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.
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 1 · splenectomy
Temp 37.9
Platelets 460 and rising
Left basal reduced air entry
NG tube draining modestly
Which of these needs action?
The read
The chest, mostly: left lower lobe collapse is near-universal after splenectomy, so analgesia and physiotherapy earn their keep. The platelet rise is expected and often exceeds 1000 before drifting down; it is a reason for vigilance about thromboprophylaxis, not alarm. The vaccination checklist has a date on it before discharge.
POD 0 overnight · open abdomen after damage control
Temp 36.8 after rewarming
pH 7.34
Lactate 2.1 from 6.0
Noradrenaline weaning
Packs in, relook booked
What does the morning team need to know?
The read
That the physiology has been won back and the relook window is open: warm, clearing lactate and falling pressors mean the 24-to-48-hour return can be definitive. The handover names what was packed, what was stapled off without anastomosis, and what the operating surgeon wants examined first at the relook.
Day 2 · rib fractures in a 78-year-old
Five left-sided rib fractures
Sats 91% on 2L
Poor cough, pain 8/10 on inspiration
CXR: left basal atelectasis
Where is this heading, and what changes the trajectory?
The read
Toward pneumonia and a ventilator, unless the pain is treated as the respiratory disease it is: escalate analgesia early, an erector spinae or paravertebral block earns its keep here, add humidified oxygen and aggressive physiotherapy. Elderly rib fractures kill on day five, not day one, and the intervention that saves them happens on day one.
Emergencies
The calls that cannot wait
Tension pneumothorax
Recognise: Respiratory distress, one silent hyperresonant hemithorax, distended neck veins, tracheal shift late, and a falling pressure.
First move: Decompress now, on clinical findings: needle or finger thoracostomy, then a drain. The X-ray you waited for is the one in the coroner's file.
Traumatic cardiac arrest
Recognise: Loss of output after injury: the causes are hypovolaemia, tension, tamponade, and hypoxia, not the fibrillating myocardium of medical arrest.
First move: Treat causes, not rhythm: bilateral chest decompression, blood fast, and thoracotomy where penetrating criteria are met. Compressions on an empty heart fix nothing on their own.
The exsanguinating pelvis
Recognise: Unstable ring on imaging or examination with haemodynamic instability that transfusion does not hold.
First move: Binder on, blood running, and the packing-versus-angiography decision made in minutes with orthopaedics and interventional radiology in the same conversation.
The lethal triad in the OR
Recognise: Non-surgical ooze from every raw surface, core temperature falling, gas worsening despite controlled named-vessel bleeding.
First move: Declare damage control aloud: pack, abbreviate, temporary closure, ICU. The bravest sentence in trauma surgery is 'we are stopping here'.
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.