Trauma in adults TinTin ED 9th

199 Questions

What is predicted to become the fifth leading cause of death worldwide by 2030?

Road traffic crashes

Which age group accounts for nearly half of all deaths due to trauma?

Children and adults under the age of 46 years

What are the highest case fatality rates in the United States related to trauma?

Firearm, suffocation, and drowning/submersion

What should trauma care be organized according to?

Rapid assessment, triage, resuscitation, diagnosis, and therapeutic intervention

What is predicted to become the fifth leading cause of death worldwide by 2030?

Road traffic crashes

What is the leading cause of death among children and adults under the age of 46 years?

Trauma

What are the major causes of death following trauma?

Head injury, chest injury, and major vascular injury

What concept should trauma care be organized according to?

Rapid assessment, triage, resuscitation, diagnosis, and therapeutic intervention

What did the Trauma Care Systems Planning and Development Act of 1990 aim to establish?

A system to triage injured patients rapidly

How are trauma centers certified for their designation?

Based on the institution’s commitment of personnel and resources

What is the purpose of a well-run trauma center?

To provide multidisciplinary evaluation and smooth transitions between different care settings

What do some states rely on for the designation of certain hospitals as trauma centers?

A verification process offered by the American College of Surgeons

What did the Trauma Care Systems Planning and Development Act of 1990 aim to establish?

A model trauma care system plan for each state

What is the purpose of a well-run trauma center?

To provide smooth transitions between the ED, diagnostic radiology suite, operating room, and postoperative intensive care setting

How are trauma centers certified for their designation?

By relying on a verification process offered by the American College of Surgeons

What should trauma care be organized according to?

A systematic approach

What should EMS providers inform the receiving ED about prior to the patient's arrival at the hospital?

Mechanism of trauma, suspected injuries, vital signs, clinical symptoms

What is the purpose of a focused history obtained from the patient, family members, witnesses, or prehospital providers?

To provide important information regarding circumstances of the injury, ingestion of intoxicants, preexisting medical conditions

What is undertaken quickly in ED care of the trauma patient to identify and treat immediately life-threatening conditions?

Primary survey

For patients transported to EDs that are not trauma centers, what should be considered immediately?

Whether transfer to a trauma center is appropriate and what resuscitation or stabilization can or should be performed prior to transfer

What should EMS providers inform the receiving ED about prior to the patient's arrival at the hospital?

Mechanism of trauma, suspected injuries, vital signs, clinical symptoms

What is the purpose of a focused history obtained from the patient, family members, witnesses, or prehospital providers?

To provide important information regarding circumstances of the injury and medication use

What is undertaken quickly in ED care of the trauma patient to identify and treat immediately life-threatening conditions?

Primary survey

For patients transported to EDs that are not trauma centers, what should be considered immediately?

Whether transfer to a trauma center is appropriate and what resuscitation or stabilization can or should be performed prior to transfer

In what situation may cricothyroidotomy be needed?

Severe maxillofacial injury

When are the NEXUS and Canadian Cervical Spine Rule useful for assessing cervical spine injury?

In awake and alert patients

What is recommended for patients meeting NEXUS or Canadian criteria for low risk of cervical spine injury?

Full examination of the cervical spine, including active range-of-motion testing

What maneuver should be performed simultaneously with in-line stabilization of the head and neck to determine airway patency?

Jaw thrust maneuver

In which patients may insertion of an oral airway be difficult?

Patients with an active gag reflex

When should nasal airway insertion be avoided?

Patients with suspected basilar skull fractures

Why are video laryngoscopy devices beneficial in trauma patients?

They aid in vocal cord visualization while minimizing cervical spine manipulation

What technique is recommended for intubation in trauma patients?

Rapid-sequence intubation

When might cricothyroidotomy be necessary in trauma patients?

Severe maxillofacial injury precluding endotracheal intubation

In which patients are NEXUS or Canadian criteria useful for assessing cervical spine injury?

Awake and alert patients

In patients with suspected basilar skull fractures, what airway management technique should be avoided?

Inserting a nasal airway

In comatose patients with a Glasgow Coma Scale score between 3 and 8, what is recommended to protect the airway and prevent secondary brain injury from hypoxemia?

Performing endotracheal intubation

What technique is beneficial in trauma patients as it aids in vocal cord visualization while minimizing cervical spine manipulation?

Using a video laryngoscopy device

When managing agitated trauma patients with head injury, hypoxia, or drug- or alcohol-induced delirium, what should be considered to prevent self-injury?

Using physical restraints

What is the preferred initial imaging modality for the cervical spine in trauma patients?

When should spinal immobilization be maintained during resuscitation of a trauma patient?

Throughout the resuscitation process

How should urgent operative procedures be affected by imaging results in trauma patients?

Imaging results will not change the immediate management

In trauma system entry criteria, what fall height would warrant consideration for triage and trauma system entry?

20 feet

In the context of trauma system entry criteria, what speed of motorcycle crash would warrant consideration for triage and trauma system entry?

20 mph

In the context of trauma system entry criteria, what type of collision at a certain speed would warrant consideration for triage and trauma system entry?

Auto–pedestrian collision at >5 mph

In trauma system entry criteria, what fall height would warrant consideration for triage and trauma system entry?

20 feet

In the context of trauma system entry criteria, what speed of motorcycle crash would warrant consideration for triage and trauma system entry?

20 mph

What type of collision at a certain speed would warrant consideration for triage and trauma system entry in the context of trauma system entry criteria?

Auto–pedestrian or auto–bicycle collision at >5 mph

What is a requirement for Level 1 Trauma Centers?

At least 1200 trauma patients yearly

What is a characteristic of Level 1 Trauma Centers' critical care service?

Surgically directed

What is an activity that Level 1 Trauma Centers are expected to conduct?

Trauma research

What is a requirement for Level 1 Trauma Centers?

Treating at least 1200 trauma patients yearly

What is an essential characteristic of Level 1 Trauma Centers' critical care service?

Surgically directed critical care service

What activity is Level 1 Trauma Centers expected to conduct?

Conduct trauma research

What should be assessed in the Disability portion of the trauma assessment?

Pupil size and reactivity

What is the recommended action for identifying and controlling scalp wound bleeding?

Direct pressure

What is the purpose of logrolling the patient during the Exposure portion of trauma assessment?

To inspect and palpate thoracic spine, flank, back, and buttocks

What should be evaluated for in the Secondary Survey of trauma assessment?

Peripheral pulses for vascular compromise

What is the recommended intervention for a patient with a depressed level of consciousness or inability to protect the airway in trauma resuscitation?

Perform endotracheal intubation with in-line stabilization

What should be considered for suspected tension pneumothorax in trauma resuscitation?

Immediate needle thoracostomy

What is the initial step to assess blood volume status in trauma resuscitation?

Assess skin color, capillary refill, and pulse

What should be considered for suspected pericardial tamponade in trauma resuscitation?

Pericardiocentesis

What is the recommended action for identifying and managing airway obstruction in trauma resuscitation?

Perform endotracheal intubation with in-line stabilization

What should be considered for suspected tension pneumothorax in trauma resuscitation?

Immediate needle thoracostomy

What should be assessed to determine blood volume status in trauma resuscitation?

Radial/femoral/carotid pulse

When should central venous or interosseous access be considered in trauma resuscitation?

If peripheral sites are unavailable

What should be assessed in the Disability portion of the trauma assessment?

Pupil size and reactivity

What is the recommended action for identifying and controlling scalp wound bleeding?

Direct pressure, sutures, or surgical clips

What should be considered for suspected pericardial tamponade in trauma resuscitation?

Focused echocardiography

When managing agitated trauma patients with head injury, what should be considered to prevent self-injury?

Physical restraints and close monitoring

What is the recommended intervention for controlling active external bleeding in trauma patients?

Applying direct pressure

What is the purpose of applying a tourniquet in trauma resuscitation?

To control external hemorrhage

In which setting is the use of tourniquets common for trauma patients?

Prehospital and battlefield

What intervention is warranted for asymmetric or absent breath sounds in an intubated patient?

Partially withdraw the endotracheal tube from the right mainstem bronchus

What is indicated if massive hemothorax or vascular injury is suspected in a trauma patient?

Thoracotomy or video-assisted thoracic surgery

What should be performed for a patient with tension pneumothorax in trauma resuscitation?

Needle thoracostomy

What intervention is warranted for a sucking chest wound in a trauma patient?

Application of an occlusive dressing

What is the recommended intervention for controlling active external bleeding in trauma patients?

Application of a tourniquet

What is the purpose of noting the heart rate and pulse pressure in young, previously healthy trauma patients?

To identify early clues to impending hemodynamic compromise

What is QuikClot Combat Gauze used for in trauma resuscitation?

To control arterial or venous bleeding

What intervention is indicated if massive hemothorax or vascular injury is suspected in a trauma patient?

Needle thoracostomy

What should be done if there are asymmetric or absent breath sounds in an intubated patient?

Partially withdraw the endotracheal tube from the right mainstem bronchus or reintubate

For a trauma patient with paradoxical movement of a chest wall segment, what intervention is warranted?

Thoracotomy

What is the recommended action for identifying and managing airway obstruction in trauma resuscitation?

Performing cricothyroidotomy

According to NEXUS criteria, which of the following indicates the need for cervical spine imaging?

Posterior midline cervical spine tenderness

What is the significance of meeting all NEXUS criteria?

Low risk of cervical spine injury

What does failure to meet any one NEXUS criterion indicate?

Need for cervical spine imaging

What is the initial step to assess blood volume status in trauma resuscitation?

Establish two large-bore IV lines and infuse lactated Ringer’s

What should be avoided during airway management in patients with suspected basilar skull fractures?

Use of nasogastric tubes

What is the second-line option for administering medications and blood products in trauma patients?

Intraosseous (IO) catheter

What should be used to maximize flow rates during infusion for trauma patients?

Pressure bag

What is the fluid of choice for initial resuscitation?

Lactated Ringer’s

After rapid infusion of 2 L of crystalloid solution, what should be done if there is no marked improvement in hypotensive patients?

Transfuse type O blood

What is the recommended ratio of packed red blood cells to fresh frozen plasma in massive transfusion protocols?

1:1

What contributes to the coagulopathy and should be corrected as quickly as possible?

Hypothermia

When is resuscitative endovascular balloon occlusion of the aorta (REBOA) potentially indicated?

In patients with traumatic life-threatening hemorrhage below the diaphragm who are unresponsive to resuscitation

What is an emerging tool in the management of noncompressible torso hemorrhage?

Resuscitative endovascular balloon occlusion of the aorta (REBOA)

What complications are associated with REBOA?

Arterial disruption, hematoma, thromboemboli, dissection, and extremity ischemia.

What does data from both military and civilian experience reveal about patients receiving >10 units of packed red blood cells and fresh frozen plasma?

Decreased mortality when they simultaneously receive fresh frozen plasma in a ratio of packed red blood cells to fresh frozen plasma of 1:1 rather than 1:4.

What is the initial recommended fluid for resuscitation in trauma patients?

Lactated Ringer’s

What is the second-line option for administering medications and blood products in trauma patients?

Intraosseous catheterization

What should be avoided in airway management for patients with suspected basilar skull fractures?

Nasal airway insertion

What is recommended for controlling active external bleeding in trauma patients?

Application of a tourniquet proximal to the bleeding site

What is the fluid of choice for initial resuscitation?

Lactated Ringer’s

What is the recommended action if hypotensive patients do not show marked improvement after rapid infusion of 2 L of crystalloid solution?

Transfuse type O blood

What is the recommended ratio of fresh frozen plasma to packed red blood cells in massive transfusion protocols?

1:1

What contributes to the coagulopathy in major trauma patients?

Acidosis and hypothermia

When is resuscitative endovascular balloon occlusion of the aorta (REBOA) potentially indicated?

For traumatic life-threatening hemorrhage below the diaphragm in unresponsive patients

What are the potential complications of resuscitative endovascular balloon occlusion of the aorta (REBOA)?

Arterial disruption, hematoma, thromboemboli, dissection, and extremity ischemia.

What does aggressive volume resuscitation not substitute for?

Definitive hemorrhage control

How does administration of fresh frozen plasma affect mortality in patients receiving >10 units of packed red blood cells?

Decreased mortality (26%) compared to higher mortality (87.5%) with lower ratio administration.

What is the effect of early administration of tranexamic acid within 1 hour of injury?

Decreases the relative risk of death from bleeding by 32%

What is a criticism of the CRASH-2 study?

Heterogeneous patient populations studied

When is administration of tranexamic acid less effective and potentially harmful?

More than 3 hours after injury

What did studies involving >20,000 patients report regarding the risk reduction of death from bleeding with tranexamic acid?

10% to 15%

What is the reported risk reduction of death from bleeding with the administration of tranexamic acid?

10% to 15%

When is the administration of tranexamic acid less effective and potentially harmful?

After 6 hours of injury

What is the effect of early administration of tranexamic acid within 1 hour of injury?

Decreases relative risk of death from bleeding by 32%

What is the purpose of assessing the Glasgow Coma Scale (GCS) in trauma patients?

To monitor consciousness and evaluate progress or deterioration during treatment

What does a total Glasgow Coma Scale (tGCS) score consist of?

Eye, verbal, and motor components

In what situation may some systems use only the motor component of the GCS (mGCS) to triage patients?

When it is difficult to record the tGCS for trauma patients

What does a score of 15 on the Glasgow Coma Scale (GCS) indicate?

It does not exclude the presence of traumatic brain injury

What components make up the Glasgow Coma Scale (GCS)?

Eye, verbal, and motor

What should not be simply attributed to altered mental status in trauma patients?

Intoxication

What score on the Glasgow Coma Scale (GCS) does not exclude the presence of traumatic brain injury?

In some systems, what component of the GCS is used to triage trauma patients?

Motor component (mGCS)

What is a high-risk factor that mandates radiography according to the Canadian Cervical Spine Rule?

Age over 64 years

Which low-risk factor allows safe assessment of range of motion according to the Canadian Cervical Spine Rule?

Simple rear-end collision

What indicates the need for radiography according to the Canadian Cervical Spine Rule?

Inability to rotate neck actively (45 degrees left and right)

What is the GCS motor response point for extension to pain?

At what GCS motor response point does the patient exhibit withdrawal to pain?

Which GCS motor response point indicates the patient's ability to obey commands?

What does a GCS Verbal response point of 2 indicate?

Incomprehensible sound

What is the GCS Verbal response point for being oriented?

What is the GCS Verbal response point for using inappropriate words?

At what GCS motor response point does the patient exhibit extension to pain?

Point 2

What GCS eye opening point represents no response?

Point 4

At what GCS verbal response point does the patient exhibit incomprehensible sounds?

Point 3

What intervention should be performed immediately if tension pneumothorax is clinically suspected during trauma resuscitation?

Needle thoracostomy

In patients requiring intubation during trauma resuscitation, what should be provided when the cervical collar is removed?

In-line immobilization

What should be obtained to assess endotracheal tube placement and exclude pneumothorax during trauma resuscitation?

Chest radiograph or ultrasound

What should be performed to quickly identify patients with intracranial injuries who may benefit from operative treatment during the primary survey in trauma resuscitation?

Defer any procedures until after head CT is performed

What should be done if tension pneumothorax is clinically suspected during the primary survey?

Immediately perform tube thoracostomy

What is the recommended approach for patients requiring intubation with suspected traumatic brain injury?

Provide in-line immobilization when the cervical collar is removed during intubation

In equivocal cases, what can confirm the presence of pneumothorax and prompt emergent intervention?

Ultrasound (US)

What should be obtained to assess endotracheal tube placement and exclude pneumothorax in trauma patients?

Chest radiograph or ultrasound (US)

What indicates the emergent need for exploratory laparotomy in a patient with penetrating abdominal injury?

Abdominal tenderness or distention on palpation, coupled with hypotension

What is the recommended intervention for patients with penetrating chest trauma and witnessed signs of life during transport to or in the ED, and at least cardiac electrical activity upon arrival?

Performing ED thoracotomy

What should be done if a patient with a penetrating gunshot wound to the abdomen requires emergent exploratory laparotomy?

CT is not indicated

What is the best course of action for objects deeply impaled in the chest and abdomen?

Leave in place and transport the patient to the operating room for surgical removal under direct visualization

What is indicated for patients in traumatic arrest upon arrival to the ED?

A critical decision regarding the appropriate level of intervention, including the use of emergent thoracotomy

What did one study analyzing 862 patients undergoing ED thoracotomy reveal about neurologically intact survivors?

The proportion of neurologically intact survivors was 3.9%

What was observed regarding survival rates among thoracic stab wound victims who showed breathing or pulse in the field?

The survival rate was 23%

What is recommended for patients with blunt trauma and no respiration or pulse in the field?

ED thoracotomy is not indicated

When should ED thoracotomy be performed according to recommendations?

For patients with penetrating chest trauma with witnessed signs of life during transport to or in the ED, and at least cardiac electrical activity upon arrival.

What should any recommendation for termination or escalation of resuscitative efforts be based on?

An immediate search for readily reversible causes including cardiac tamponade, pneumothorax, massive hemoperitoneum, and presence/absence of ongoing cardiac activity.

What should be performed if tension pneumothorax is clinically suspected?

Immediate tube thoracostomy

What should be deferred until after head CT is performed in patients with suspected traumatic brain injury?

Procedures not correcting a specific problem discovered during the primary survey

What should be provided when the cervical collar is removed during intubation in patients requiring intubation?

In-line immobilization

What can confirm the presence of pneumothorax and prompt emergent intervention in equivocal cases?

Ultrasound (US)

What is the recommended action for patients with penetrating abdominal injury showing abdominal tenderness, distention, and hypotension?

Immediate exploratory laparotomy

In the context of a penetrating gunshot wound to the abdomen, what should be done if emergent exploratory laparotomy is required?

CT is not indicated

What is the recommended approach for impaled objects deeply lodged in the chest and abdomen?

Leave the object in place and transport the patient to the operating room

In cases of traumatic cardiac arrest, what justifies performing an emergency department (ED) thoracotomy?

Witnessed signs of life during transport or in the ED and at least cardiac electrical activity upon arrival

What does one study analyzing 862 patients undergoing ED thoracotomy reveal about neurologically intact survivors?

The proportion of neurologically intact survivors was 3.9%

What is indicated if there are no survivors among patients with blunt trauma and no respiration or pulse in the field?

ED thoracotomy is not indicated

When should the secondary survey be initiated in trauma assessment?

After basic functions have been corrected in conjunction with the primary survey

How can bleeding from scalp lacerations be controlled?

With plastic Raney clips or staples that grasp the full thickness of the scalp

What should be inspected for in a trauma patient with suspected basilar skull fracture?

Tympanic membranes for hemotympanum and repeat pupil examination

When is rectal examination no longer routinely performed in alert trauma patients?

Without evidence of pelvic or spinal injury

What imaging technique is recommended for definitive imaging of the chest and abdomen-pelvis?

CT scan with IV contrast

Which examination is a rapid screening tool for identifying major intraperitoneal bleeding, pericardial tamponade, pneumothorax, and hemothorax?

Extended FAST examination

What type of injuries may require further imaging and hospital observation due to being undiagnosed initially?

Esophageal, diaphragm, and small bowel injuries

For patients not rapidly transported to the operating room or CT suite, what radiographic imaging is recommended?

Cervical spine, chest, and pelvic radiographs

What is essential for patients without clear indications for surgery?

Serial examinations

What should be performed to exclude fractures in trauma patients?

Appropriate extremity radiographs

What is a rapid screening tool for identifying major intraperitoneal bleeding?

Extended FAST examination

What should be performed alongside head CT in certain cases?

Cervical spine CT

What can quickly detect injuries not clinically apparent but comes with increased ionizing radiation exposure?

Liberal approach to CT scanning

What laboratory study includes urine dipstick testing for blood?

Pregnancy test

What should be provided when the cervical collar is removed during intubation in patients requiring intubation?

ECG with troponin I levels

What should be assessed during the secondary survey of a trauma patient?

Blood pressure, pulse rate, and response to interventions

What is the recommended action when there is facial trauma or evidence of basilar skull fracture?

Insert the gastric tube through the mouth rather than the nose

How can bleeding from scalp lacerations be controlled?

With plastic Raney clips or staples that grasp the full thickness of the scalp

Under what circumstance is a rectal examination no longer routinely performed in alert trauma patients?

When there is no blood at the urethral meatus and a normal prostate

What is the recommended imaging protocol for patients not rapidly transported to the operating room or CT suite?

Cervical spine, chest, and pelvic radiographs

What is the purpose of the extended FAST examination in trauma assessment?

To identify major intraperitoneal bleeding, pericardial tamponade, pneumothorax, and hemothorax

What is the initial imaging modality recommended for excluding fractures in extremities?

Appropriate extremity radiographs

When should a chest radiograph be obtained for trauma patients?

Only for gunshot wounds to the torso

What should be considered for patients with head, cervical spine, and chest injuries?

Imaging of the entire spine

What is a concern associated with a liberal approach to CT scanning in trauma patients?

Increased risk of missed injuries not clinically apparent

What are routine laboratory studies recommended for trauma patients older than 55?

Blood type and screen, hemoglobin level, urine dipstick testing for blood, ethanol level, pregnancy test, capillary blood glucose level, and ECG with troponin I levels

What is the recommended course of action for patients with hemodynamic instability and ongoing bleeding?

Expeditious transportation to the operating room with personnel capable of performing ongoing resuscitation accompanying the patient

When may blunt abdominal injuries become clinically apparent despite initial CT findings?

During serial examinations at regular intervals

What is the estimated blood loss for Class III hemorrhage in mL?

1500–2000

In Class IV hemorrhage, what is the approximate percentage of blood volume lost?

In Class II hemorrhage, what is the expected pulse rate (beats/min)?

140

What is the estimated blood loss for a Class III hemorrhage?

1500–2000 mL

What is the pulse rate for a Class I hemorrhage?

140 beats/min

What is the pulse pressure for a Class II hemorrhage?

Decreased

Study Notes

Perform retrograde urethrography before inserting a Foley catheter if there is meatal blood or prostate displacement, indicating a urethral injury.
Perform a manual and speculum examination for vaginal bleeding and possible vaginal lacerations in the presence of a pelvic fracture.
Evaluate extremities for fracture and soft tissue injuries, checking peripheral pulses.
Perform a more thorough neurologic examination, checking motor and sensory function.
Undiagnosed injuries, such as esophageal, diaphragm, and small bowel injuries, may require further imaging and hospital observation.
Standard radiographic imaging for patients not rapidly transported to the operating room or CT suite includes cervical spine, chest, and pelvic radiographs.
A chest radiograph is required for gunshot wounds to the torso, with or without abdominal films, depending on the site of injury.
The extended FAST examination is a rapid screening tool for identifying major intraperitoneal bleeding, pericardial tamponade, pneumothorax, and hemothorax.
CT scan with IV contrast is for definitive imaging of the chest and abdomen-pelvis.
Obtain appropriate extremity radiographs to exclude fractures.
Consider imaging of the entire spine, especially in patients with head, cervical spine, and chest injuries.
Cervical spine CT is often performed alongside head CT.
Liberal approach to CT scanning can quickly detect injuries not clinically apparent but comes with increased ionizing radiation exposure.
Routine laboratory studies include blood type and screen, hemoglobin level, urine dipstick testing for blood, ethanol level, pregnancy test, capillary blood glucose level, and ECG with troponin I levels for patients older than 55.
Patients with hemodynamic instability and ongoing bleeding should be expeditiously transported to the operating room, and personnel capable of performing ongoing resuscitation should accompany the patient.
Serial examinations are essential for patients without clear indications for surgery.
Blunt abdominal injuries may not be readily apparent on initial CT and may become clinically apparent upon serial examinations.
Consider admission or observation for patients with closed head trauma, normal levels of consciousness, and requiring repeat neurologic examinations, as well as patients at risk for delayed pneumothorax or pulmonary contusion.
Perform retrograde urethrography before inserting a Foley catheter if there is meatal blood or prostate displacement, indicating a urethral injury.
Perform a manual and speculum examination for vaginal bleeding and possible vaginal lacerations in the presence of a pelvic fracture.
Evaluate extremities for fracture and soft tissue injuries, checking peripheral pulses.
Perform a more thorough neurologic examination, checking motor and sensory function.
Undiagnosed injuries, such as esophageal, diaphragm, and small bowel injuries, may require further imaging and hospital observation.
Standard radiographic imaging for patients not rapidly transported to the operating room or CT suite includes cervical spine, chest, and pelvic radiographs.
A chest radiograph is required for gunshot wounds to the torso, with or without abdominal films, depending on the site of injury.
The extended FAST examination is a rapid screening tool for identifying major intraperitoneal bleeding, pericardial tamponade, pneumothorax, and hemothorax.
CT scan with IV contrast is for definitive imaging of the chest and abdomen-pelvis.
Obtain appropriate extremity radiographs to exclude fractures.
Consider imaging of the entire spine, especially in patients with head, cervical spine, and chest injuries.
Cervical spine CT is often performed alongside head CT.
Liberal approach to CT scanning can quickly detect injuries not clinically apparent but comes with increased ionizing radiation exposure.
Routine laboratory studies include blood type and screen, hemoglobin level, urine dipstick testing for blood, ethanol level, pregnancy test, capillary blood glucose level, and ECG with troponin I levels for patients older than 55.
Patients with hemodynamic instability and ongoing bleeding should be expeditiously transported to the operating room, and personnel capable of performing ongoing resuscitation should accompany the patient.
Serial examinations are essential for patients without clear indications for surgery.
Blunt abdominal injuries may not be readily apparent on initial CT and may become clinically apparent upon serial examinations.
Consider admission or observation for patients with closed head trauma, normal levels of consciousness, and requiring repeat neurologic examinations, as well as patients at risk for delayed pneumothorax or pulmonary contusion.

Learn about the impact of traumatic injury on public health, including statistics on ED visits, mortality rates, and leading causes of trauma-related deaths. Understand the significance of trauma as the leading cause of death among children and adults under the age of 46.

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