Surgery SC034: Hit By A Van, In Shock With Internal Bleeding: Abdominal Injury

Question 1

Trauma in HK

Answer 1

• > 90% Blunt trauma

- Very few penetrating trauma

Question 2

Trimodal death distribution

Answer 2

Aim to suppress 2nd curve (Early deaths) by golden hour management

Question 3

Primary survey

Answer 3

• Refer to SC WCS 83
• ABCDE
• Simultaneously with Resuscitation
• Universal precaution + PPE well observed

Question 4

Pathologies in Trauma

Answer 4

1. Head
   - Brain contusion
   - Epidural / Subdural haemorrhage
   - Traumatic SAH
   - Skull fracture
2. Chest
   - Lung / Cardiac contusion
   - Cardiac tamponade
   - Pneumothorax
   - Haemothorax
   - Rib fracture
3. Abdomen
   - Liver / Splenic laceration / contusion
   - Mesenteric laceration
   - Bowel contusion
   - Bowel perforation
4. Retroperitoneal (may be missed by FAST scan)
   - Renal contusion
   - Pancreatic contusion
   - Aortic injury (dissection, pseudoaneurysm, haematoma, perforation) —> Feel for ***peripheral pulses
5. Perineum
   - Bladder contusion / perforation
   - Urethral injury
6. Bone / Soft tissue
   - Long bone fracture
   - Haemorrhage
   - Fat embolism

Question 5

Management

Answer 5

See SC WCS 83