Dr. Carey's Trauma Bullets - August 2019

October 25, 2019

Dr. Carey's recap of the August 2019 Joint EM - Trauma Conference. High yield learning points inspired by our own trauma patients.

High-yield areas for improvement:


  • Involvement of the trauma service in injuries after fall mechanisms
  • Failure to recognize early decompensation, avoid focusing solely on the systolic blood pressure, tachycardia is often the first sign of decline
  • If a cervical collar is cleared, always document HOW (ex. NEXUS, Canadian C-spine, etc)
  • If you are obtaining a CT on a patient (especially at an outside hospital), consider scanning the chest and abdomen together – the same contrast load is involved, and concomitant injuries can be overlooked/not addressed
  • CT does not rule out hollow viscus injury, consider serial exams and surgical consultation in seatbelt signs
  • Many burn centers prefer bacitracin with non-adherent gauze wrapped in a dry dressing. Do not use Silvadene, patients are typically debrided almost immediately on arrival


  • Most common pediatric mechanisms are falls and improperly restrained MVCs
  • Family education on properly restraining children is key
  • All NAT transfers from outside hospitals should be transferred to the Trauma service, who will then consult specialists as needed (ophtho, ENT, etc)

Neurosurgery injury consultations

  • Epidural hematoma
  • Subdural hematomas 1cm or greater
  • ANY midline shift

Orthopedic injury consultations

  • Pelvic fractures with hemodynamic instability
  • Extremity injuries with vascular or neurologic compromise
  • Multiple long-bone fractures associated with hemorrhagic shock

Injury Severity Score (ISS)

  • Score to assess trauma severity.  Higher scores correlate with morbidity, mortality, and duration of hospitalization
  • Major or polytrauma is defined as a score of 15+

Based upon the Abbreviated Injury Scale (AIS)

The body is divided into six regions:

  1. Head and neck/cervical spine
  2. Face – facial skeleton, nose, mouth, eyes, and ears
  3. Chest – thoracic spine and diaphragm
  4. Abdomen and pelvic contents – abdominal organs and lumbar spine
  5. Extremities and pelvic girdle
  6. External

ISS = A2+ B2+ C2

Where A, B, C are the AIS scores of the three most injured ISS body regions

Related Posts

While we make every effort to produce accurate information, we are still learning. This clinical material on this website represents how we have interpreted what we have seen or read. We welcome any comments, suggestions or correction of errors. We take no money from drug or device companies. By reading the content of this website, you agree not to use this information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer applies to any and all content on this website. Under no circumstances shall any of the contributors on this website be responsible for damages arising from use of this website.

This website should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website.

Stay in Touch

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form