating trauma. CT signs guide diagnosis; laparoscopy/thoracoscopy confirm and repair with non‑absorbable sutures ± mesh for large defects.

U

• Unstable Pelvic Fracture Hemorrhage - Binder, Packing, Angio, REBOA

  Apply pelvic binder at the greater trochanters, exclude other bleeding sources, and proceed to preperitoneal packing, angioembolization, or REBOA based on physiology and resources.