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

  Suspected blunt cardiac injury is screened with an admission ECG and troponin I. A normal ECG plus normal troponin I effectively rules out clinically significant BCI in the EAST guideline; either abnormality prompts monitored care, while echocardiography is reserved for hemodynamic instability or persistent arrhythmia.

C

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

  For an obtunded adult after blunt trauma, a normal high-quality multidetector CT of the cervical spine is generally sufficient for collar removal under an established trauma protocol when the scan is technically adequate and interpreted as negative. Routine MRI after a negative high-quality CT is not required solely because the patient cannot be examined, but MRI or specialist review remains appropriate when CT is inadequate, neurologic findings are present, or there is a specific concern for ligamentous or
• 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

  Damage-control laparotomy is a staged strategy for exsanguinating or physiologically exhausted trauma patients in whom prolonged definitive surgery would worsen hypothermia, acidosis, coagulopathy, and shock. The first operation controls hemorrhage and contamination rapidly, leaves temporary abdominal closure when needed, and transfers the patient to ICU resuscitation. Definitive reconstruction and fascial closure occur after physiology is restored.

E

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

  Extremity vascular injury requires rapid recognition of threatened limb ischemia and active hemorrhage. Hard signs such as pulsatile bleeding, expanding hematoma, absent distal pulses with ischemia, bruit/thrill, or obvious arterial disruption generally mandate immediate operative or endovascular management without delaying for imaging. Stable patients with soft signs can be screened with arterial pressure index/ABI, with CTA used when the index is abnormal or suspicion persists.

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

  Massive hemothorax is life-threatening intrathoracic hemorrhage causing hypovolemia and impaired ventilation. Immediate treatment is large-bore tube thoracostomy plus blood-based resuscitation. Operative intervention is guided by physiology and ongoing output; classic triggers include roughly 1.5 L immediate drainage or persistent bleeding around 200 mL/hour, but hemodynamic instability and continuing transfusion need matter more than a rigid number.
• 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

  Massive transfusion protocols are designed for patients with life-threatening hemorrhage who need immediate, coordinated delivery of blood components and hemorrhage-control resources. In trauma, priorities are rapid source control, balanced component resuscitation or whole blood when available, minimization of crystalloid, early correction of hypocalcemia and hypothermia, and laboratory or viscoelastic guidance as resuscitation evolves.

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

  Open pelvic fracture combines unstable ring injury with communication to the skin, rectum, vagina, or perineum and carries extreme hemorrhage and infection risk. Immediate care integrates pelvic hemorrhage control, broad-spectrum antibiotics, tetanus prophylaxis, early debridement, mechanical stabilization, and targeted management of rectal, genitourinary, and soft-tissue injuries. Fecal or urinary diversion is selective and based on wound location and organ injury rather than automatic for every open fract

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

  Selective nonoperative management is appropriate for carefully selected hemodynamically stable patients with penetrating abdominal trauma who lack peritonitis, evisceration requiring operation, uncontrolled hemorrhage, or another clear surgical indication. Management requires high-quality CT when appropriate, repeated examinations by experienced clinicians, serial vital signs and laboratory assessment, and immediate operative capability if the patient deteriorates.
• 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

  Hemodynamically unstable pelvic fracture is a hemorrhage-control emergency. Apply a pelvic binder centered over the greater trochanters, initiate balanced hemostatic resuscitation, exclude rapidly treatable thoracic and intraperitoneal bleeding, and mobilize definitive pelvic hemorrhage control. Preperitoneal pelvic packing, angioembolization, external fixation, and selected REBOA are complementary tools chosen according to physiology, bleeding pattern, resources, and associated injuries.