›Tourniquet for extremity life threatening hemorrhage
›Junctional hemostatic packing for groin or axilla local protocol dependent
›Massive transfusion protocol activation local protocol dependent
›Calcium repletion during massive transfusion local protocol dependent
›TXA for suspected major hemorrhage within 3 hours local protocol dependent
›Adult dose 1 g IV over 10 minutes
›Then 1 g IV over 8 hours
Regional management pathways
›Regional management pathways
›Neck penetrating injury with platysma violation
›Hard signs
›Immediate operative management
›No hard signs
›CTA neck
›Aerodigestive evaluation based on symptoms and trajectory
›Thoracic penetrating injury
›Tension physiology
›Immediate decompression
›Large hemothorax
›Tube thoracostomy
›Surgical escalation thresholds local protocol dependent
›Abdominal penetrating injury
›Unstable or peritonitis
›Immediate laparotomy
›Stable without peritonitis
›CT strategy based on mechanism and location
›Serial abdominal exams
›Extremity penetrating injury
›Hard signs
›Immediate vascular surgery involvement
›No hard signs
›ABI or API
›CTA extremity if abnormal ABI or concerning trajectory
Antibiotics and tetanus
›Infection prevention
›Tetanus prophylaxis per immunization status
›Antibiotics by wound type local protocol dependent
›Contaminated wounds
›Open fractures
›Hollow viscus injury concern
Analgesia and sedation
›Analgesia and sedation
›Multimodal analgesia
›Procedural sedation considerations in shock
›Avoid hypotension worsening agents when unstable
Reassessment loop
›Reassessment loop
›Repeat vitals every 5 to 15 minutes when unstable
›Repeat airway and breathing exam after interventions
›Repeat pulse checks after splinting or tourniquet changes
›Repeat hemoglobin and lactate trending local protocol dependent
17Disposition/dispo28
Level of care criteria
›Level of care criteria
›OR immediate
›Hemodynamic instability with suspected internal bleeding
›Peritonitis
›Hard signs vascular injury
›Cardiac tamponade concern
›ICU
›Ongoing transfusion requirement
›Vasopressor requirement
›Mechanical ventilation
›High grade solid organ injury with instability risk
›Inpatient admission
›Penetrating injury with cavity violation
›Chest tube management
›Vascular injury managed nonoperatively
›Observation pathway
›Stable with negative initial imaging but trajectory risk
›Serial exams required
›Discharge
›Superficial soft tissue injury only
›Normal neurovascular exam
›Reliable follow up and return precautions
Transfer criteria
›Transfer criteria
›Need for trauma center resources
›Need for vascular surgery
›Need for cardiothoracic surgery
›Pediatric trauma resources
›REBOA capability local protocol dependent
18Discharge Instructions/di31
Copy discharge instructions
›Copy discharge instructions
›You were treated for a penetrating injury and your evaluation did not show a dangerous internal injury today
›Wound care
›Keep the wound clean and dry for the first 24 hours
›After 24 hours gentle soap and water daily
›Apply a thin layer of ointment if recommended
›Keep dressing in place as instructed
›Pain control
›Use acetaminophen as directed on the label
›Avoid NSAIDs if you were told you have increased bleeding risk
›Avoid alcohol and driving if taking sedating pain medicine
›Activity
›Avoid strenuous activity and heavy lifting until cleared
›Protect the injured area from impact
›Follow up
›Follow up with your primary care clinician or wound clinic within 24 to 72 hours
›Return for suture or staple removal as instructed
›Return to the emergency department now for
›Worsening bleeding
›New swelling or rapidly enlarging bruising
›New numbness or weakness
›Cold pale or painful limb
›Trouble breathing
›Chest pain
›Fainting
›Severe or worsening abdominal pain
›Vomiting blood
›Black or bloody stools
›Fever
›Redness spreading from the wound
›Pus drainage
19References/r6
Guidelines and landmark evidence
›Core references
›American College of Surgeons Committee on Trauma Advanced Trauma Life Support ATLS 11
›Eastern Association for the Surgery of Trauma Practice Management Guideline Selective Nonoperative Management of Penetrating Abdominal Trauma 2010
›Eastern Association for the Surgery of Trauma Practice Management Guideline Neck Trauma Penetrating Zone II 2008
›Western Trauma Association Critical Decisions in Trauma Penetrating Neck Trauma 2013
›CRASH 2 trial Tranexamic Acid in Trauma 2010
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.