Penetrating trauma:
Penetrating trauma has several differences in review of management and treatment when compared to blunt trauma. The biggest difference is the change from a ‘stay and play’ mindset to a ‘load and go’. It is widely recognised that the definitive treatment of penetrating trauma patients is in a hospital or physician-based setting. This is due to the ultimate treatment for any significant penetrating wound or haemorrhage to be managed by surgery.
As a clinician, you will still need to review the primary survey aspects and manage deficits identified as this aims to prolong any stability or homeostasis the patient has, but emphasis will also be on loading and going in the Ambulance whilst management is ongoing throughout. It may be difficult as a solo clinician in the back of a moving Ambulance to manage a polytrauma patient with a penetrating injury. If there is back up on scene who can also travel with you, this will make the management a lot easier.
As discussed throughout this course, fluid management is different depending on penetrating trauma of the torso or limbs. If penetration of the torso, then the aim of fluid therapy is to maintain a palpable central pulse or a target Systolic blood pressure of 60 mmHg. If blunt trauma or penetrating limb trauma, then the aim of fluid therapy is to maintain a palpable peripheral pulse or a Systolic blood pressure of 90 mmHg. As previously discussed in Trauma Module 1, this is to reduce the effect of increased hydrostatic pressure causing clot disruption due to increased blood pressure.
If the patient has an impalement injury, it is important not to remove the impaling object. Removal of the object could lead to further haemorrhage and tissue disruption. The aim should be to dress around the object and stabilise it. If the object is pulsating then do not completely immobilise the object.
Further considerations to penetrating injuries include the need for analgesia, Oxygen administration, Tranexamic Acid following local guidelines, and advanced clinical support if available.