SurgSpace / Specialties / Trauma & Acute Care Surgery
Trauma & Acute Care Surgery
Time-critical operative care of the injured patient: the primary survey that finds the killer first, damage control that trades anatomy for physiology, and the discipline of doing the least surgery that keeps someone alive tonight so the right surgery can happen tomorrow.
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
Blunt splenic injury, grade III on CT, heart rate 104, BP 108/70 after one unit of blood. Theatre, angiography, or observation?
Observe
For the stable patient: serial examination, serial haemoglobin, bed rest, and a low threshold to escalate. Most splenic injuries never see a knife.
Angioembolisation
For the stable patient with contrast blush or high-grade injury: keeps the spleen and its immunology, at the price of needing a capable suite now.
Trauma laparotomy
For the unstable or non-responding patient: physiology overrules the scan, and splenectomy in a bleeding patient is a life-saving operation, not a failure.
The scan grades the injury; the vital signs grade the patient. Management follows the patient. A grade V spleen in a stable patient may be embolised; a grade II in a crashing one may be removed.
Penetrating chest trauma, output lost four minutes ago in front of the team. Resuscitative thoracotomy?
Open the chest
Witnessed penetrating arrest with short downtime is the indication the operation was designed for: relieve tamponade, control the wound, clamp the aorta if needed.
Do not open
Blunt arrest with prolonged downtime and no signs of life: the thoracotomy adds risk to the team and no survival to the patient.
Resuscitative thoracotomy is not a last rite, it is a procedure with real survivors and strict entry criteria: penetrating mechanism, witnessed arrest, minimal downtime. Outside those criteria its survival approaches zero.
Trauma laparotomy, bleeding controlled after splenectomy and liver packing, but pH 7.19, temperature 34.5, and non-surgical ooze appearing. Finish the operation or abbreviate?
Definitive surgery
For the warm, stable patient: resect, anastomose, close. The operation ends the problem tonight.
Damage control
For the patient in the triad: pack, staple, leave the abdomen open, and hand a survivable physiology to the ICU. Return in 24 to 48 hours.
The abdomen is closed when the patient can afford it. Coagulopathic ooze is the field telling you the laboratory is now the operating surgeon: stop, pack, and let the ICU operate on the physiology.
The rotation
Your first day here
- Learn where everything lives in the trauma bay before the first call: the drain trolley, the blood fridge, the binder. Seconds spent searching are borrowed from the patient.
- On a trauma call, find your role and stay in it: the team leader's choreography only works when each pair of hands does one job.
- The primary survey is a loop, not a checklist: any deterioration sends you back to A.
- Know the massive transfusion protocol number and trigger before you need it, and watch how the team leader declares it aloud.
- Read the damage control module before your first laparotomy: the decisions in that operation make no sense without it.
- Write times down: time of injury, time of arrival, time units were given. Trauma decisions are judged against a clock, and someone has to be holding it.
Hub shaped by the Surgical Specialties Lead with the Trauma surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.