From the Guidelines
The primary management of trauma should follow a systematic approach, prioritizing life-threatening conditions and establishing the foundation for definitive care, as outlined in the latest guidelines, such as the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. The management of trauma involves a step-by-step approach to address the patient's airway, breathing, circulation, disability, and exposure.
- First, secure the airway by clearing obstructions, using jaw thrust maneuvers, or inserting an endotracheal tube if necessary.
- For breathing, ensure adequate ventilation, administer oxygen, and decompress tension pneumothorax if present.
- Control hemorrhage by applying direct pressure, using tourniquets for extremity bleeding, and administering tranexamic acid within 3 hours of injury, as recommended by recent guidelines 1.
- Establish IV access with two large-bore catheters and initiate fluid resuscitation with warmed crystalloids.
- For hemorrhagic shock, use blood products in a 1:1:1 ratio of packed red cells, plasma, and platelets, as supported by the latest evidence 1.
- Assess neurological status using the Glasgow Coma Scale and check pupillary responses.
- Finally, completely expose the patient to identify all injuries while preventing hypothermia using warming blankets. This approach is crucial in reducing the number of preventable deaths attributable to traumatic injury, as highlighted in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. Key decision points in the management of trauma patients should be guided by a systematic diagnostic and therapeutic approach, as outlined in the latest guidelines 1.
From the Research
Primary Management of Trauma
The primary management of trauma involves several key components, including:
- Resuscitative interventions to stabilize the patient 2
- Early administration of tranexamic acid to reduce bleeding and mortality 3, 4, 5
- Rapid assessment and treatment of life-threatening injuries, such as massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest 6
- Management of airway, circulation, and breathing, as well as identification of neurologic problems and whole body clinical examination 6
Key Interventions
Some key interventions in the primary management of trauma include:
- Administration of tranexamic acid as soon as possible after injury, with a recommended dose of 1g bolus + 1g infusion/8h intravenously 3, 5
- Use of focused assessment with sonography in trauma (FAST) to identify spontaneous intraperitoneal hemorrhage 6
- Thoracotomy for patients with massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest 6
- Emergency laparotomy for patients with symptoms of perforated hollow viscous 6
Goals of Primary Management
The primary goals of trauma management are to:
- Provide effective resuscitative interventions while minimizing the time from injury to definitive care 2
- Reduce mortality and morbidity through early administration of tranexamic acid and other interventions 3, 4, 5
- Prevent and stop bleeding and secondary injuries, such as painful compartment syndrome or intra-abdominal infections (IAIs) 6