Overview
This lecture covers trauma assessment and management, focusing on wound care, documentation, forensic evidence handling, and the systemic complications known as the "lethal diamond" during trauma.
Wound Assessment & Documentation
- Use precise terms: abrasion, avulsion, cut, ecchymosis (bruise), hematoma, laceration, patterned injury, and stab wound.
- Measure and accurately describe wounds in documentation.
- Photograph wounds if legal evidence is needed.
- Assess for foreign bodies (glass, gravel, dirt) in wounds.
- Evaluate sensory, motor, and vascular function (wiggle fingers, sensation, pulses, capillary refill).
Wound Cleansing & Closure
- Numb area with lidocaine or provide analgesia if needed before cleaning.
- Clean wounds with normal saline (preferred) or iodine (must be rinsed out after use).
- Remove all foreign material and apply a non-adherent dressing.
- For primary closure, wounds are fully closed (stitches, staples, Steri-Strips for minor wounds).
- For high-risk or contaminated wounds, delay closure, pack with gauze, and cover with an occlusive dressing.
- Document the number of stitches or staples used.
Tetanus, Antibiotics & Forensic Evidence
- Give tetanus booster if >5 years since last dose or status unknown.
- Provide antibiotics based on wound type, contamination risk, and signs of infection.
- Collect forensic evidence carefully; dry and store clothing in paper bags, not plastic.
- Maintain chain of custody, documenting transfer details and never leave evidence unattended.
Trauma Complications: The Lethal Diamond
- The lethal diamond: hypocalcemia, acidosis, coagulopathy, and hypothermia.
- Acidosis: blood loss lowers oxygen, causing lactic acid buildup and impaired clotting.
- Coagulopathy: hemorrhage and fluid dilution reduce clotting factors, causing more bleeding and risk of DIC (disseminated intravascular coagulation).
- Hypocalcemia: calcium loss from blood loss and citrate in transfusions impairs clotting and heart function.
- Hypothermia: exposure and blood loss lower body temp, worsening clotting and bleeding.
Management of Trauma Complications
- Keep trauma bay warm (78–80°F/25–27°C), remove wet clothing, use warm blankets and IV fluids.
- Give calcium gluconate with blood transfusions per protocol to prevent hypocalcemia.
- Avoid excessive IV fluids; prioritize blood products (PRBCs, platelets, FFP).
- Early hemorrhage control and use lactated Ringer’s solution over normal saline.
Hemorrhage Control & Transfusion
- External bleeding: apply direct pressure, reinforce dressings, use proximal pressure or tourniquet (2–3 inches above wound), and document application/removal.
- Internal bleeding: recognize signs (tachycardia, cool skin, hypotension, delayed refill), keep patient supine, transfuse as indicated, and prepare for surgery.
- For massive transfusion protocol (MTP): follow protocol for calcium administration and blood warming to prevent hypothermia and arrhythmias.
- Obtain relevant labs: CBC, BMP, type and crossmatch.
Key Terms & Definitions
- Abrasion — Superficial skin injury from friction.
- Avulsion — Tearing away of tissue.
- Ecchymosis — Bruising.
- Hematoma — Localized blood collection outside blood vessels.
- Laceration — Irregular wound from tearing.
- Coagulopathy — Impaired blood clotting.
- Hypocalcemia — Low blood calcium.
- Lethal Diamond — Trauma complication: hypocalcemia, acidosis, coagulopathy, hypothermia.
- Massive Transfusion Protocol (MTP) — >10 units blood in 24 hrs or >5 units in 1 hr.
Action Items / Next Steps
- Review wound terminology and documentation practices.
- Study the components and management of the lethal diamond.
- Follow facility protocol for blood product administration and calcium supplementation.
- Prepare for assessment on wound care, trauma complications, and hemorrhage control.