اذا وقع حادث مروري لشخص ما وهو على دراجة نارية وتم اسعافة الى مستشفى وتبين

Initial Management and Resuscitation: On hospital arrival, the critical priority is to secure the airway, breathing, and circulation following the ATLS and NICE major trauma guidelines. If the patient cannot maintain airway or ventilation, perform drug-assisted rapid sequence intubation (RSI) as soon as possible, ideally within 45 minutes of injury, preferably at the scene or immediately on hospital arrival NICE NG39. If RSI fails, employ basic airway maneuvers and airway adjuncts or surgical airway as needed NICE NG39. Provide oxygen therapy and monitor respiratory status continuously.

Hemorrhage Control: Control external bleeding by applying direct pressure and, if necessary, tourniquets for major limb hemorrhage refractory to pressure. For suspected pelvic fractures with active bleeding, apply a purpose-made pelvic binder immediately to reduce pelvic volume and tamponade bleeding NICE NG37,NICE NG39. Intravenous tranexamic acid should be administered as soon as possible in patients with major trauma and active or suspected bleeding, ideally within the first 3 hours post-injury NICE NG39,NICE NG37. Prompt activation of a massive hemorrhage protocol may be required given the critical condition.

Fracture Stabilization: Temporarily immobilize suspected fractures using appropriate splints such as traction splints for fractures above the knee or vacuum splints for other long bone fractures NICE NG37. Elevate limbs and regularly monitor neurovascular status to detect complications such as compartment syndrome, maintaining vigilance for the first 48 hours after injury NICE NG37. Avoid irrigating open fractures until operative debridement, and cover open wounds with saline-soaked dressings in the pre-hospital setting NICE NG37.

Imaging and Diagnostic Work-up: Perform urgent whole-body CT scanning in stable patients or after initial resuscitation in unstable patients if feasible, to identify fractures, vascular injury, and bleeding sources NICE NG39. Use chest X-ray and eFAST ultrasound to assess for pneumothorax, hemothorax, or pericardial tamponade NICE NG39. Post-intervention imaging may be necessary to detect delayed complications such as delayed hemothorax and guide further interventions Hao et al. 2025.

Management of Vascular Injury and Bleeding: Use clinical signs such as absent pulses, expanding hematoma, or active bleeding to diagnose major vascular injury, and do not rely solely on capillary refill or Doppler signals NICE NG37. Immediate surgical exploration is indicated for persistent hard signs of vascular injury after limb alignment. In devascularized limbs, vascular shunts may temporize perfusion before definitive repair NICE NG37. Early surgical or endovascular control of bleeding is critical. If endovascular repair is not feasible due to thrombosis or anatomy, conservative management with close monitoring, delayed anticoagulation, and selective use of inferior vena cava filters can be effective for venous injuries as shown in recent case series Alnuaimi et al. 2026.

Chest Trauma Management: In case of tension pneumothorax with hemodynamic instability, perform emergency chest decompression followed by chest tube insertion NICE NG39. Open pneumothoraces should be covered with occlusive dressings and monitored for progression. Repeat imaging is essential to identify delayed hemothorax, which may occur even hours after initial assessment and necessitate drainage or embolization Hao et al. 2025.

Fluid Resuscitation: Administer warmed isotonic crystalloid cautiously to maintain perfusion while avoiding dilutional coagulopathy. Early blood product transfusion is preferred according to massive hemorrhage protocols. Monitor hemodynamics and laboratory markers to guide ongoing resuscitation NICE NG39.

Pain Management and Sedation: Provide adequate analgesia using multimodal pain control strategies, cautiously monitoring for respiratory compromise in critical patients NICE NG37,NICE NG39.

Monitoring and Complication Prevention: Continuous monitoring for signs of compartment syndrome, worsening hemorrhage, neurological deterioration, or respiratory compromise is mandatory. Conduct regular neurovascular assessments of injured limbs and neurological status using tools such as Glasgow Coma Scale or AVPU as appropriate NICE NG37,Abady et al. 2026.

Multidisciplinary Care and Definitive Management: Multidisciplinary teams involving orthopaedics, vascular surgery, trauma surgery, radiology, and critical care should coordinate to plan definitive fracture fixation, vascular repair, or embolization NICE NG37,Alnuaimi et al. 2026. Damage control surgery may be necessary in unstable patients. Early mobilisation and rehabilitation planning should begin once the patient stabilizes NICE CKS.

Transfer and Documentation: Identify the appropriate receiving facility, preferably a major trauma centre with orthoplastic and vascular capabilities. Use structured handover protocols and trauma documentation datasets to ensure continuity of care NICE NG37,Abady et al. 2026. Thorough documentation is essential for medico-legal and quality improvement purposes.