Trauma

Trauma in the medical sense means any injury to human tissues and organs caused by an external force. Trauma includes all injuries caused by an external force, from minor (cuts and bruises) to critical (major brain or spinal injuries).

Trauma is usually categorised as blunt or penetrating.

  • Blunt injuries are caused by impact or other force applied from or with a blunt object.
  • Penetrating injuries are caused when the body is pierced by an object, and may be caused by injuries such as stabbings and gunshot wounds.

Blunt injuries are usually internal and not obvious, so they are more difficult to assess and diagnose than penetrating injuries.

Road traffic accidents, including motor vehicle, motorbikes and pedestrians are the most common causes of trauma that need admission into intensive care in Australia.

Common types of trauma in ICU (intensive care unit)

The most common type of trauma presenting in ICU is brain injuries (see the Traumatic Brain Injury section below). Other common types of trauma include chest, abdominal and orthopaedic (bone) injuries.

If people have injuries to many parts of their body, this is known as multi-trauma. Multi-trauma is often serious and its care complex, often involving a number of medical specialists, which is why the person is in ICU.

Traumatic brain injury

A traumatic brain injury occurs when an outside force impacts the head hard enough to cause the brain to move within the skull, or when the force causes the skull to break and directly hurts the brain. This force may cause a single problem (e.g. a bleed) or a mix of problems. This is called the ‘primary injury’. Without proper treatment, further or ‘secondary injuries’ may occur, due to a mix of problems such as swelling or bruising to the brain, poor breathing and low blood pressure. There are a number of different primary injuries including:

  • closed head injury – where the skull is intact
  • open head injury – where the skull is penetrated
  • penetrating trauma – where any object including skull fragments enters the brain
  • contusion – where there is bruising or bleeding into brain tissue
  • haemorrhages (intra-cerebral, subdural, subarachnoid or epidural)
  • diffuse axonal injury – where the brain cells are stretched and injured by rapid rotational movements of the head.

Traumatic brain injuries can be mild, moderate or severe, depending on the damage to the brain.

  • A mild injury or concussion is diagnosed when a person experiences a brief change in their mental status (such as memory loss or headache) at the time of the injury. Often there is no sign of damage on a brain scan.
  • A person suffering moderate injury can lose consciousness for several minutes and be confused, sleepy and agitated in the following days to weeks.
  • When brain injury is severe, the person is described as being in a coma. Many terms are used for a severe brain injury, which are complex and may have been described incorrectly in the media.

Coma is a word used to describe a person who is unconscious, or a state where the person is unable to respond to the spoken word or to a stimulus (such as a pinch to the shoulder or on the chest). There are varying levels of coma/unconsciousness. Sometimes the person may be able to move and open their eyes, but they are unable to obey commands (semi-conscious or semi-comatose).

When the brain injury is severe, the person may be so deeply comatose that they can no longer cough or swallow properly. This means they could inhale their own saliva. To protect the airway and lungs, the person will need a tube placed into their throat and be connected to a breathing machine (ventilator) to help them breathe properly. After a severe brain injury, the brain may start to swell and the patient's condition may deteriorate as the hours go by.

What happens in ICU?

Anyone admitted to hospital with severe trauma will need specialised care in an Intensive Care Unit (ICU). People injured away from a major trauma centre will need to be transferred.

At first, if the injury can be treated with an operation, this will happen as soon as possible. Other treatment may include:

  • monitoring of the heart rate, blood pressure, oxygen levels and temperature – this will be seen on a bedside monitor
  • inserting an arterial line to monitor blood pressure and to take blood samples
  • monitoring of the pressure in the brain (ICP monitoring) and using an external ventricular drain (EVD) to help reduce the pressure inside the brain
  • using a central venous catheter and/or infusion pumps to give medicines and intravenous (IV) fluids, such as sedatives (to slow down the brain’s activity), analgesics (pain killers) and antibiotics (for infections)
  • giving oxygen via a face mask or artificial ventilation via an endotracheal tube or tracheostomy to assist with breathing
  • feeding via a nasogastric tube to ensure the person receives nutrition
  • inserting an indwelling urinary catheter to drain and measure urine output
  • performing chest X-rays and other tests, such as blood tests.

What are the complications of trauma?

  • Pain it is common for a person with trauma to experience pain, so providing them with analgesia (pain medicine) is a very important part of treatment.
  • Haemorrhage – losing large amounts of blood can cause shock. Other complications can also arise after the person receives massive blood transfusions.
  • Infection / sepsis – the presence of open wounds increase the risk of infection.
  • Multi-organ failure severe haemorrhage and injury to multiple organs increase the risk of multi-organ failure (where more than one organ, such as the heart, lungs and kidneys, fail to work). If this happens, the person may need dialysis to support their kidneys, mechanical ventilation to support the lungs, and medicines to support the heart so that blood may be pumped effectively to all the organs of the body.

How long will the person stay in ICU?

This depends on how badly injured the person is injured and how quickly they begin to recover.

One of the most frustrating things for families is the difficulty to predict how the person will be after suffering a severe trauma, especially when it involves a brain injury.

It may be a struggle in the first few days to keep the person alive, and it is only after this that the extent of the damage may be known. If the patient wakes up (regains consciousness), they may behave differently to how they would have before their injury. This may be very uncomfortable and confronting for the person and their relatives and friends. Regaining control of the body and being able to live in society are challenges for the person who survives a major injury.


Publication details

Trauma, version 2. Revised by Glenn Sisson, Project support officer, ITIM, April 2016.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.