Chapter 43 - Trauma and burns

Summary

The primary survey for trauma includes establishing the definitive airway, breathing, circulation with haemorrhage control, fluid resuscitation, coagulopathy and clearance of the cervical spine. In practice, assessment of the airway, breathing and circulation is often carried out simultaneously by different members of the trauma team. All trauma patients are administered high-flow oxygen and monitored by pulse oximetry. Shock in trauma is mostly caused by hypovolaemia secondary to haemorrhage. Cardiogenic shock due to tamponade is difficult to detect clinically, but classically causes hypotension, distended neck veins and muffled heart sounds. Coagulopathy, hypothermia and acidosis are termed as the lethal triad of trauma as each factor exacerbates the others leading to life threatening bleeding and exsanguination. In burns, airway compromise can happen quickly and airway should be secured early if problems are suspected. Burns injuries can lead to high loss of fluids and fluid requirement should be calculated and resuscitation started early.