Trauma and burns
Structured assessment of the injured patient, head, chest and spinal trauma, and burns. Australian trauma training follows the EMST (ATLS) approach.
High-yield points
Primary survey: control catastrophic haemorrhage, then Airway with C-spine protection, Breathing, Circulation, Disability, Exposure.
Tension pneumothorax: immediate decompression; in adults the 4th/5th intercostal space anterior to the mid-axillary line is now preferred.
Haemorrhagic shock: permissive hypotension, tranexamic acid within 3 hours, activate massive transfusion protocol.
Head injury: use GCS; Canadian CT head rule decides imaging; watch anticoagulated patients closely.
C-spine: Canadian C-spine rule or NEXUS to decide imaging.
Burns first aid: cool running water for 20 minutes, useful up to 3 hours after injury; remove jewellery; cover with cling film.
Burns referral: over 10% TBSA in adults (5% in children), full thickness, or burns to face, hands, feet, genitals, perineum or major joints, plus inhalation or circumferential burns.
Remember non-accidental injury in children and elder abuse when the mechanism does not fit.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Primary survey | ATLS principles. | Largely the same; taught as EMST (the RACS version of ATLS). |
| Mechanisms | Two-wheeler road crashes, falls and assault dominate. | Road trauma, farm injuries (quad bikes, machinery) and drowning are major themes. |
| Rural trauma | Patients travel or are referred to a tertiary centre. | Long-distance retrieval by the Royal Flying Doctor Service or state services, so stabilisation and packaging for transfer is examined. |
| Medico-legal | Register a medico-legal case (MLC) and inform police. | No MLC system; police are not automatically informed. Report certain deaths to the coroner; blood alcohol rules vary by state. |
Primary survey
India (MBBS)
ATLS principles.
Australia (AMC): what the exam expects
Largely the same; taught as EMST (the RACS version of ATLS).
Mechanisms
India (MBBS)
Two-wheeler road crashes, falls and assault dominate.
Australia (AMC): what the exam expects
Road trauma, farm injuries (quad bikes, machinery) and drowning are major themes.
Rural trauma
India (MBBS)
Patients travel or are referred to a tertiary centre.
Australia (AMC): what the exam expects
Long-distance retrieval by the Royal Flying Doctor Service or state services, so stabilisation and packaging for transfer is examined.
Medico-legal
India (MBBS)
Register a medico-legal case (MLC) and inform police.
Australia (AMC): what the exam expects
No MLC system; police are not automatically informed. Report certain deaths to the coroner; blood alcohol rules vary by state.
The Australian context
Road trauma, farm injuries (quad bikes, machinery) and drowning are major causes of trauma in Australia. Rural patients are often retrieved long distances by the Royal Flying Doctor Service or state retrieval services, so stabilisation for transfer is a real exam theme.