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General management of trauma


General management of trauma
General management of trauma
General management of trauma
General management of trauma

Trauma may occur as a result of motor vehicle crash, fights, fall, gunshot, sports, animal bites etc. and is associated with head, musculoskeletal, lacerations, visceral and neurovascular injuries. The aim of managing trauma is to prevent life threatening complications that may lead to increased morbidity and mortality.

There is a systematic trauma protocol in place, Glascow coma score (level of consciousness), trauma score, ABCDE protocol, emphasizing on the primary survey, resuscitation and finally secondary survey.

For Airway


• If airway is patent?
• Any secretions?
• For tongue fall?
• Any mouth/nose bleeding?
• If patient drowned?
• If patient vomited?
• If patient aspirated?


• Place an oral airway.
• Raise the chin of mandible
• Suctioning if required
• Endotracheal intubation (ETT)

For B (breathing)


• and record Respiratory rate (normal 10-20/min adults; 30– 60/min children)
• Chest asymmetry,
• Abnormal movements
• Chest indrawing
• Locate the trachea centrality
• Ensure air entry into both lungs by auscultation


• Assist breathing by mouth to mouth, ambu bag or nasal prongs
• If fails do ETT and mechanical ventilation
• Place the chest tube in case of hemothorax, pneumothorax or tension types
• Plaster the open chest wound

For C(circulation)


• Arterial pulse
• BP
• Heart sounds for signs of shock


• Treat shock accordingly
• Set an I.V. line with isotonic fluids

For D (Disability)


• Level of consciousness using GCS scale


• Treat the head injury accordingly

For E (exposure)


• Un-dress the patient to observe for signs of soft tissue injuries or fractures
• Blunt injuries to the chest, abdomen or the dorsal spine may indicate the life threatening ailment underneath


• Catheterize
• NGT insertion
• Treat accordingly
• Surgery may be indicated based on specialist requirement

Signs and Symptoms

Diagnostic Criteria

• There is a history of trauma
• Level of consciousness
• General Treatment
• Community/Dispensary Level Interventions


Depend on the type of injury, the following may be indicated
• X- Ray
• CT scan
• Blood investigations


  • Pharmacological

    • Ampicillin 500 mg IV 6 hourly

    • Chloramphenicol 500 mg IV 6 hourly
    • Cloxacillin 500 mg IV 6 hourly

    Anti-tetanus prophylaxis according to the protocol

    Anti-rabies according to the protocol

    Refer if specialist intervention is required
  • Non-pharmacological

    • Minimize bleeding and dress wounds
    • Assess cardiac function: arterial pulse, BP and capillary refill.
    • If unconscious put in coma position and protect the spine.
    • Consider anti-tetanus prophylaxis according to the protocol
    • Catheterize bladder in unconscious patient.
    • Give IV Normal Saline or Ringer’s Lactate
    • Do not feed patient, if unconscious put an NGT tube and an oxygen face mask
    • If there are open wounds do surgical debridement and dress:


Updated on,

6 Novemba 2020 10:01:02


    1. STG
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