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18.1 General Management of Trauma

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Trauma may occur as a result of motor vehicle crash, fights, fall, gunshot, sports, animal bites etc. and is associated with head, musculoskeletal, lacerations, visceral and neurovascular injuries. The aim of managing trauma is to prevent life threatening complications that may lead to increased morbidity and mortality. There is a systematic trauma protocol in place, Glascow coma score (level of consciousness), trauma score, ABCDE protocol, emphasizing on the primary survey, resuscitation and finally secondary survey.

Diagnostic criteria

  • There is a history of trauma
  • Level of consciousness

General Treatment

Community/Dispensary Level Interventions

  • Clear airway
  • Minimize bleeding and dress wounds
  • Assess cardiac function: arterial pulse, BP and capillary refill.
  • Administer analgesics for pain control
    A: Diclofenac injections 75mg 8hrly
  • Splint long bone fractures
    Use available splint and neck collar
  • If unconscious put in coma position and protect the spine.
  • Consider anti-tetanus prophylaxis according to the protocol (see table below)
  • Refer to the centres/health facilities where there is expertise.

Health Centre Level Interventions

  • Manage as above, capitalizing on ABCDE Trauma Protocol, review the resuscitation therapy given before arrival
  • Catheterize bladder in unconscious patient.
  • Give IV Normal Saline or Ringer’s Lactate
  • Do not feed patient, if unconscious put an NGT tube and an oxygen face mask
  • If there are open wounds do surgical debridement and dress:

Give A: Ampicillin 500 mg IV 6 hourly


B: Chloramphenicol 500 mg IV 6 hourly


B: Cloxacillin 500 mg IV 6 hourly

  • Anti-tetanus prophylaxis according to the protocol (see table below)
  • Anti rabies according to the protocol
  • Refer if
    • Comatose for ICU care and brain CT scan
    • Open fracture if surgery not feasible
    • Failed to resuscitate, need blood transfusion or laparotomy is necessary

Hospital Level Interventions

  • Manage as above-primary and secondary survey, review the resuscitation management given before arrival to hospital
  • Search systematically according to ABCDE Trauma Protocol for any signs of major injury such as:
    • Head and Eye injury
    • Dental trauma
    • Fractured spine
    • Chest injuries
    • Internal abdominal/Pelvic injuries
  • Manage accordingly. Emergency/casualty room set up is mandatory.
  • Refer if specialist intervention is required

Table 18.1: ABCDE Trauma Protocol

Assess Intervention
A (airway) Is it patent?

Any secretions?

Tongue fall?

Any mouth/nose bleeding?

Did patient drowned? Vomited?


Place an oral airway.

Raise the chin of mandible

Suctioning if required

Endotracheal intubation


B (breathing) Record the respiratory rate

(normal 10-20/min adults; 30–

60/min children)

Assess for chest asymmetry, abnormal movements or chest indrawing

Locate the trachea centrality Ensure air entry into both lungs by auscultation

Assist breathing by mouth to mouth, ambu bag or nasal prongs

If fails do ETT and mechanical ventilation

Place the chest tube in case of hemothorax, pneumothorax or tension types

Plaster the open chest wound

C(circulation) Assess arterial pulse, BP and heart sounds for signs of shock Treat shock accordingly

Set an I.V. line with isotonic fluids

D (Disability) Assess level of consciousness using GCS scale Treat the head injury


E (exposure) Un-dress the patient to observe for signs of soft tissue injuries or fractures. Blunt injuries to the chest, abdomen or the dorsal spine may indicate the life threatening ailment underneath. Catheterize

NGT insertion

Treat accordingly. Surgery may be indicated based on specialist requirement

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