Trauma medicine, also known as emergency medicine, refers to the treatment of a physical wound caused by an external source. It can also be described as “a physical wound or injury, such as a fracture or blow”. Trauma injuries can be life threating if not treated within the “golden hour” which is a nickname for the first hour after a traumatic injury and is known to be the most crucial time for treatment. There are a multitude of causes for trauma injuries that affect the mind and body in many different ways. The leading causes of death due to trauma are blunt trauma, motor vehicle accidents, and falling accidents.
The use of alcohol and drugs such as cocaine increase the risk of trauma by making traffic collisions, violence and abuse more likely. Intentional injury such as being shot or stabbed, creating an open wound, are classified as penetrating trauma. Penetrating traumas such as those listed above are more complex due to the fact that they commonly include blunt traumas and sometimes burn injuries. In the United States, most deaths caused by penetrating trauma occur in urban areas, and 80% of these deaths are caused by firearms. The heightened risk factors in urban areas create a perfect setting for penetrating traumas.
Prevention of injury is difficult in such settings due to these risk factors and the inability to educate large populations on developing strategies to reduce said risk factors. Education for the reduction of trauma may include information about the importance of seatbelts, child car seats, helmets, alcohol control, and increased enforcement against illegal behaviors. The public health system is a major issue in treating traumas, especially in urban areas. With these injuries, prehospital care (EMTs) is crucial. Blood loss and infection may create an even greater threat to the patient’s life than the actual injury.
Post injury rehabilitation systems such as physical therapy are also crucial in proper healing of the wound. Unfortunately, in the society we live the saying “an ambulance takes longer than pizza delivery” is commonly true. Before arriving at a hospital, the use of stabilization techniques improves the chances of a person surviving the transport to the nearest trauma-equipped hospital. A healthcare provider should ensure their own safety and take appropriate isolation precautions. A primary survey is then performed, consisting of checking and treatingairway, breathing, and circulation followed by an assessment on the level of consciousness.
To prevent further injury, unnecessary movement of the spine is minimized by securing the neck with a cervical collar, and the back with a long spine board with head supports. With the shortage of emergency medical personnel and a lack of knowledge and proper education, prehospital care becomes virtually useless and can sometimes reverse progress. The body’s response to traumatic injury is often at the site of the injury and in most cases throughout the entire body. The body’s natural reaction to trauma is to protect vital organs, allow for cell duplication, and to heal the site of the wound.
Healing is often dependent on severity, age, sex, and the addition of medication or physical therapy. Inflammation is also common among trauma injuries. The body’s natural instinct to protect the wound is to inflame although in some cases can cause further damage. The body will also increase its glucose production and begin burning fat as energy for cell duplication. Diagnosis of trauma injury can be difficult due to the body’s natural reactions and injuries or existing medical problems that may be unknown at the time.
Diagnosis often requires a primary physical exam and a secondary physical exam. The primary exam focuses mainly on immediate life threating issues such as a bleeding wound or an object stuck in the body. The secondary exam then covers the entire surface of the body to find any remaining injuries caused by either the trauma or a preexisting condition. The secondary exam may include full body X-rays, a neurological exam, CAT scan, CT scan, an ultrasound or a plethora of other radiologic exams. Surgical techniques may also be used to treat and diagnose a trauma injury.
Injury to the chest and head often require the addition of a tube or catheter to drain excess fluids. Medications may also be used in treatment to reduce or increase blood flow, speed up the process of clotting, speed up or slow down the heart rate, induce coma, and sometimes temporarily paralyze a patient. Surgery is also common in the treatment of trauma not only at the site of injury but in controlling hemorrhaging as well. Often times more than one surgical procedure may be necessary, beginning with managing severe trauma first and leaving less critical procedures until the patient is more stable.
Post medical treatment, a patient will often require psychotherapy for disorders such as PTSD (post-traumatic stress disorder) common among those suffering from penetrating trauma. Other common psychological disorders that follow a trauma include depression and anxiety disorders. The recovery time can often be very great with trauma injuries and may prevent one from participating in activities such as sports or social gathering. Through the inability to jump back into everyday life comes a sense of isolation for most.
It becomes apparent that within a second their life has been changed forever. Many victims of a traumatic injury will fall into a depression as they become more and more aware of the severity of their injury. Anxiety plays a large role in the psychological health of those injured. The simple pop of a soda can may bring a shoot victim back to the scene of the accident just as the sight of a knife can be traumatizing for a stab victim. Post-traumatic stress disorder is extremely common among soldiers returning home after war after injury.
Certain sights, sounds, and even sounds may send the soldier spiraling back into combat mode. Trauma is the sixth leading cause of death worldwide, accounting for 10% of all mortalities, and is therefore a serious public health problem with significant social and economic costs. Trauma medicine encompasses a variety of treatments including prehospital care, immediate surgery, medications, radiologic exams, physical therapy, mental therapy, and recovery time. Trauma victims are forced to come face to face with the fact that one moment can change a life forever.
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