Trauma is a physical injury caused by transfer of energy to the body resulting in tissue damage. It commonly occurs due to:

• Road traffic crashes

• Falls

• Assaults and fights

• Gunshot injuries

• Sports injuries

• Animal and human bites

• Occupational accidents

• Burns and drowning

Trauma may involve multiple systems including:

• Head and brain

• Chest and lungs

• Abdomen and viscera

• Musculoskeletal system

• Neurovascular structures

• Soft tissues (lacerations, crush injuries)

The primary goal of trauma management is early identification and treatment of life-threatening conditions to reduce mortality and long-term disability. Management follows a structured and standardized approach using:

• Primary survey

• Resuscitation

• Secondary survey

• Definitive care

Core clinical tools include:

• ABCDE trauma protocol

• Glasgow Coma Scale (GCS)

• Trauma scoring systems

ABCDE Trauma Protocol

A — Airway (with cervical spine protection)

Assessment

• Is airway patent?

• Presence of secretions

• Tongue obstruction

• Blood in mouth or nose

• Vomiting or aspiration

• Drowning history

• Facial trauma

Interventions

• Cervical spine immobilization

• Jaw thrust / chin lift maneuver

• Suction secretions

• Insert oropharyngeal airway

• Endotracheal intubation (ETT) if compromised airway

B — Breathing

Assessment

• Respiratory rate

  • Adults: 10–20/min

  • Children: 30–60/min (age dependent)

• Chest symmetry

• Chest indrawing/paradoxical movement

• Tracheal deviation

• Air entry bilaterally on auscultation

Interventions

• Oxygen therapy

• Bag-valve-mask ventilation

• Endotracheal intubation if respiratory failure

• Chest tube insertion for:

  • Pneumothorax

  • Tension pneumothorax

  • Hemothorax

• Seal open chest wounds

C — Circulation (Hemorrhage control)

Assessment

• Pulse rate and volume

• Blood pressure

• Capillary refill

• Signs of shock

• External bleeding

Interventions

• Control bleeding (direct pressure/tourniquet)

• Establish two large-bore IV lines

• Give isotonic fluids (Normal saline or Ringer’s lactate)

• Blood transfusion if indicated

• Treat shock

D — Disability (Neurological status)

Assessment

• Glasgow Coma Scale (GCS)

• Pupil size and reactivity

• Limb movement

Intervention

• Manage head injury appropriately

• Prevent secondary brain injury (oxygenation + perfusion)

E — Exposure / Environment control

Assessment

• Fully undress patient

• Look for hidden injuries

• Examine back and spine

• Identify chest/abdominal trauma

Intervention

• Prevent hypothermia

• Insert urinary catheter

• Insert nasogastric tube

• Urgent surgery if indicated

Hospital Level Interventions

After stabilization:

Perform systematic secondary survey

Look for:

• Head and eye injuries

• Dental trauma

• Spinal fractures

• Chest injuries

• Abdominal/pelvic injuries

• Long bone fractures

Provide emergency department resuscitation and refer for specialist care when required.

Signs and Symptoms

Depend on injury pattern but commonly include:

• Pain

• Bleeding

• Swelling

• Loss of consciousness

• Difficulty breathing

• Deformity of limbs

• Vomiting

• Shock

• Neurological deficits

Diagnostic Criteria

Diagnosis is clinical and based on:

• History of trauma

• Level of consciousness (GCS)

• ABCDE findings

• Systemic examination

• Imaging confirmation

Investigations

Bedside

• Pulse oximetry

• Blood glucose

• Urinalysis

Laboratory

• Full blood count

• Blood group and cross-match

• Electrolytes

• Coagulation profile

Imaging

• X-rays (suspected fractures)

• FAST ultrasound (abdominal bleeding)

• CT scan (head, chest, abdomen in stable patient)

Treatment

Community / Dispensary Level Interventions

• Clear airway

• Control bleeding and dress wounds

• Assess pulse, BP, capillary refill

• Give analgesics

• Immobilize fractures

• Neck collar application

• Recovery position if unconscious

• Tetanus prophylaxis

• Immediate referral

Pharmacological Management

Analgesia

• Diclofenac 75 mg IM every 8 hours

Antibiotics (open wounds)

Choose one:

• Ampicillin 500 mg IV 6 hourly

• Chloramphenicol 500 mg IV 6 hourly

• Cloxacillin 500 mg IV 6 hourly

Fluids

• Normal saline

• Ringer’s lactate

Prophylaxis

• Anti-tetanus (TT ± TIG)

• Anti-rabies if animal bite

Health Centre Level Interventions

• Follow ABCDE protocol

• Bladder catheterization

• Oxygen therapy

• IV fluids

• NGT insertion if unconscious

• Surgical debridement and wound care

• Antibiotics

• Tetanus prophylaxis

• Rabies prophylaxis

Non-Pharmacological Management

• Splint fractures

• Spine immobilization

• Warm patient (prevent hypothermia)

• Monitoring vital signs

• Continuous reassessment

Prevention

• Road safety enforcement

• Seatbelt and helmet use

• Workplace protective equipment

• Violence prevention programs

• Fall prevention in elderly

• Sports protective gear

• Animal vaccination programs