In major trauma, the first few hours can make the difference not just in the emergency room but also weeks and months later. A crush injury, multiple fractures or suspected nerve damage may appear to be primarily an orthopaedic problem, but severe trauma can simultaneously damage blood vessels, muscles and vital organs. This is why quick assessment and coordinated treatment are essential.
First, look for life-threatening problems and control them. Individual fractures should be treated after severe bleeding, breathing problems, head or chest injuries and shock. The trauma team will usually take a structured approach to assessing the airway, breathing and circulation while also looking for injuries that may not be immediately obvious.
Crush injuries require special attention. When a limb or part of the body is compressed for a long time, it can cause severe damage to muscle tissue. With the release of the pressure, substances released from injured muscle can enter the bloodstream and potentially cause dangerous electrolyte disturbances and kidney injury.
This is called crush syndrome. Early fluid resuscitation, urine output monitoring and close observation for complications are therefore important components of initial management.
Another issue is multiple fractures. It’s not simply putting every bone back where it belongs immediately. First, doctors have to find out if there is damage to major blood vessels, nerves or surrounding soft tissue.
A fracture with poor blood supply can be a threat to the limb. Swelling within a confined muscle compartment can lead to compartment syndrome, a surgical emergency. Delay in treatment can cause permanent muscle and nerve damage.
Nerve injuries can be equally misleading. On first examination, the extent of injury may not be apparent, but the patient may have numbness, weakness or loss of movement. The condition of the limb may change with the development of swelling, and repeated neurological and vascular assessments are often necessary.
Infection is another major concern, particularly with open fractures and significant soft tissue injury. These injuries may need early wound assessment, antibiotics, surgical cleaning and stabilisation. There are times when not just one but several operations are necessary.
The concept of a 'golden hour' should not be interpreted to imply that every trauma must be definitively treated within precisely 60 minutes. Instead, it underlines an important principle. The earlier a severely injured patient reaches a proper trauma centre and receives systematic assessment, bleeding control and timely intervention, the better the chance to prevent avoidable complications.
For families, the message is simple: after a major accident, don't wait until the pain or swelling gets unbearable. Get emergency care immediately if you have loss of sensation, increasing pain or weakness, pale or cold limbs, uncontrolled bleeding, or altered level of consciousness.
In trauma, time is not only about saving a life. It can also be about saving a limb, keeping nerve function and improving the chance of recovery.
(The author is a senior consultant, head of orthopaedic trauma, HOSMAT Hospitals, Bengaluru)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
