What is the treatment for Road Traffic Accident (RTA) injuries?

Treatment for Road Traffic Accident (RTA) Injuries

The treatment for Road Traffic Accident (RTA) injuries requires immediate systematic trauma assessment and management following ATLS principles, with priority given to life-threatening injuries through the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure). 1

Initial Assessment and Management

Primary Survey (ABCDE)

1. Airway maintenance with cervical spine protection

   • Secure airway while maintaining cervical spine immobilization
   • Clear obstructions and consider advanced airway management if GCS < 8 or airway compromise

2. Breathing and ventilation

   • Administer high-flow oxygen
   • Assess for pneumothorax, hemothorax, flail chest
   • Perform needle decompression or tube thoracostomy for tension pneumothorax

3. Circulation with hemorrhage control

   • Control external bleeding with direct pressure
   • Establish large-bore IV access (at least two lines)
   • Administer warmed crystalloid fluids initially
   • Implement massive transfusion protocol if needed with balanced ratio of blood products 1
   • Early use of tranexamic acid within 3 hours of injury for significant hemorrhage 1

4. Disability (neurological evaluation)

   • Rapid neurological assessment (GCS, pupillary response, limb movement)
   • Identify signs of traumatic brain injury
   • Maintain cerebral perfusion pressure

5. Exposure/Environmental control

   • Complete examination of the patient
   • Prevent hypothermia with warming blankets and warmed fluids

Specific Injury Management

Traumatic Brain Injury (TBI)

• Maintain systolic BP > 110 mmHg and oxygen saturation > 90%
• Elevate head 30° if no spinal injury suspected
• Avoid hypotension and hypoxia
• Consider neurosurgical consultation for GCS < 8 or deteriorating neurological status 1

Thoracic Injuries

• Identify and treat life-threatening conditions: tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, cardiac tamponade 1
• Consider tube thoracostomy for pneumothorax/hemothorax
• Evaluate for cardiac contusion with ECG, cardiac enzymes, and echocardiography if indicated 1

Abdominal Injuries

• FAST (Focused Assessment with Sonography for Trauma) or CT scan for detection of free fluid 1
• Urgent surgical intervention for hemodynamically unstable patients with significant intra-abdominal fluid 1
• CT scan for stable patients with suspected torso bleeding 1

Pelvic Injuries

• Apply pelvic binder for unstable pelvic fractures
• Consider angioembolization for ongoing pelvic bleeding
• Early fixation of unstable fractures 1

Extremity Injuries

• Control hemorrhage
• Assess neurovascular status
• Immobilize fractures
• Early orthopedic consultation for fracture management
• Consider compartment syndrome in crush injuries 2

Spinal Injuries

• Maintain spinal immobilization until cleared
• Obtain appropriate imaging (CT/MRI) based on clinical assessment
• Neurosurgical consultation for spinal cord injury or unstable fractures

Hemorrhage Control and Resuscitation

Hemodynamically Unstable Patients

• Immediate identification of bleeding source 1
• Surgical control for penetrating injuries with shock 1
• Damage control surgery for severe bleeding
• Resuscitative endovascular balloon occlusion of the aorta (REBOA) in selected cases
• Maintain permissive hypotension (SBP 80-90 mmHg) until definitive hemorrhage control in penetrating trauma without TBI 1

Coagulopathy Management

• Early assessment of coagulation status
• Targeted blood product replacement based on coagulation tests
• Consider point-of-care viscoelastic testing (TEG/ROTEM) if available 1
• Maintain normothermia, normal calcium levels, and pH > 7.2

Secondary Survey and Definitive Care

• Complete head-to-toe examination once primary survey completed
• Advanced imaging (CT scans) for detailed injury assessment
• Specialist consultations as needed (neurosurgery, orthopedics, maxillofacial)
• Tetanus prophylaxis
• Antibiotic prophylaxis for open fractures
• DVT prophylaxis when bleeding controlled
• Pain management

Special Considerations

Pediatric Patients

• Children have different physiologic responses to trauma
• Maintain higher index of suspicion for internal injuries despite normal vital signs
• Equipment and medication doses must be weight-appropriate

Elderly Patients

• Lower physiologic reserve
• Higher mortality with similar injury severity
• More susceptible to hypothermia and coagulopathy
• Review medications (especially anticoagulants)

Pregnant Patients

• Left lateral tilt to relieve IVC compression
• Consider fetal assessment if mother is stable
• Radiation risks must be balanced against diagnostic benefits

Pitfalls to Avoid

1. Delayed recognition of occult bleeding - Maintain high index of suspicion for internal hemorrhage despite initially normal vital signs

2. Inadequate pain control - Proper analgesia improves outcomes and patient cooperation

3. Overlooking secondary injuries - Complete thorough secondary survey once primary threats addressed

4. Hypothermia - Actively prevent and treat as it worsens coagulopathy and outcomes

5. Delayed surgical consultation - Early involvement of surgical teams improves outcomes for patients requiring operative intervention

6. Neglecting mechanism of injury - High-energy mechanisms (especially MVAs) should raise suspicion for serious injuries even with minimal initial symptoms 1, 3

7. Focusing only on obvious injuries - Distracting injuries may mask more serious conditions