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TRAUMA

Traumameans wound or injuryand is caused by an external source or force. It is the sixth leading cause of death worldwide, accounting for 10% of all mortalities, and is therefore a serious public health problem with significant social and economic costs.

Classification:

Trauma can be classified according to the area of the body affected:

Head injury, Chest trauma, Abdominal trauma, Extremity trauma, Facial trauma, Spinal cord injury, Genitourinary system trauma, Pelvic trauma, Soft tissue injury. Trauma involving more than one anatomical area is referred as multiple trauma or polytrauma.

Trauma may also be classified by the type of force applied to the body, such as blunt trauma or penetrating trauma.

The care of acutely injured people encompasses pre-hospital assessment and care by emergency medical services personnel, emergency department assessment, treatment, and stabilization, and possible in-hospital care among all age groups.

Causes:

The leading cause of traumatic death is blunt trauma. Motor vehicle accidentsand falling accidents are subsets of blunt trauma and are the number one and two causes of traumatic death. The use of drugs such as alcohol or illicit drugs such as cocaine increases the risk of trauma, by making traffic collisions, violence, and abuse more likely. Other drugs such as benzodiazepines increase the risk of trauma in elderly people. In addition, intentional injury is a common cause of traumas. Penetrating trauma is caused when a foreign body such as a bullet or a knife enters the tissue of the body, creating an open wound.

Blast injury is a complex cause of trauma because it commonly includes both blunt and penetrating trauma, and may also be accompanied by a burn injury.

Pathophysiology:

The body responds to traumatic injury both systemically and locally at the injury site. The inflammatory process that occurs after trauma protects against further injury and starts the healing process.This response attempts to protect vital organsand to allow the damage to heal. Healing time depends on sex, age and severity of injury.

Management:

The initial evaluation follows a protocol of primary survey, resuscitation, secondary survey, and either definitive treatment or transfer to an appropriate trauma center for definitive care. This approach is the heart of the Advanced Trauma Life Support (ATLS) protocol, which is designed to identify life-threatening injuries and to initiate stabilizing treatment in a rapidly efficient manner.

The primary physical examinationconsists of checking and treating airway, breathing, and circulation followed by an assessment on the level of consciousness.The primary survey involves performing resuscitative procedures and interventions to treat life-threatening conditions. This ongoing effort involves monitoring patient vital signs, protecting the airway with assisted ventilation and oxygenation as required, and providing resuscitation with intravenous fluids.

The secondary examination consists of a systematic assessment of all systems and the entire body surface to find all injuriesfrom head to toe. The purpose of the secondary examination is to identify all injuries so that they may be treated definitively.

Persons with major trauma commonly have chest and pelvic X-rays taken. Dependent on the mechanism of injury and clinical status, an ultrasound or CT scan may be needed as adjuncts in the assessment or diagnosis of traumatic injuries.

Prevention:

By identifying risk factors present within a community and creating solutions to decrease the incidence of injury, trauma referral systems can help to enhance the overall health of a population. Some common forms of legislation regarding injury prevention typically involve seatbelts, child car seats, helmets, alcohol control, and increased enforcement.

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