1. Principles of damage control resuscitation: 
(applied to trauma patients in hemorrhagic shock)
-Permissive hypovolaemia (hypotension): sacrifice perfusion for hemorrhage control. Titrate pressures (with 250mL boluses) to mental status in awake patients, or to palpable radial pulses, or to systolic > 70-80 in penetrating and >90 in blunt trauma. Too much volume, esp with non-FFP, leads to worsening of hemorrhage, dilution of coag factors and loosening of platelet plugs, also increases ICP.
-Haemostatic transfusion (resuscitation): 1:1:1 of FFP, pRBC, platelets + tranexamic acid if you can give it within 3 hours (PROPPR trial currently underway to eval 1:1:1 vs 2:1:1 ffp/rbc/platelets). Avoidance of crystalloids (NS, Hartmann’s, LR) and colloids (gelofusion, haemaccel, or volulyte), they dilute out clotting factors and hemoglobin and worsen hypothermia.
-NO PRESSORS: early vasopressor use is independently associated with an increased risk of death with published HR's ranging from 2 to 17(!!); that means that they are associated with increased mortality after adjusting for severity of injury and volume status. Use only if cardiovascular collapse is imminent and all attempts to resuscitate with fluids have failed (i.e. patient not fluid responsive)
-Damage control surgery or angiography to treat the cause of bleeding
-Once hemostasis is achieved, restore organ perfusion and oxygen delivery with definitive resuscitation
source: {BMJ Review Paper}
2. Optimal volume status: 
-A&O x3
-UOP 0.5-2.0
-CVP<15
In adults, optimal fluid access is 2 peripheral 16 gauge IVs. If unavailable, go to femoral central line (fastest, easiest to insert line; only CI is if you suspect massive IVC injury, in which case you'll have to go for IJ or subclavian) or saphenous vein cut-down. In children <4, IO (prox tibia) is second choice.
3. Shock diagnosis: 
-Hypotensive, low CVP: either hemorrhagic/hypovolemic (pancreatitis, burns, peritonitis, diarrhea) or vasomotor (i.e. anaphylaxis). Fluids will help in both, but the former will be much more responsive to fluids. Pressors will worsen things in the former, ameliorate in the latter.
-Hypotensive, high CVP: tamponade (u/s to r/o) vs tension pneumo (listen to lungs) vs cardiogenic failure from massive MI. In these cases, don't push fluids.
4. Cranial trauma:
-Linear fractures: if closed, leave to heal. If open (have wound over it) go to OR to close wound; if comminuted or depressed, go to OR to fix fracture.
-Skull base fractures: observation, no antibiotics unless indicated for some other reason, CT c-spine to evaluate for damage.
-LOC in the context of a head injury-- always get a CT to r/o bleed.
-Neurological damage from trauma comes from 3 places: initial blow, bleeding that causes midline shifts (manage surgically) and increased ICP later (manage medically).
5. Acute brain bleeds:
-Epidural: ends with fixed dilated pupil on ipsilateral side, decerebrate on opposite side. Emergency craniotomy leads to impressive recovery.
-Subdural: usually really bad trauma, really sick patient; if there is a midline shift go for craniotomy, if not, put something in to follow ICP (i.e. IVC) and manage medically to prevent more ICP: hyperventilation, fluid underload, mannitol/lasix, head of bed > 30 deg, sedation/hypothermia to decrease O2 need. Try not to drop systemic pressures so low that you start losing other organs, but realize that the brain takes priority. Prognosis is poor.
-Diffuse axonal injury: surgery only if there is hemorrhage. Otherwise maintain ICP medically.
-Chronic subdural: surgical evacuation provides rapid cure.
6. Penetrating neck trauma:
-Go to surgery only if there are signs of expanding hematoma, deteriorating vital signs, or obvious signs of esophageal/tracheal injury (coughing up blood). For GSW to upper neck, do angiograms; for lower neck, angiograms, gastrografin then barium swallow if gastrografin shows no leak, scopes of trachea and esophagus. Knife wounds: watch.
-CT c-spine for everyone
7. Spine injury:
-Transection (nothing below), Brown Sequard (lose pain/temp contra, feeling/motor ipsi): clean cut
-Anterior cord (lose STT/CST, fine DCML = no pain or temp or movement, OK positional and vibratory senses): vertebral burst fractures
-Central cord (lose STT/CST = so burning pain and paralysis in limbs): forced neck hyperextension in old people, i.e. getting rear-ended.
-MRI to evaluate, steroids (don't help if it was transected)
8. Chest injury facts:
-Rib fracture can lead to pain, atelectasis and eventually pneumonia
-Pneumothorax: chest tube anterior, superior
-Hemothorax: chest tube posterior. Lung is low pressure, bleed usually stops on its own. If > 1.5 L evacuated at beginning or >100-200 cc/hour afterwards for 4-6 hours, then a systemic vessel was probably hit (intercostal, or internal mammary), thoracotomy will be indicated.
-Sucking chest wound: occlusive dressing (taped 3 sides), chest tube
-In bad trauma, screen for internal injuries, pulm or card contusion or aortic transection/rupture in bad trauma.
-Pulm contusion: can happen immediately or 48 hours out, monitor with ABG and CXR (white out lungs). Sensitive to fluids, can get pulm edema easily, so restrict fluids, give colloids, diuretics, fluid restriction, vent support if needed.
-Cardiac contusion: suspect if you see a sternal fracture; monitor with EKG, cardiac enzymes (troponins are sensitive, send for them anytime you see sternal fracture). Watch out for arrhythmias.
-Aortic rupture: no symptoms until the adventitia ruptures, killing the patient. Suspicion must be very high. Anytime there is a big deceleration injury, injuries of hard to break bones (scapula, first rib, sternum), get a CXR. If you don't see mediastinal widening, only non-invasive tests indicated (spiral CT is fastest, can also do transesophageal echo, MRI angio). If you see mediastinal widening, still try the noninvasive tests first but aortogram is indicated if the others are inconclusive.
-Rupture of trachea/bronchus: persistent air leak in chest tube, subQ emphysema (esp upper chest/neck), dx with CXR, find lesion with bronchoscopy, intubate and go to OR. Other causes of subQ emphysema- esophageal rupture, usually in setting of endoscopy.
-Fat embolism: long bone trauma, DIC-picture: respiratory distress, petechiae (axilla/neck), fever, tachycardia, platelet consumption. Tx with respiratory support
9. X-ray will not diagnose acute osteomyeltis: even early changes like swelling or periosteal elevation may not be obvious for several days, and bone destruction will not be visible for weeks. use bone scan: "Radionuclide scanning (ie, bone scan) sensitivity: (84 to 100 percent) specificity: (70 to 96 percent) for the diagnosis of osteomyelitis in children. In addition, scintigraphy is helpful early in the course, usually readily available, relatively inexpensive, and it may not require as much sedation as MRI in young children. However, it may not perform as well in neonates or in patients with community-associated methicillin-resistant S. aureus infections, and will not reveal foci of purulence within and near bone (eg, intramedullary abscesses or muscular phlegmon) Scintigraphy is useful when: MRI is not available and imaging other than plain radiography is needed to confirm a diagnosis of osteomyelitis, The area of suspected infection cannot be localized, or Multiple areas of involvement are suspected" (from uptodate)

10. Pathologic fracture in an adult means tumor, usually mets. Bone scan, whole body PET to look for mets and primary-- in women, breast; men, prostate; smokers, lung.