Pathophys. of trauma
Blunt chest trauma, absent breath sounds, hypoxia.
Task: Explain the pathophysiology of tension pneumothorax.
Air trapped pleural space → ↑ intrathoracic pressure.
Lung collapse + mediastinal shift.
Patient pale, cool, clammy after blood loss.
Task: State the pathophysiology of hypovolaemic shock.
↓ Volume → ↓ preload → ↓ stroke volume.
↓ Cardiac output → ↓ MAP.
Tissue hypoxia → anaerobic metabolism → acidosis.
Burns to face/neck, singed nasal hairs.
Task: State your airway management priorities.
High-flow O₂.
Anticipate airway oedema → early RSI backup.
Continuous SpO₂/EtCO₂.
Traumatic amputation of forearm with severe bleed.
Task: Describe circulation control measures
Direct pressure → haemostatic dressing → tourniquet.
IV/IO access, permissive hypotension.
Preserve limb: wrap in moist sterile gauze, cool bag.
Burns patient with tachypnoea and confusion.
Task: List two differentials besides burn shock.
CO poisoning.
Hypovolaemia.
Inhalation injury.
Unstable pelvis, hypotension.
Task: Outline the pathophysiology of pelvic haemorrhage.
Venous plexus/arterial injury → massive bleed.
Retroperitoneal space can hold >2 L blood.
Leads to hypovolaemic shock + instability.
Cord injury above T6, hypotension, bradycardia.
Task: Explain the pathophysiology of neurogenic shock.
Loss of sympathetic tone (cord above T6).
Vasodilation + bradycardia.
↓ SVR + ↓ CO → hypotension, warm skin.
Patient with suspected TBI, GCS 6.
Task: Outline airway and breathing management in TBI.
MILS + jaw thrust (no head tilt).
Intubate if GCS ≤8.
Maintain SpO₂ ≥95%, EtCO₂ 35–40 mmHg.
Isolated femur fracture with swelling and deformity.
Task: State priorities for circulation and splinting.
Analgesia + IV access.
Traction splint to reduce bleed/pain.
Monitor for shock (1–1.5 L loss).
Trauma patient with hypotension and JVD.
Task: State two differentials to tension pneumothorax.
Tension pneumothorax.
Cardiac tamponade.
Massive haemothorax.
Patient pulled from a house fire, facial burns, hoarse voice.
Task: Explain the pathophysiology of inhalation injury.
Heat/soot → airway mucosal oedema + obstruction.
Toxins impair alveolar gas exchange.
Risk of hypoxia & CO poisoning.
Penetrating chest wound, JVD + muffled heart sounds.
Task: Describe the pathophysiology of cardiac tamponade.
Blood in pericardium → pressure ↑.
Restricted ventricular filling.
↓ Preload → ↓ CO → obstructive shock.
Suspected tension pneumothorax post-blunt trauma.
Task: Describe immediate management steps.
High-flow O₂.
Needle decompression immediately.
Prepare for chest drain in hospital.
Suspected internal abdominal bleed post-RTC.
Task: Describe circulation management and fluid strategy.
Permissive hypotension (250 mL CSL aliquots).
Pelvic binder if indicated.
Pre-alert trauma centre.
Post-fall, spinal pain but also altered LOC.
Task: Name two differential diagnoses.
TBI/concussion.
Hypoglycaemia.
Intoxication.
Crush entrapment for 1 hour, develops arrhythmias.
Task: Describe the pathophysiology of hyperkalaemia in crush syndrome.
Prolonged ischaemia → muscle necrosis.
K+, myoglobin, acids released on reperfusion.
Causes dysrhythmias + renal damage.
MI patient now hypotensive with pulmonary oedema.
Task: Explain the pathophysiology of cardiogenic shock.
Myocardial pump failure (MI/arrhythmia).
↓ Contractility → ↓ stroke volume.
Pulmonary oedema + hypotension.
Spinal injury with high cervical lesion.
Task: Explain airway/breathing support required.
Support ventilation (loss of intercostals).
SpO₂ + EtCO₂ monitoring.
Anticipate early fatigue, possible intubation.
Pelvic fracture with hypotension.
Task: Outline circulation and exposure management plan.
Binder early → reduce volume.
IV/IO, permissive fluids.
Keep warm, rapid transport.
Head injury with confusion and vomiting.
Task: State two differentials for altered mental state.
Stroke/ICH.
Hypoglycaemia.
Intoxication.
A 24-year-old chef splashes boiling oil on both forearms.
Task: State the pathophysiology of burns.
Heat → protein denaturation + cell death.
↑ Capillary permeability → plasma leak → oedema.
Pain from nociceptor activation (dermal burns).
Trauma patient, bilateral absent breath sounds, hypoxia.
Task: Explain the pathophysiology of obstructive shock from tension pneumothorax.
Air trapped → mediastinal shift.
↓ Venous return → ↓ preload/CO.
Hypoxia + obstructive shock.
Crush patient post-extrication with hypoxia.
Task: State airway/breathing considerations in crush syndrome.
High-flow O₂.
Monitor for chest trauma effects.
Support ventilations if hypoxic.
Multi-system trauma with hypothermia.
Task: Explain exposure priorities and prevention of hypothermia.
Remove wet clothing.
Cover with blankets/cling wrap.
Warm environment/fluids.
Limb deformity post-trauma.
Task: List three differentials for limb pain/swelling.
Fracture.
Dislocation.
Compartment syndrome.