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Trauma

  • Definition

    Trauma is a serious injury or shock to the body. It is caused by a physical force, such as violence or an accident. The injury may be complicated by psychiatric, behavioral, and social factors. This can cause the injuries to be greater than just physical ones.
    Brain Trauma from Whiplash
    Whiplash brain
    Copyright © Nucleus Medical Media, Inc.
  • Causes

    Some causes of trauma include:
    • Motor vehicle accidents
    • Falls
    • Near-drowning
    • Gunshots
    • Fires and burns
    • Stabbing
    • Other physical assault
    • Fire, flood, earthquake, lightening, or other natural disaster
    • Contact sports
    • Electrical shock
    • Animal attacks
    • Explosions
    • Plane crashes
  • Risk Factors

    Trauma is more likely if you are aged 1-44 years. Other factors that may increase the chance of trauma include:
    • Not wearing a seatbelt in a vehicle
    • Drinking alcohol and driving a vehicle or boat
    • Cell phone use (especially texting), or other distractions while driving
    • Improper use or storage of firearms
    • Unsafe home conditions that can lead to falls, such as unsecured area rugs, wet floors, cords running across the middle of the room, or poorly lit halls and stairwells
    • Not wearing proper protective equipment while playing sports, or while working with or using dangerous equipment (like a chainsaw)
    • Improper use of dangerous machinery, such as powertools, chainsaws, lawn mowers, or snowblowers
    • Fighting with fists or weapons, especially after drinking alcohol
    • Improper car seat use that results in a child falling from an elevated surface, or the occupied car seat flipping or rolling
    • Not using smoke detectors or not changing dead batteries in a timely manner
    • Swimming alone or without previous lessons
    • Not watching your child while they are swimming
    • Not using lifejackets while swimming or boating
    • Improper fencing or locks around swimming pools
    • Approaching an animal unsafely or aggressively
  • Symptoms

    Symptoms depend on the type or extent of injuries. Symptoms may include:
    • Pain, with or without swelling
    • External (visible) or internal (not visible) bleeding
    • Breathing problems
    • Headache, nausea, vomiting, amnesia, or altered mental status
    • Visible deformity, which may occur with a fracture
    • Loss of feeling and/or muscle strength
    • Changes in bowel or bladder function, including inability to urinate or have a bowel movement
    • Loss of consiousness
    • Coma
    In addition, the following psychological effects may occur in response to trauma:
  • Diagnosis

    A medical team will assess your symptoms and medical history. A thorough physical exam will be done. It may include a chest exam, abdomen and pelvic exam, exam of extremities, and a neurologic exam. A psychological exam and/or suicide assessment may also be done.
    Your bodily fluids may be tested. This can be done with blood tests.
    Your vital signs may be tested. This can be done with:
    Imaging tests can be used to evaluate the injured area. These may include:
  • Treatment

    Treatment depends on the cause, severity, or location of the injury.
    Immobilize and Stabilize the Injury
    Severe injuries need to be immobilized to reduce the risk of further damage. Once this is complete, an assessment for life-threatening injuries or complications will be done. Stabilizing an injury may require:
    • Splinting or bracing
    • A breathing tube for a blocked airway
    • IV fluids
    • Mechanical ventilation to take over breathing
    • Nutritional support
    • Admission to the hospital for monitoring
    Surgery
    Some injuries may require surgery. This may be done immediately to sustain life or at a later time to repair damage. Examples of surgery may include:
    • Vascular surgery to control bleeding
    • Neurosurgery to repair the spinal cord, brain, and/or nerves
    • Creating a tracheostomy to restore or improve breathing—this may be temporary or permanent
    • Repairing or connecting broken bones with wires, screws, or plates
    • Reconstructive or plastic surgery
    • Debridement (removing dead tissue) and skin grafting for severe burns
    • Creating a urostomy or colostomy to restore bladder and bowel function—this may be temporary or permanent
    Some procedures, such as fracture repairs, may be delayed until swelling resolves.
    Recovery and Rehabilitation
    For some, recovery may be short (days or weeks). For others, it may take a long time (months or years). This may include the use of assisted devices like a cane or wheelchair. Severe injuries, especially to the head, neck, and spinal cord, may require short- or long-term (or permanent) rehabilitation.
    In general, recovery and rehabilitation includes one or more of the following:
    • Physical therapy—to maintain or regain as much movement as possible
    • Occupational therapy—to assist in everyday tasks and self-care
    • Respiratory therapy—to assist with breathing
    • Speech and swallowing therapy
    • Psychological therapy—to improve mood and decrease depression
  • Prevention

    To help reduce your chance of trauma:
    • Always use seat belts.
    • Never drive or operate any equipment while under the influence of alcohol or drugs. Certain medications can be dangerous as well.
    • Do not use a cell phone while driving.
    • Keep poisons, medication, and cleaning supplies locked up. Keep them away from small children.
    • Teach children to swim. Teach all family members about water safety.
    • Never swim alone, always swim with a buddy.
    • Develop a fire safety plan.
    • Make sure all alarm and fire equipment is up to date such as smoke alarms, carbon monoxide alarms, and fire extinguishers.
    • If you have firearms in the house, make sure they are kept unloaded. Keep them in a locked location.
    • Wear helmets while biking.
    • Wear the right safety equipment for all sports and recreation activities.
    • Wear appropriate protective gear when using power tools.
    • Help prevent falls in the home. Install night-lights, grab bars, and hand rails.
    • Avoid putting yourself at risk for an accident, violence, or other physical trauma.
  • RESOURCES

    Family Doctor—American Academy of Family Physicians http://familydoctor.org

    National Safety Council http://www.nsc.org

    CANADIAN RESOURCES

    Canadian Association of Emergency Physicians http://www.caep.ca

    Trauma Association of Canada http://www.traumacanada.org

    References

    Approach to the trauma patient. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/injuries;-poisoning/approach-to-the-trauma-patient/approach-to-the-trauma-patient. Updated July 2015. Accessed December 28, 2015.

    Majou R, Farmer A. ABC of psychological medicine: trauma. BMJ. 2002;325(7361):426-429.

    Major trauma—emergency management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Accessed December 28, 2015.

    Spinal cord injury—acute management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 10, 2015. Accessed December 28, 2015.

    Spinal cord injury—chronic management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 18, 2015. Accessed December 28, 2015.

    Trauma fact sheet. National Institute of General Medical Sciences website. Available at: https://www.nigms.nih.gov/Education/pages/Factsheet%5FTrauma.aspx. Updated November 2012. Accessed December 28, 2015.

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