introduction to severe trauma

The right patient,
at the right time,
at the right hospital.

A severe trauma is the product of an event able to cause single or multiple lesions that are immediately or potentially life threatening or are able to cause serious future handicap.

Mortality from severe trauma is > 8-10%.

Severe trauma is an extremely complex but challenging pathology to deal with, its treatment needs:

• primary centralization, from the scene of the accident to the nearest Trauma Centre, or as it more often happens, transporting the patient from a smaller hospital towards the Trauma Centre after a primary assessment of the patient;
• specific complex trauma skills and diagnostic-therapeutic management ( what kind of treatment and priorities, what kind of diagnostics and when to carry them out ). This type of treatment needs a multidisciplinary team working together, ruled by a trauma leader, within a time limit known as the golden hour.

A rapid and accurate identification of a severe trauma can be done:

• on the scene of the accident with the use of a check list considering various issues such as:
  • dynamics of the accident at risk for severe trauma (e.g. - falling from a height > 5 meters, ejection from the vehicle, frontal crash, etc. );
  • alteration of physiological parameters (use of the Revised Trauma Score);
  • evident life threatening traumatic lesions or possibly highly invalidating lesions;
• inside the hospital in case of:
  • need for emergency endotracheal intubation
  • systolic blood pressure < 90 mm Hg
  • Glasgow Coma Scale < 9
  • penetrating lesions of head-thorax-abdomen
  • Injury Severity Score > 15