TOPIC 11. TRAUMA – BLUNT TRAUMA
1. Definition and mechanisms
Blunt trauma is injury caused by impact, compression, acceleration–deceleration or crushing without an object penetrating the body. External wounds may be absent despite severe internal injury.
Direct impact: force applied directly to tissue, causing contusion, fracture or organ injury.
Compression/crush: tissue compressed between an external force and a rigid structure; may cause muscle necrosis, compartment syndrome and crush syndrome.
Acceleration–deceleration: organs move relative to fixed attachments, producing shear injury (e.g. aortic or mesenteric injury).
Blast-related blunt injury: may coexist with penetrating and primary blast injury.
2. Common injuries
Head: concussion, skull fracture, intracranial haemorrhage and diffuse axonal injury.
Chest: rib fractures, pulmonary contusion, pneumothorax, haemothorax, cardiac injury and blunt aortic injury.
Abdomen: splenic or hepatic laceration, renal injury, bowel/mesenteric injury and retroperitoneal haemorrhage.
Pelvis: pelvic fracture with potentially massive haemorrhage and associated bladder/urethral injury.
Limbs: fractures, dislocations, muscle injury, vascular injury and compartment syndrome.
3. Assessment – structured trauma approach
Use a systematic xABCDE approach, adapting to local trauma protocols and available resources.
4. Investigations
- Bedside eFAST can identify free intraperitoneal/pericardial fluid and pneumothorax/haemothorax in appropriate settings.
- Chest and pelvic radiographs may be used in unstable or selected patients; CT with contrast is the principal detailed imaging method for stable patients with suspected internal injury.
- Blood tests: full blood count, blood group and crossmatch, blood gas/lactate, coagulation profile, electrolytes, renal function and urinalysis as indicated.
- Imaging must not delay immediate life-saving intervention in an unstable patient with a clear indication for surgery.
5. Management principles
- Treat life threats first; summon trauma, anaesthesia, surgical and relevant specialty teams early.
- Control haemorrhage, resuscitate with blood components when indicated, correct coagulopathy, hypothermia and acidosis, and avoid excessive crystalloid administration in major haemorrhage.
- Use damage-control surgery or interventional radiology in selected unstable patients; definitive repair may follow physiological stabilisation.
- Non-operative management is appropriate for selected stable solid-organ injuries with close monitoring and access to urgent intervention.
- Provide analgesia, tetanus prophylaxis when indicated, wound care, fracture stabilisation, VTE prevention and rehabilitation.
6. Complications
- Haemorrhagic shock, respiratory failure, infection, acute kidney injury and multiorgan dysfunction.
- Compartment syndrome, rhabdomyolysis and crush syndrome after prolonged compression.
- Missed bowel/mesenteric injury, delayed bleeding, thromboembolism and post-traumatic disability.
Exam point: The severity of blunt trauma cannot be judged by external appearance. A patient may have major internal bleeding with minimal visible injury; repeat examination and appropriate imaging are essential.