Chapter 32 - Trauma

Summary

This chapter deals with trauma and the specific issue of burns. The diagnostic workup and treatment approach to the injured pregnant patient follows the Advanced Trauma Life Support (ATLS) algorithm of the American College of Surgeons Committee on Trauma. Although multiple facets of trauma care occur concurrently in an organized resuscitation bay, the sequence of prioritization begins with airway, breathing, and circulation, plus disability and exposure (ABC-DE), followed by the secondary survey, comprising detailed physical examination and diagnostic adjuncts such as radiography, ultrasound (specifically focused assessment with sonography for trauma (FAST)), and CT. Primary survey in pregnant patients includes assessment and maintenance of the ABCs. The secondary survey comprises a complete history and physical examination along with diagnostic adjuncts. The care of the burned patient is critically anchored on the principles of rapid fluid resuscitation, early nutrition replacement, early excision and skin grafting, and intense physical rehabilitation.