General approach + Polytrauma

Question 1

What are the 3 key stages in the initial management of trauma?

Answer 1

1. Primary survey: ABCDE
2. Secondary survey: complete history and thorough physical examination. additional diagnostic tests tailored
3. Tertiary survey: delayed re-examination of patient (24h after admission)

Question 2

What type of blood should be transfused if there is history of haemorrhage or ongoing haemorrhage?

Answer 2

transfuse type O negative blood

Question 3

What are the key features of the secondary survey in trauma?

Answer 3

• complete history and thorough physical examination performed
• additional diagnostic tests tailored to remaining symptoms, mechanism of injury and patient comorbidities

Question 4

At what point is the secondary survey performed in trauma?

Answer 4

after the primary survey has been completed and the patient is deemed stable

Question 5

What is the main aim of the secondary survey in trauma management?

Answer 5

to minimise the risk of missed injuries

Question 6

When is the tertiary survey usually performed as part of the trauma assessment?

Answer 6

usually 24 hours after admission

Question 7

What is the main goal of the tertiary survey in trauma management?

Answer 7

to detect changes due to previously undetected injuries

Question 8

Where should most cases of polytrauma be managed?

Answer 8

most should be diverted to major trauma centres

Question 9

What is the approach to managing cases of polytrauma?

Answer 9

immediate treatment is for life-threatening conditions, followed by limb-threatening injuries

definitive management for a femur fracture can be done a few days down the line with traction/external fixation as a temporary measure until the patient is stable, however a ruptured aorta can’t wait

Question 10

What is the first principle of managing polytrauma cases?

Answer 10

damage control