Injury in humans: Difference between revisions

{{Infobox disease

| Name = Injury

| Image = US Navy 040723-N-8977L-008 Navy Hospital Corpsmen and Medical Officers assess the treatment and prognosis of a patient with a gunshot wound.jpg

| Alt = Health care providers attending to a person on a stretcher with a gunshot wound to the head. The patient is intubated, and a mechanical ventilator is visiblein the background.

| Caption = Health care providers attending to a person on a stretcher with a [[Ballistic trauma|gunshot wound]] to the head. The patient is [[tracheal intubation|intubated]], and a mechanical ventilator is visiblein the background.

| DiseasesDB = 28858

| ICD10 = {{ICD10|T|79||S|00}}

| ICD9 = {{ICD9|900}}-{{ICD9|957}}

| ICDO =

| OMIM =

| OMIM_mult =

| MedlinePlus = 000024

| eMedicineSubj =

| eMedicineTopic =

| eMedicine_mult = [http://emedicine.medscape.com/trauma/ trauma]

| MeshID = D014947

}}

An '''injury''' or '''trauma''' (sometimes referred to as a '''traumatic injury''') is [[wikt:damage|damage]] to a biological [[organism]] caused by physical harm.<ref>{{cite web|url=http://www.nlm.nih.gov/medlineplus/woundsandinjuries.html |title=Wounds and Injuries: MedlinePlus |publisher=Nlm.nih.gov |accessdate=2014-03-29}}</ref> There are many causes of injury that can affect a person in different ways, both anatomically and physiologically. Depending on the severity of injury, quick management and transport to an appropriate facility may be necessary to prevent loss of life or limb.

Various classification scales exist for use with trauma to determine the severity of injuries, which is used to determine the resources used and for statistical collection. The initial assessment is critical in determining the extent of injuries and what will be needed to manage an injury, and treating immediate life threats. The assessment involves a physical evaluation and can also include the use of imaging tools to accurately determine a type of injury and to formulate a course of treatment. A major trauma is injury that can potentially lead to serious outcomes. For research purposes, a major trauma is often defined based on an [[injury severity score]] (ISS) of greater than 15.<ref>{{cite journal|last=Palmer|first=C|title=Major trauma and the injury severity score--where should we set the bar?|journal=Annual proceedings / Association for the Advancement of Automotive Medicine. Association for the Advancement of Automotive Medicine|year=2007|volume=51|pages=13–29|pmid=18184482}}</ref>

In 2002, unintentional and intentional injuries were the fifth and seventh leading causes of deaths worldwide, accounting for 6.23% and 2.84% of all deaths.

[[File:Xraymachine.JPG|thumb|The knee of a patient is examined with help of [[radiography]] after an injury.]]

Injuries are generally classified by either severity or by the location of damage.<ref>Moore 2013, p. 77</ref> <!--percentages of total incidence-->Injuries may also be classified by [[Demographics|demographic group]], such as age or gender.<ref name="Rosen2010">{{cite book|title=Rosen's emergency medicine: concepts and clinical practice 7th edition|last=Marx|first=J|year=2010|publisher=Mosby/Elsevier|location=Philadelphia|isbn=978-0-323-05472-0|pages=243–842}}</ref> It may also be classified by the type of force applied to the body, such as [[blunt trauma]] or [[penetrating trauma]]. Clinically, injury is classified using the [[Barell matrix]], which is based on [[International Statistical Classification of Diseases and Related Health Problems#ICD-9-CM|ICD-9-CM]] data for the purposes of research collection and analysis. The purpose of the matrix is to internationally standardize the classification of trauma.<ref>{{Cite web|url = http://www.cdc.gov/nchs/injury/ice/barell_matrix.htm|title = The Barell Injury Diagnosis Matrix, Classification by Body Region and Nature of the Injury|accessdate = 19 June 2013|publisher = Center for Disease Control}}</ref> Major trauma is sometimes classified by body area; injuries affecting 40% are [[polytrauma]], 30% [[head injury|head injuries]], 20% [[chest trauma]], 10%, [[abdominal trauma]] and 2%, [[Limb (anatomy)|extremity]] trauma<ref name="Rosen2010">{{cite book|title=Rosen's emergency medicine: concepts and clinical practice 7th edition|last=Marx|first=J|year=2010|publisher=Mosby/Elsevier|location=Philadelphia|isbn=978-0-323-05472-0|pages=243–842}}</ref><!--percentages of total incidence--><ref name="ER2008" />

Various scales exist to provide a quantifiable metric to measure the severity of injuries. The value can be used for [[triage|triaging]] a patient or for statistical analysis. Injury scales measure damage to anatomical parts, physiological values (blood pressure etc.), [[comorbidity|comorbidities]] or a combination of those. The [[abbreviated injury scale]] and the [[Glasgow coma scale]] are commonly used to quantify injuries for the purpose of triaging and allow a system to monitor or "trend" a patient's condition in a clinical setting.<ref>Moore 2013, p. 77-98</ref> The data can also be used in epidemiological investigations and for research purposes.<ref>{{cite conference | url=http://www.cdc.gov/nchs/data/injury/DicussionDocu.pdf | title=Discussion document on injury severity measurement in administrative datasets | publisher=Centers for Disease Control and Prevention | accessdate=2013-05-24 |date=September 2004 | pages=1–3}}</ref>

===Systems===

The United States [[Bureau of Labor Statistics]] developed the Occupational Injury and Illness Classification System (OIICS). Under this system injuries are classified by

*nature,

*part of body affected,

*source and secondary source, and

*event or exposure.

The OIICS was first published in 1992 and has been updated several times since.<ref>{{cite web |url=http://wwwn.cdc.gov/wisards/oiics/ |publisher=[[Centers for Disease Control and Prevention]] |title=Occupational Injury and Illness Classification System |accessdate=2014-03-24}}</ref>

The [[World Health Organization]] developed the International Classification of External Causes of Injury (ICECI). Under this system, injuries are classified by

*mechanism of injury,

*objects/substances producing injury,

*place of occurrence,

*activity when injured,

*the role of human intent,

and additional modules. The classification is designed to allow researchers to study the cause of injuries and [[injury prevention]].<ref>{{cite web |url=http://www.who.int/classifications/icd/adaptations/iceci/en/ |title=International Classification of External Causes of Injury (ICECI) |publisher=[[World Health Organization]] |accessdate=2014-03-24}}</ref>

The Orchard Sports Injury Classification System (OSICS) is used to classify injuries to enable research into specific sports injuries.<ref>{{cite journal|last1=Rae|first2=K|last2=Orchard|first2=J|title=The Orchard Sports Injury Classification System (OSICS) version 10|journal=Clin J Sport Med.|date=May 2007|volume=17|issue=3|pages=201–4|pmid=17513912|accessdate=2014-03-29}}</ref>

==Causes==

Injuries can be caused by any combination of external forces that act physically against the body.<ref>Moore 2013, p. 2</ref> The leading causes of traumatic death are [[blunt trauma]], [[Traffic collision|motor vehicle collisions]] and [[Falling (accident)|falls]].<ref name="EMT-BMcGraw">{{cite book|title=McGraw-Hill's EMT-Basic|last=DiPrima Jr.|first=PA|pages=227–33|publisher=McGraw-Hill|isbn=978-0-07-149679-7}}</ref> Subsets of blunt trauma, are the number one and two causes of traumatic death.<ref name="ec11">{{cite book|title=Emergency Care|author=Dickenson ET, Limmer D, O'Keefe MF|isbn=978-0-13-500523-1|year=2009}}</ref>

For statistical purposes, injuries are classified as either intentional such as suicide, or unintentional, such as a motor vehicle collision. Intentional injury is a common cause of traumas.<ref name="isbn0-340-92826-3">{{cite book |author=Jeff Garner; Greaves, Ian; Ryan, James R.; Porter, Keith R. |title=Trauma care manual |publisher=Hodder Arnold |location=London |year=2009 |pages= |isbn=978-0-340-92826-4 |oclc= |doi= |accessdate=}}</ref> Penetrating trauma is caused when a [[foreign body]] such as a bullet or a knife enters the [[tissue (biology)|body tissue]], creating an open wound. In the United States, most deaths caused by penetrating trauma occur in urban areas and 80% of these deaths are caused by firearms.<ref name="isbn078173200x">{{cite book|author=Medzon R, Mitchell EJ|title=Introduction to Emergency Medicine|publisher=Lippincott Williams & Willkins|location=Philadelphia|year=2005|pages=393–431|isbn=978-0-7817-3200-0}}</ref> [[Blast injury]] is a complex cause of trauma because it commonly includes both blunt and penetrating trauma, and may also be accompanied by a [[burn injury]]. Trauma may also be associated with a particular activity, such as an [[occupational injury|occupational]] or [[sports injury]].{{citation needed|date=October 2013}}

==Pathophysiology==

The body responds to traumatic injury both systemically and at the injury site.<ref name="trauma care">{{cite book | title=Manual of Definitive Surgical Trauma Care | publisher=Hodder Arnold Publishers | author=Boffard, Kenneth | year=2007 | location=London, England | isbn=978-0-340-94764-7}}</ref> This response attempts to protect vital organs such as the liver, to allow further cell duplication and to heal the damage.<ref>{{cite doi|10.1383/surg.21.9.240.16923}}</ref> The healing time of an injury depends on various factors including sex, age, and the severity of injury.<ref name="ICU Book" />

The symptoms of injury can manifest in many different ways including:<ref>Pietzman 2002, p. 21</ref>

* [[Altered mental status]]

* Fever

* [[Tachycardia|Increased heart rate]]

* Generalized [[edema]]

* Increased [[cardiac output]]

* Increased rate of metabolism

Various organ systems respond to injury to restore [[homeostasis]] by maintaining perfusion to the heart and brain.<ref>Pietzman 2002, p. 17</ref> [[Inflammation]] after injury occurs to protect against further damage and starts the healing process. Prolonged inflammation can cause [[multiple organ dysfunction syndrome]] or [[systemic inflammatory response syndrome]].<ref>Pietzman 2002, p. 19</ref> Immediately after injury, the body increases production of glucose through [[gluconeogenesis]] and its consumption of fat via [[lipolysis]]. Next, the body tries to replenish its energy stores of glucose and protein via [[anabolism]]. In this state the body will temporarily increase its maximum expenditure for the purpose of healing injured cells.<ref name="ICU Book">{{cite book |author=Kenneth M Sutin; Marino, Paul L. |title=The ICU book |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2007 |pages= |isbn=978-0-7817-4802-5 |oclc= |doi= |accessdate=}}</ref><ref name="pmid15910820">{{cite journal |author=Keel M, Trentz O |title=Pathophysiology of polytrauma |journal=Injury |volume=36 |issue=6 |pages=691–709 |date=June 2005 |pmid=15910820 |doi=10.1016/j.injury.2004.12.037 |url=http://linkinghub.elsevier.com/retrieve/pii/S0020-1383(04)00552-2 |accessdate=2012-07-20}}</ref>

==Diagnosis==

[[File:Shotgun wound-xray.JPG|thumb|alt=Radiograph of a close-range shotgun blast injury to the knee. Birdshot pellets are visible within and around the shattered patella, distal femur and proximal tibia.|Radiograph of a close-range [[shotgun]] [[blast injury]] to the [[knee]]. [[Birdshot|Birdshot pellets]] are visible within and around the shattered [[patella]], distal [[femur]] and proximal [[tibia]].]]

===Physical examination===

Primary [[physical examination]] is undertaken to identify any life-threatening problems, after which the secondary examination is carried out. This may occur during transportation or upon arrival at the hospital. The secondary examination consists of a systematic assessment of the [[Abdomen|abdominal]], [[Human pelvis|pelvic]] and [[Chest|thoracic]] areas, a complete inspection of the body surface to find all injuries, and a [[neurological examination]]. Injuries which may manifest themselves later may be missed during the initial assessment, such as when a patient is brought into a hospital's emergency department.<ref name="ATLS2008" /> Generally the physical examuination is preformed in a systematic way that first checks for any immediate life threats (primary survery), and then taking a more in depth examination (secondary survey).<ref>Moore 2013, p</ref>

===Imaging===

Persons with major trauma commonly have chest and pelvic [[Radiography|X-rays]] taken,<ref name="ER2008" /> and depending on the mechanism of injury and presentation, are subject to a [[Focused assessment with sonography for trauma]] (FAST) exam to check for internal bleeding. For those with relatively stable blood pressure, heart rate, and sufficient [[Oxygenation (medical)|oxygenation]], [[X-ray computed tomography|CT scans]] are considered effective.<ref name="ER2008" /><ref name="Trauma2010" /> [[Full-body CT scan]]s, known as pan-scans, improve the survival rate of those who have suffered major trauma.<ref name="Huber2009">{{cite journal|author=Huber-Wagner S, Lefering R, Qvick LM, ''et al.''|title=Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study|journal=Lancet|volume=373|issue=9673|pages=1455–61|year=2009|pmid=19321199|doi=10.1016/S0140-6736(09)60232-4}}</ref> These scans use intravenous injections for the [[radiocontrast]] agent, but not oral administration.<ref name="Allen2004">{{cite journal|author=Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH|title=Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma|journal=J Trauma|volume=56|issue=2|pages=314–22|year=2004|pmid=14960973|doi=10.1097/01.TA.0000058118.86614.51}}</ref> There are concerns of radiation exposure from CT scans on the kidneys, but routine CT scans on the kidneys have shown no associated harm.<ref name="Trauma2010">{{cite journal|author=McGillicuddy EA, Schuster KM, Kaplan LJ, ''et al.''|title=Contrast-induced nephropathy in elderly trauma patients|journal=J Trauma|volume=68|issue=2|pages=294–7|year=2010|pmid=20154540|doi=10.1097/TA.0b013e3181cf7e40}}</ref>

In the U.S., CT or [[Magnetic resonance imaging|MRI]] scans are performed on 15% of trauma victims in emergency rooms.<ref name="Korley2010">{{cite journal|author=Korley FK, Pham JC, Kirsch TD|title=Use of advanced radiology during visits to US emergency departments for injury-related conditions,1998–2007| journal=JAMA| volume=304| issue=13| pages=1465–71| year=2010| pmid=20924012| doi=10.1001/jama.2010.1408}}</ref> Where blood pressure is low or the heart rate is increased{{mdash}}likely from bleeding in the abdomen{{mdash}}immediate surgery bypassing a CT scan is recommended.<ref>{{cite journal |author=Neal MD, Peitzman AB, Forsythe RM, ''et al.'' |title=Over reliance on computed tomography imaging in patients with severe abdominal injury: is the delay worth the risk? |journal=J Trauma |volume=70 |issue=2 |pages=278–84 |date=February 2011 |pmid=21307722 |doi=10.1097/TA.0b013e31820930f9 |url=}}</ref>

===Surgical techniques===

Surgical techniques, using a tube or catheter to [[Diagnostic peritoneal lavage|drain fluid from the peritoneum]], [[chest tube|chest]], or the [[pericardiocentesis|pericardium around the heart]] are often used in cases of severe blunt trauma to the chest or abdomen{{mdash}}especially when a person is experiencing early signs of [[shock (circulatory)|shock]]. In those with [[hypotension|low blood-pressure]], likely because of bleeding in the abdominal cavity, [[laparotomy|cutting through the abdominal wall surgically]] is indicated.<ref name="ER2008" />

==Prevention==

{{main|Injury prevention}}

By identifying risk factors present within a community and creating solutions to decrease the incidence of injury, trauma referral systems can help to enhance the overall health of a population.<ref name="Hoyt2007">{{cite journal|last1=Hoyt|first1=DB|last2=Coimbra|first2=R|title=Trauma systems|journal=Surgical Clinics of North America|volume=87|issue=1|pages=21–35, v–vi|year=2007|pmid=17127121|doi=10.1016/j.suc.2006.09.012}}</ref> Commonly, injury prevention strategies are used to prevent injuries in children, who are a high risk population.<ref name="child prevention">{{cite book | title=Injury Prevention for Young Children: A Research Guide | publisher=Greenwood |author=Walker, Bonnie | year=1996 | pages=2 | isbn=978-0-313-29686-4}}</ref> Generally, injury prevention strategies involve educating the general public about specific risk factors and developing strategies to avoid or reduce injuries.<ref name="cdcinjury">{{cite book | title=CDC Injury Fact Book | publisher=National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta, Georgia | year=2006 | location=Atlanta, Georgia | pages=35–101}}</ref> Legislation intended to prevent injury typically involves seatbelts, child car seats, helmets, alcohol control, and increased enforcement.{{sfn|Greaves, Porter, Ryan, Garner|2008|p = 6}} Other controlable factors, such as the use of drugs including [[alcoholic beverage|alcohol]] or [[cocaine]] increases the risk of trauma by increasing the likelihood of traffic collisions, violence and abuse occurring.<ref name="ER2008" /> Other drugs such as [[benzodiazepine]]s increase the risk of trauma in [[old age|elderly]] people.<ref name="ER2008" />

The care of acutely injured people in a public health system involved bystanders, community members, health care professionals, and health care systems. It encompasses [[pre-hospital trauma assessment]] and care by [[emergency medical services]] personnel, emergency department assessment, treatment, and stabilization, and in-hospital care among all age groups.<ref name="CDC">{{cite web|url=http://www.cdc.gov/injuryresponse/acute_injury.html|title=Centers for Disease Control and Prevention Injury Prevention and Control: Injury Response: Acute Injury Care}}</ref> An established trauma system network is also an important component of community disaster preparedness, facilitating the care of people who have been involved in disasters that cause large numbers of casualties, such as earthquakes.<ref name="Hoyt2007" />

==Management==

[[File:US Navy 010531-N-3889M-004 Navy Corpsman Field Training Exercise.jpg|thumb|alt=Color photograph of a United States Navy hospital corpsman listening for correct placement of an endotracheal tube in a simulated trauma victim during a search and rescue exercise. His assistant is holding a bag of intravenous fluid.|A [[United States Navy|Navy]] corpsmen listens for the correct tube placement on an [[tracheal intubation|intubated]] trauma victim during a [[search and rescue]] exercise]]

[[File:Schockraum Uniklinik MA.jpg|thumb|alt=Color photograph of a room designed to handle major trauma. Visible are an anesthesia machine, a Doppler ultrasound device, a defibrillator, a suction device, a gurney, and several carts for storing surgical instruments and disposable supplies.|Typical trauma room]]

===Pre-hospital===

The pre-hospital use of [[Stabilization (medicine)|stabilization]] techniques improves the chances of a person surviving the journey to the nearest trauma-equipped hospital. Emergency Medicine Services determines which patients need treatment at a [[trauma center]] as well as provide primary stabilization by checking and treating [[ABC (medicine)|airway, breathing, and circulation]].<ref name="ATLS2008">{{cite book|first=American College of Surgeons|last=Committee on Trauma|authorlink=American College of Surgeons|title=ATLS: Advanced Trauma Life Support Program for Doctors|publisher=American College of Surgeons|location=Chicago|edition=8th|year=2008|isbn=978-1-880696-31-6}}</ref>

Unnecessary movement of the spine is often minimized by securing the neck with a [[cervical collar]] and placing the person an a [[long spine board]] with head supports. This can be accomplished with other medical transport devices such as a [[Kendrick Extrication Device|Kendrick extrication device]], before moving the person.<ref name="Karbi1988">{{cite journal|first=OA|last=Karbi|first2=DA|last2=Caspari|first3=CH|last3=Tator|title=Extrication, immobilization and radiologic investigation of patients with cervical spine injuries|journal=[[Canadian Medical Association Journal]]|volume=139|issue=7|pages=617–21|year=1988|pmc=1268249|pmid=3046734}}</ref> It is important to quickly control severe bleeding with direct pressure to the wound and consider the use of of [[hemostatic agents]] or [[tourniquet]]s if the bleeding continues.<ref name="Moore2013p154">Moore 2013, p. 154-166</ref> Conditions like impending airway obstruction, enlargening neck hematoma, or unconsciousness require intubation. It is unclear, however, if this is best done before reaching hospital or in the hospital.<ref name="Bulger2007">{{cite journal|last=Bulger|first=EM|coauthors=Maier, RV|title=Prehospital care of the injured: what's new.|journal=The Surgical clinics of North America|date=2007 Feb|volume=87|issue=1|pages=37–53, vi|pmid=17127122}}</ref>

Rapid transportation of severely injured patients improves the outcome in trauma.<ref name="ER2008">{{cite journal|last1=Bonatti|first1=H|last2=Calland|first2=JF|title=Trauma|journal=Emergency Medicine Clinics of North America|volume=26|issue=3|pages=625–48|year=2008|pmid=18655938|doi=10.1016/j.emc.2008.05.001}}</ref><ref name="ATLS2008" /> Helicopter EMS transport reduces mortality compared to ground-based transport in adult trauma patients.<ref>{{cite journal|last=Sullivent|first=EE|coauthors=Faul, M, Wald, MM|title=Reduced mortality in injured adults transported by helicopter emergency medical services|journal=Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors|date=Jul–Sep 2011|volume=15|issue=3|pages=295–302|pmid=21524205|doi=10.3109/10903127.2011.569849}}</ref> Before arrival at the hospital, the availability of [[advanced cardiac life support|advanced life support]] does not greatly improve the outcome for major trauma when compared to the administration of [[basic life support]].<ref name="Stiell2008">{{cite journal|author=Stiell IG, Nesbitt LP, Pickett W, ''et al.''|title=The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity|journal=CMAJ|volume=178|issue=9|pages=1141–52|year=2008|pmid=18427089|pmc=2292763|doi=10.1503/cmaj.071154}}</ref><ref name="Liberman2007">{{cite journal|author=Liberman M, Roudsari BS|title=Prehospital trauma care: what do we really know?|journal=Curr Opin Crit Care|volume=13|issue=6|pages=691–6|year=2007|pmid=17975392|doi=10.1097/MCC.0b013e3282f1e77e}}</ref> Evidence is inconclusive in determining support for prehospital [[Intravenous therapy|intravenous fluid resuscitation]] while some evidence has found it may be harmful.<ref name="Dretzke2004">{{cite journal|author=Dretzke J, Sandercock J, Bayliss S, Burls A|title=Clinical effectiveness and cost-effectiveness of prehospital intravenous fluids in trauma patients|journal=Health Technol Assess|volume=8|issue=23|pages=iii, 1–103|year=2004|pmid=15193210}}</ref> Hospitals with designated trauma centers have improved outcomes when compared to hospitals without them,<ref name="ER2008" /> and outcomes can improve when persons who have experienced trauma are transferred directly to a trauma center.<ref name="Nirula2010">{{cite journal|author=Nirula R, Maier R, Moore E, Sperry J, Gentilello L|title=Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality|journal=J Trauma|volume=69|issue=3|pages=595–9; discussion 599–601|year=2010|pmid=20838131|doi=10.1097/TA.0b013e3181ee6e32}}</ref>

===In-hospital===

Management of those with trauma often requires the help of many health care specialties including physicians, nurses, and social workers. Cooperation allows multiple actions to be completed at once. Generally the first step of managing trauma is to preform a primary survey that evaluates a persons airway, breathing, circulation, and neurologic status.<ref>Moore 2013, p 160</ref> After immediate life threats are controlled a person it is either determined to move into an operating room for immediate surgical correction of the injuries, or to preform a secondary survey, a more detailed head-to-toe assessment of the person.<ref>Moore 2013, p 163</ref>

Indications for intubation include airway obstruction, inability to protect the airway, and respiratory failure.<ref>{{cite journal|last=Nemeth|first=J|coauthors=Maghraby, N; Kazim, S|title=Emergency airway management: the difficult airway.|journal=Emergency medicine clinics of North America|date=2012 May|volume=30|issue=2|pages=401–20, ix|pmid=22487112}}</ref> Examples of these indications include penetrating neck trauma, expanding neck hematoma, and being unconscious among others. In general, the method of intubation used is [[rapid sequence intubation]] followed by ventilation. Assessment of circulation in those with trauma includes control of active bleeding. When a person is first brought in, vital signs are checked, an [[ECG]] is performed, and, if needed, vascular access is obtained. If there is no cardiac activity, chest compressions may be started. A [[focused assessment with sonography for trauma|FAST]] exam can help assess for internal bleeding. In certain traumas, such as [[maxillofacial]] trauma, it can be beneficial to have a highly trained health care provider available to maintain airway, breathing, and circulation.<ref name="Maxillofacial">{{cite journal|author=Krausz AA, El-Naaj IA, Barak M |title=Maxillofacial trauma patient: coping with the difficult airway |journal=[[World Journal of Emergency Surgery : WJES]] |volume=4 |issue= |pages=21 |year=2009|pmid=19473497 |pmc=2693512 |doi=10.1186/1749-7922-4-21 |url=http://www.wjes.org/content/4//21|accessdate=2012-08-02}}</ref>

===Intravenous fluids===

Traditionally, high volume [[intravenous fluids]] were given to people who had poor perfusion due to trauma.<ref name="EMB11" /> This is still appropriate in cases with isolated extremity trauma, thermal trauma, or head injuries.<ref name="COCC2010">{{cite journal|author=Roppolo LP, Wigginton JG, Pepe PE|title=Intravenous fluid resuscitation for the trauma patient|journal=Curr Opin Crit Care|volume=16|issue=4|pages=283–8|year=2010|pmid=20601865|doi=10.1097/MCC.0b013e32833bf774}}</ref> Lots of fluids generally though appear to increase the risk of death.<ref>{{cite journal|last=Wang|first=CH|coauthors=Hsieh, WH; Chou, HC; Huang, YS; Shen, JH; Yeo, YH; Chang, HE; Chen, SC; Lee, CC|title=Liberal Versus Restricted Fluid Resuscitation Strategies in Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies.|journal=Critical care medicine|date=Dec 11, 2013|pmid=24335443}}</ref> The current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries, allowing mild hypotension to persist.<ref name="Rosen2010">{{cite book|title=Rosen's emergency medicine: concepts and clinical practice 7th edition|last=Marx|first=J|year=2010|publisher=Mosby/Elsevier|location=Philadelphia, PA|isbn=978-0-323-05472-0|page=2467}}</ref><ref name="COCC2010" /> Targets include a [[mean arterial pressure]] of 60&nbsp;mmHg, a [[systolic blood pressure]] of 70–90&nbsp;mmHg,<ref name="EMB11" /><ref name="Tint10">{{cite book |author=Tintinalli, Judith E. |title=Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli))|publisher=McGraw-Hill Companies |location=New York |year=2010 |page=176 |isbn=978-0-07-148480-0 |oclc= |doi= |accessdate=}}</ref> or until adequate ability to think and peripheral pulses are present.<ref name="EMB11" />

As no intravenous fluids used for initial resuscitation have been shown to be superior, warmed [[Lactated Ringer's solution]], continues to be the solution of choice.<ref name="EMB11">{{cite journal|last=Cherkas|first=David|title=Traumatic Hemorrhagic Shock: Advances In Fluid Management|journal=Emergency Medicine Practice|date=Nov 2011|volume=13|issue=11|url=http://www.ebmedicine.net/store.php?paction=showProduct&catid=8&pid=244}}</ref> If blood products are needed, a greater relative use of [[fresh frozen plasma]] and [[platelet]]s to [[packed red blood cells]] has been found to improve survival and lower overall blood product use;<ref name="Greer2010">{{cite journal|author=Greer SE, Rhynhart KK, Gupta R, Corwin HL|title=New developments in massive transfusion in trauma|journal=Curr Opin Anaesthesiol|volume=23|issue=2|pages=246–50|year=2010|pmid=20104173|doi=10.1097/ACO.0b013e328336ea59}}</ref> a ratio of 1:1:1 is recommended.<ref name="Tint10" /> The success of platelets has been attributed to the fact that they can prevent coagulopathy from developing.<ref name="wsj">{{cite web |url=http://online.wsj.com/article/SB10001424127887324712504578131360684277812.html |title=In Medical Triumph, Homicides Fall Despite Soaring Gun Violence|work=Wall street Journal|accessdate=2012-12-09}}</ref> [[Cell salvage and autotransfusion]] can also be used.<ref name="EMB11" />

[[Blood substitutes]] such as [[hemoglobin-based oxygen carriers]] are in development, however as of 2013 there are none available for commercial use in North America or Europe.<ref name="EMB11" /><ref name="UPT2008">{{cite web|url=http://www.uptodate.com/online/content/topic.do?topicKey=transfus/11560&selectedTitle=1~8&source=search_result|title=UpToDate Inc.|accessdate=2010-11-13}}</ref><ref name="Spahn2005">{{cite journal|author=Spahn DR, Kocian R|title=Artificial O2 carriers: status in 2005|journal=Curr. Pharm. Des.|volume=11|issue=31|pages=4099–114|year=2005|pmid=16378514|doi=10.2174/138161205774913354|url=http://www.bentham-direct.org/pages/content.php?CPD/2005/00000011/00000031/0011B.SGM}}</ref> These products are only available for general use in South Africa and Russia.<ref name="UPT2008" />

===Medications===

[[Tranexamic acid]] decreases the mortality rate in people who are bleeding due to trauma.<ref name="CRASH2010">{{cite journal|last1=Crash-2 Trial|first1=Collaborators|last2=Shakur|first2=H|last3=Roberts|first3=R|last4=Bautista|first4=R|last5=Caballero|first5=J|last6=Coats|first6=T|last7=Dewan|first7=Y|last8=El-Sayed|first8=H|last9=Gogichaishvili|first9=T|last10=Gupta|first10=S|last11=Herrera|first11=J|last12=Hunt|first12=B|last13=Iribhogbe|first13=P|last14=Izurieta|first14=M|last15=Khamis|first15=H|last16=Komolafe|first16=E|last17=Marrero|first17=M. A.|last18=Mejía-Mantilla|first18=J|last19=Miranda|first19=J|last20=Morales|first20=C|last21=Olaomi|first21=O|last22=Olldashi|first22=F|last23=Perel|first23=P|last24=Peto|first24=R|last25=Ramana|first25=P. V.|last26=Ravi|first26=R. R.|last27=Yutthakasemsunt|first27=S|title=Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial|journal=The Lancet|volume=376|issue=9734|pages=23–32|year=2010|pmid=20554319|doi=10.1016/S0140-6736(10)60835-5|display-authors=8}}</ref><ref>{{cite journal|last=Cap|first=AP|coauthors=Baer, DG, Orman, JA, Aden, J, Ryan, K, Blackbourne, LH|title=Tranexamic acid for trauma patients: a critical review of the literature|journal=The Journal of trauma|date=July 2011|volume=71|issue=1 Suppl|pages=S9–14|pmid=21795884|doi=10.1097/TA.0b013e31822114af}}</ref> For severe bleeding, for example from [[Coagulopathy|bleeding disorders]], [[recombinant factor VIIa]]{{mdash}}a protein that assists blood clotting{{mdash}}may be appropriate.<ref name="ER2008" /><ref name="COCC2010" /> While it decreases blood use it does not appear to decrease the mortality rate.<ref>{{cite journal |author=Hauser CJ, Boffard K, Dutton R, ''et al.'' |title=Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage |journal=J Trauma |volume=69 |issue=3 |pages=489–500 |date=September 2010 |pmid=20838118 |doi=10.1097/TA.0b013e3181edf36e |url=}}</ref> In those without previous factor VII deficiency its use is not recommended outside of trial situations.<ref>{{cite journal|last=Simpson|first=E|coauthors=Lin, Y; Stanworth, S; Birchall, J; Doree, C; Hyde, C|title=Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia.|journal=Cochrane database of systematic reviews (Online)|date=Mar 14, 2012|volume=3|pages=CD005011|pmid=22419303|doi=10.1002/14651858.CD005011.pub4}}</ref> Other medications may be used in conjunction with other procedures to stabilize a person who sustained a significant injury.<ref name="Rosen2010" />

===Surgery===

The decision whether to perform surgery is determined by the extent of the damage and the anatomical location of the injury. Bleeding must be controlled before definitive repair can occur.<ref>{{cite book |author=Andrew B., MD Peitzman; Andrew B. Peitzman; Michael, MD Sabom; Donald M., MD Yearly; Timothy C., MD Fabian |title=The trauma manual |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2002 |pages= |isbn=978-0-7817-2641-2 }}</ref> [[Damage control surgery]] is used to manage severe trauma in which there is a [[Trauma triad of death|cycle]] of [[metabolic acidosis]], [[hypothermia]], and [[hypotension]].<ref name="ER2008" /> It involves performing the least number of procedures to save life and limb; less critical procedures are left until the victim is more stable.<ref name="ER2008" />

==Prognosis==

Trauma deaths occur in immediate, early, or late stages. Immediate deaths are usually due to [[apnea]], severe brain or high spinal cord injury, or rupture of the heart or of large blood vessels. Early deaths occur within minutes to hours and are often due to [[subdural hematoma|hemorrhages in the brain's outer meningeal layer]], [[epidural hematoma|torn arteries]], [[hemothorax|blood around the lungs]], [[pneumothorax|air around the lungs]], [[ruptured spleen]], [[Abdominal trauma#Liver|liver laceration]], or [[pelvic fracture]]. Immediate access to care can be crucial to prevent death in persons experiencing major trauma. Late deaths occurs days or weeks after the injury<ref name="ATLS2008" /> and are often related to infection.<ref>Moore 2013, p 330</ref> Prognosis is better in countries with a dedicated trauma system where injured persons have quick and effective access to proper treatment facilities.<ref name="ER2008" />

Long-term prognosis is frequently complicated by pain; over half of trauma patients have moderate to severe pain one year after injury.<ref name="Rivara2008">{{cite journal|author=Rivara FP, Mackenzie EJ, Jurkovich GJ, Nathens AB, Wang J, Scharfstein DO|title=Prevalence of pain in patients 1 year after major trauma|journal=Arch Surg|volume=143|issue=3|pages=282–7; discussion 288|year=2008|pmid=18347276|doi=10.1001/archsurg.2007.61}}</ref> Many also experience a reduced [[quality of life]] years after an injury,<ref name="Ulvik2008">{{cite journal|author=Ulvik A, Kvåle R, Wentzel-Larsen T, Flaatten H|title=Quality of life 2-7 years after major trauma|journal=Acta Anaesthesiol Scand|volume=52|issue=2|pages=195–201|year=2008|pmid=18005377|doi=10.1111/j.1399-6576.2007.01533.x}}</ref> with 20% of victims sustaining some form of disability.<ref name="Peitzman2008">{{cite book|editor=Peitzman AB, Rhodes M, Schwab CW, Yealy DM, Fabian TC|title=The Trauma Manual|edition=3rd|year=2008|chapter=Pediatric Trauma|pages=499–514|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-6275-5|asin=0781762758}}</ref>

Physical trauma can lead to development of [[post-traumatic stress disorder]] (PTSD).<ref name="DSM">{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders|chapter=309.81 Posttraumatic Stress Disorder|pages=424–429|url=http://www.cirp.org/library/psych/ptsd2/|work=Diagnostic and statistical manual of mental disorders, fourth edition|publisher=American Psychiatric Association|location=Washington, USA|year=1994}}</ref> One study has found no correlation between the severity of trauma and the development of PTSD.<ref name="Feinstein1991">{{cite journal|first=A|last=Feinstein|first2=Ray|last2=Dolan|title=Predictors of post-traumatic stress disorder following physical trauma: an examination of the stressor criterion|journal=Psychological Medicine|year=1991|volume=21|issue=1|pages=85–91|pmid=2047509|publisher=Cambridge University Press|doi=10.1017/S0033291700014689}}</ref>

==Epidemiology==

{{Further|List of preventable causes of death}}

[[Image:Injuries world map - Death - WHO2004.svg|thumb|Deaths from injuries per 100,000&nbsp;inhabitants in 2004<ref name="WHO">{{cite web|url=http://www.who.int/entity/healthinfo/global_burden_disease/gbddeathdalycountryestimates2004.xls|title=Death and DALY estimates for 2004 by cause for WHO Member States|format=xls|work=World Health Organization|year=2004|accessdate=2010-11-13}}</ref>

{{Multicol}}

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{{legend|#ff8400|150-175}}

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{{legend|#ff2c00|250-275}}

{{legend|#cb0000|> 275}}

{{Multicol-end}}]]

[[File:Accidents.svg|thumb|alt=|Incidence of accidents by activity in Denmark]]

Trauma is the sixth leading cause of death worldwide, resulting in five million or 10% of all deaths annually.<ref name="Epi09" /><ref name="Oxford2010" /> It is the fifth leading cause of significant disability.<ref name="Epi09">{{cite journal|author=Søreide K|title=Epidemiology of major trauma|journal=The British journal of surgery|volume=96|issue=7|pages=697–8|year=2009|pmid=19526611|doi=10.1002/bjs.6643|url=http://www.ingentaconnect.com/content/jws/bjs/2009/00000096/00000007/art00001}}</ref> About half of trauma deaths are in people aged between 15 and 45 years and is the leading cause of death in this age group.<ref name="Oxford2010">{{cite book|last=Porter|first=edited by Jason Smith, Ian Greaves, Keith|title=Major trauma|year=2010|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-954332-8|page=2|url=http://books.google.ca/books?id=xOoU93wIA60C&pg=PA2|edition=1. publ.}}</ref> Injury affects more males; 68% of injuries occur in males<ref name="2013nejm" /> and death from trauma is twice as common in males as it is in females, this is believed to be because males are much more willing to engage in risk-taking activities.<ref name="Oxford2010" /> Teenagers and young adults are more likely to need hospitalization from injuries than other age groups.<ref name="p23">Moore 2013, pp 23</ref> While elderly persons are less likely to be injured, they are more likely to die from injuries sustained due to various physiological differences that make it harder for the body to compensate for the injuries.<ref name="p23" /> The primary causes of traumatic death are central nervous system injuries and [[exsanguination|substantial blood loss]].<ref name="Epi09" />

==Research==

{{See also|Traumatology}}

Most research on trauma occurs during war and military conflicts as militaries will increase trauma research spending in order to prevent combat related deaths.<ref name="pmid18483051">{{cite journal |author=Gulland A |title=Emergency Medicine: Lessons from the battlefield |journal=[[BMJ (Clinical Research Ed.)]] |volume=336 |issue=7653 |pages=1098–100 |date=May 2008 |pmid=18483051 |pmc=2386631 |doi=10.1136/bmj.39568.496424.94 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=18483051 |accessdate=2012-07-17}}</ref> Some research is being done on patients who were admitted into an [[intensive care unit]] or trauma center and received a trauma diagnosis that caused a negative change in their health-related quality of life, with a potential to create anxiety and symptoms of depression.<ref name="pmid19088550">{{cite journal|author=Ringdal M, Plos K, Lundberg D, Johansson L, Bergbom I|title=Outcome after injury: memories, health-related quality of life, anxiety, and symptoms of depression after intensive care|journal=J Trauma|volume=66|issue=4|pages=1226–33|year=2009|pmid=19088550|doi=10.1097/TA.0b013e318181b8e3}}</ref> New preserved blood products are also being researched for use in pre-hospital care; it is impractical to use the currently available blood products in a timely fashion in remote, rural settings or in theaters of war.<ref name="pmid21718901">{{cite journal |author=Alam HB, Velmahos GC |title=New trends in resuscitation |journal=[[Current Problems in Surgery]] |volume=48 |issue=8 |pages=531–64 |date=August 2011 |pmid=21718901 |doi=10.1067/j.cpsurg.2011.04.002 |url=http://linkinghub.elsevier.com/retrieve/pii/S0011-3840(11)00074-8 |accessdate=2012-07-17}}</ref>

==Society and culture==

===Economics===

The financial cost of trauma includes both the amount of money spent on treatment and the loss of potential economic gain through absence from work. The average financial cost for the treatment of traumatic injury in the United States is around {{USD|334,000}} per person, making it costlier than the treatment of cancer and [[cardiovascular disease]]s.<ref name="PHTLS">{{cite book |author= |title=PHTLS: Prehospital Trauma Life Support |publisher=Mosby/JEMS |location= |year=2010 |pages= |isbn=0-323-06502-3}}</ref> One reason for the high cost of treatment is the increased possibility of complications, which leads to the need for more interventions.<ref name="pmid18656640">{{cite journal |author=Hemmila MR, Jakubus JL, Maggio PM, ''et al.'' |title=Real money: complications and hospital costs in trauma patients |journal=[[Surgery]] |volume=144 |issue=2 |pages=307–16 |date=August 2008 |pmid=18656640 |pmc=2583342 |doi=10.1016/j.surg.2008.05.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0039-6060(08)00289-4 |accessdate=2012-07-17}}</ref> Maintaining a trauma center is costly because they are open continuously and are always ready to receive patients.<ref name="pmid14706578">{{cite journal |author=Taheri PA, Butz DA, Lottenberg L, Clawson A, Flint LM |title=The cost of trauma center readiness |journal=[[American Journal of Surgery]] |volume=187 |issue=1 |pages=7–13 |date=January 2004 |pmid=14706578 |doi= 10.1016/j.amjsurg.2003.06.002|url=http://linkinghub.elsevier.com/retrieve/pii/S0002961003004379 |accessdate=2012-07-17}}</ref> In 2009 around {{USD|693.5 billion}} was lost due to traumatic injury in the United States.<ref>{{cite web | url=http://www.nsc.org/Documents/Injury_Facts/Injury_Facts_2011_w.pdf | title=Injury Facts | publisher=National Safety Council | accessdate=July 17, 2012}}</ref>

===Low and middle income countries===

Citizens of [[Developing country|low]] and [[middle income country|middle]] income countries (LMICs) often have higher mortality rates from injury; these countries accounted for 89% of all deaths from injury worldwide.<ref name="2013nejm">{{cite journal |author=Norton R, Kobusingye O |title=Injuries |journal=[[The New England Journal of Medicine]] |volume=368 |issue=18 |pages=1723–30 |date=May 2013 |pmid=23635052 |doi=10.1056/NEJMra1109343 }}</ref> Many of these countries do not have access to sufficient surgical care and many do not have a trauma system in place. In addition, most LMICs do not have a pre-hospital care system to initially treat and transport injured persons to hospital quickly, leading to most casualties being transported by private vehicles. Hospitals lack the appropriate equipment, organizational resources or trained staff.<ref name="care">{{cite journal |author=Sakran JV, Greer SE, Werline EC, McCunn M |title=Care of the injured worldwide: trauma still the neglected disease of modern society |journal=[[Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine]] |volume=20 |issue=1 |pages=64 |date=September 2012 |pmid=22980446 |doi=10.1186/1757-7241-20-64 |url= |pmc=3518175}}</ref><ref name="strength">{{cite journal |author=Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F |title=Strengthening the prevention and care of injuries worldwide |journal=[[The Lancet|Lancet]] |volume=363 |issue=9427 |pages=2172–9 |date=June 2004 |pmid=15220042 |doi=10.1016/S0140-6736(04)16510-0 |url= }}</ref> By 2020, the amount of trauma related deaths is expected to decline in [[high income country|high-income countries]] while in low to middle-income countries it is expected to increase.{{sfn|Greaves, Porter, Ryan, Garner|2008|p = 2}}

==Special populations==

===Children===

{{Main|Pediatric trauma}}

{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"

|-

! Cause

! Deaths per year

|-

| [[Traffic collision]]

|

260,000

|-

| [[Drowning]]

|

175,000

|-

| [[Burn]]s

|

96,000

|-

| [[Falling (accident)|Falls]]

|

47,000

|-

| [[Toxin]]s

|

45,000

|}

Due to anatomical and physiological differences, injuries in children need to be approached differently to those in adults.<ref name="Dickinson2008">{{cite book|author=Dickinson E, Limmer D, O'Keefe MF, Grant HD, Murray R|title=Emergency Care (11th Edition)|publisher=Prentice Hall|location=Englewood Cliffs, New Jersey|year=2008|pages=848–52|isbn=0-13-500524-8}}</ref> Accidents are the leading cause of death in children between 1 and 14 years old.<ref name="Peitzman2008" /> In the United States approximatively sixteen million children go to an emergency department due to some form of injury every year.<ref name="Peitzman2008" /> Boys are more frequently injured than girls by a ratio of 2:1.<ref name="Peitzman2008" /> The world's five commonest unintentional injuries in children are as follows:<ref name="BBC">{{cite news|title=UN raises child accidents alarm|author=BBC News Online|authorlink=BBC News Online|agency=[[BBC News]]|publisher=BBC|location=London|date=December 10, 2008|url=http://news.bbc.co.uk/2/hi/in_depth/7776127.stm|accessdate=2010-10-31}}</ref>

[[Body weight#Estimation in children|Weight estimation]] is an important part of managing trauma in children because the accurate dosing of medicine may be critical for resuscitative efforts.<ref name="pmid20825816">{{cite journal |author=Rosenberg M, Greenberger S, Rawal A, Latimer-Pierson J, Thundiyil J |title=Comparison of Broselow tape measurements versus physician estimations of pediatric weights |journal=[[The American Journal of Emergency Medicine]] |volume=29 |issue=5 |pages=482–8 |date=June 2011 |pmid=20825816 |doi=10.1016/j.ajem.2009.12.002 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-6757(09)00620-2 |accessdate=2012-09-08}}</ref> A number of methods to estimate weight, including the [[Broselow tape]], [[Leffler formula]] and [[Theron formula]] exist.<ref name="Ped09">{{cite journal|author=So TY, Farrington E, Absher RK|title=Evaluation of the accuracy of different methods used to estimate weights in the pediatric population|journal=Pediatrics|volume=123|issue=6|pages=e1045–51|year=2009|pmid=19482737|doi=10.1542/peds.2008-1968|url=}}</ref>

===Pregnancy===

Trauma occurs in about 5% of all pregnancies,<ref name="EMP2008">{{cite journal|last=Tibbles|first=Carrie|title=Trauma In Pregnancy: Double Jeopardy|journal=Emergency Medicine Practice|date=July 2008|volume=10|issue=7|url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=88}}</ref> and is the leading cause of maternal death. Pregnant women may additionally experience [[placental abruption]], [[Premature birth|pre-term labor]], and [[uterine rupture]].<ref name="EMP2008" /> There are diagnostic issues during pregnancy; [[ionizing radiation]] has been shown to cause birth defects,<ref name="Rosen2010" /> although the doses used for typical exams are generally considered safe.<ref name="EMP2008" /> Due to normal [[Maternal physiological changes in pregnancy|physiological changes that occur during pregnancy]], shock can be more difficult to diagnose.<ref name="Rosen2010" /><ref name="BTLS">{{cite book |author=Campbell, John Creighton |title=Basic trauma life support for paramedics and other advanced providers |publisher=Brady/Prentice Hall Health |location=Upper Saddle River, N.J |year=2000 |pages=239–47 |isbn=0-13-084584-1}}</ref> Where the woman is more than 23 weeks pregnant, it is recommended that the fetus is monitored for at least four hours by [[cardiotocography]].<ref name="EMP2008" />

A number of treatments beyond typical trauma care may be needed when the patient is pregnant. Because the weight of the uterus on the [[inferior vena cava]] can decease blood return to the heart, it can be very beneficial to lay a women in late pregnancy on the left side.<ref name="EMP2008" /> [[Rho(D) immune globulin]] in those who are rh negative, [[corticosteroids]] in those who are 24 to 34 weeks who may need delivery, or a [[caesarian section]] in the event of cardiac arrest are also recommended.<ref name="EMP2008" />

{{-}}

== Types of injury ==

=== By ultimate cause ===

** [[Stingray injury]]

** [[Lightning injuries]]

=== By modality ===

**[[Avulsion injury]]

**[[Blast injury]]

**[[Internal bleeding]]

**[[Crush injury]]

**[[Needlestick injury]]

**[[Catastrophic injury]]

*[[Repetitive strain injury]] or other [[Strain (injury)|strain injury]]

**[[Radiation-induced lung injury]]

**[[Microwave burn]]

*Injury from [[toxin]] or as adverse effect of a [[pharmaceutical drug]] (e.g., [[vaccine injury]])

**[[Toxic injury]]

*Injury from internal causes such as [[reperfusion injury]]

=== By location ===

**[[Acquired brain injury]]

**[[Coup contrecoup injury]]

**[[Diffuse axonal injury]]

**[[Frontal lobe injury]]

**[[Spinal cord injury]]

**[[Brachial plexus injury]]

**[[Peripheral nerve injury]]

**[[Sciatic nerve injury]]

**[[Injury of axillary nerve]]

*[[Lisfranc injury]]

*[[Tracheobronchial injury]]

*[[Eye injury]]

**[[Chemical eye injury]]

**[[Eye injuries during general anaesthesia]]

*[[Acute kidney injury]]

*[[Knee injury]]

**[[Anterior cruciate ligament injury]]

**[[Medial knee injuries]]

*[[Back injury]]

*[[Hand injury]]

*[[Liver injury]]

*[[Head injury]]

**[[Penetrating head injury]]

**[[Closed head injury]]

*[[Musculoskeletal injury]]

**[[Articular cartilage injuries]]

*[[Acute lung injury]]

*[[Pancreatic injury]]

*[[Thoracic aorta injury]]

*[[Biliary injury]]

*[[Chest injury]]

=== By activity ===

**[[Reverse bite injury]]

**[[Lead climbing injuries]]

**[[Grease gun injury]]

*[[Ventilator-associated lung injury]]

*[[Sea urchin injury]]

*[[Transfusion-related acute lung injury]]

*[[Illness and injuries during spaceflight]]

== See also ==

* [[List of causes of death by rate]]

== References ==

==Bibliography==

*{{cite book |author=Jeff Garner; Greaves, Ian; Ryan, James R.; Porter, Keith R. |title=Trauma Care Manual |publisher=Hodder Arnold |location=London , England|year=2009 |isbn=978-0-340-92826-4}}

*{{cite book |author=Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest J |title=Trauma, Seventh Edition (Trauma (Moore)) |publisher=McGraw-Hill Professional |location= |year=2012 |pages= |isbn=978-0-07-166351-9}}

*{{cite book |author=Andrew B., Peitzman; Michael, MD Sabom; Donald M., MD Yearly; Timothy C., MD Fabian |title=The trauma manual |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2002 |pages= |isbn=0-7817-2641-7 |oclc= |doi= |accessdate=}}

==Further reading==

*{{cite book|title=Emergency War Surgery|editor-last=Editorial Board|editor-first=Army Medical Department Center & School|publisher=[[Borden Institute]]|location=Washington, DC|edition=3rd|year=2004|url=http://www.bordeninstitute.army.mil/other_pub/ews.html}}

*{{cite book|title=Textbook of Military Medicine, Part IV: Surgical Combat Casualty Care|volume=1: Anesthesia and Perioperative Care of the Combat Casualty|editor-last=Zajtchuk|editor-first=R|editor2-last=Bellamy|editor2-first=RF|editor3-last=Grande|editor3-first=CM|publisher=Borden Institute|location=Washington, DC|year=1995|url=http://www.bordeninstitute.army.mil/published_volumes/anesthesia/anesthesia.html}}

==External links==

{{commons|Wounds}}

* [http://www.traumaconference.org/ International Trauma Conferences] (registered trauma charity providing trauma education for medical professionals worldwide)

* [http://www.trauma.org/ Trauma.org] (trauma resources for medical professionals)

* [http://www.emrap.tv/ Emergency Medicine Research and Perspectives] (emergency medicine procedure videos)

* [http://www.amtrauma.org/ American Trauma Society]

* [http://www.sjtrem.com/ Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine]

{{General injuries}}

{{Emergency medicine}}

{{DEFAULTSORT:Physical Trauma}}

[[Category:Health-related lists]]

[[Category:Medical emergencies]]

[[Category:Traumatology]]

[[Category:Causes of death]]