In severe liver injuries (class ≥III), or those with hemodynamic instability, surgical correction is generally necessary. In these severe injuries a hepatopancreatobiliary surgeon may be utilized rather than a trauma surgeon given their expertise with the organ and generally yields better outcomes. Surgical techniques such as perihepatic packing or the use of the Pringle manoeuvre can be used to control hemorrhage. Temporary control of the hemorrhage can be accomplished through direct manual pressure to the wound site. In these severe cases it is important to prevent the progression of the trauma triad of death, which often requires the utilization of damage control surgery. The common cause of death while operating is exsanguination caused by profuse loss of blood volume. Rarely, surgery entails the use of liver resection, which removes the source of the bleeding and necrotic tissue. The drastic nature of this procedure means it can only be used in hemodynamically stable patients. Another rare procedure would be liver transplantation which is typically impractical due to the logistics of finding a proper organ donor in a timely fashion.

Kousnetzoff aluminium needle is used to suture liver tear. Co-opting sutures are placed perpendicular to already placed parallel mattress sutures on either side of lacerations. Other methods are tractotomy and mesh hepatorrhaphy.

Prevention of suspension trauma is preferable to dealing with its consequences. Specific recommendations for individuals doing technical ropework are to avoid exhausting themselves so much that they end up without the energy to keep moving, and making sure everyone in a group is trained in single rope rescue techniques, especially the "single rope pickoff", a rather difficult technical maneuver that must be practiced frequently for smooth performance.

Most head injuries are of a benign nature and require no treatment beyond analgesics and close monitoring for potential complications such as intracranial bleeding. If the brain has been severely damaged by trauma, neurosurgical evaluation may be useful. Treatments may involve controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion. Second line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia. Although all of these methods have potential benefits, there has been no randomized study that has shown unequivocal benefit.

Clinicians will often consult clinical decision support rules such as the Canadian CT Head Rule or the New Orleans/Charity Head injury/Trauma Rule to decide if the patient needs further imaging studies or observation only. Rules like these are usually studied in depth by multiple research groups with large patient cohorts to ensure accuracy given the risk of adverse events in this area.

If someone is stranded in a harness, but is not unconscious or injured, and has something to kick against or stand on (such as a rock ledge or caving leg-loops) it is helpful for them to use their leg muscles by pushing against it every so often, to keep the blood pumping back to the torso. If the person is stranded in mid-air or is exhausted, then keeping the legs moving can be both beneficial and rather dangerous. On the one hand, exercising the leg muscles will keep the blood returning to the torso, but on the other hand, as the movements become weaker the leg muscles will continue to demand blood yet they will become much less effective at returning it to the body, and the moment the victim ceases moving their legs, the blood will immediately start to pool. "Pedaling an imaginary bicycle" should only be used as a last-ditch effort to prolong consciousness, because as soon as the "pedaling" stops, fainting will shortly follow. If it is impossible to rescue someone immediately, then it is necessary to raise their legs to a sitting position, which can be done with a loop of rigging tape behind the knees or specialized equipment from a rescue kit.

When workers are suspended in their safety harnesses for long periods, they may suffer from blood pooling in the lower body. This can lead to suspension trauma. Once a worker is back on the ground after a fall has been arrested on a fall protection system, a worker should be placed in the “W” position. The “W” position is where a worker sits upright on the ground with their back/chest straight and their legs bent so that their knees are in line with the bottom of their chin. For added stability, make sure that the worker’s feet stay flat on the ground. In this position, a KED board can still be used if there are any potential spinal injuries and a worker needs stabilization before transport.

Once the worker is in this position, they will need to stay in that position for at least 30 minutes. Try to leave the worker in this position until their symptoms begin to subside. The time in the “W” position will allow the pooled blood from the legs to be slowly re-introduced back into the body. By slowing the rate at which the pooled blood reaches different organs, you are giving the body more of an opportunity to filter the pooled blood and maintain internal homeostasis. http://www.rigidlifelines.com/blog/entry/suspension-traumasymptoms-and-treatment

Treatment has traditionally been splenectomy. However, splenectomy is avoided if possible, particularly in children, to avoid the resulting permanent susceptibility to bacterial infections. Most small, and some moderate-sized lacerations in stable patients (particularly children) are managed with hospital observation and sometimes transfusion rather than surgery. Embolization, blocking off of the hemorrhaging vessels, is a newer and less invasive treatment. When surgery is needed, the spleen can be surgically repaired in a few cases, but splenectomy is still the primary surgical treatment, and has the highest success rate of all treatments.

A gunshot wound (GSW) is a form of physical trauma sustained from the discharge of arms or munitions. The most common forms of ballistic trauma stem from firearms used in armed conflicts, civilian sporting, recreational pursuits and criminal activity. Ballistic trauma can be fatal or cause long-term consequences.

An immediate need in treatment is to ensure that the airway is open and not threatened (for example by tissues or foreign objects), because airway compromisation can occur rapidly and insidiously, and is potentially deadly. Material in the mouth that threatens the airway can be removed manually or using a suction tool for that purpose, and supplemental oxygen can be provided. Facial fractures that threaten to interfere with the airway can be reduced by moving the bones back into place; this both reduces bleeding and moves the bone out of the way of the airway. Tracheal intubation (inserting a tube into the airway to assist breathing) may be difficult or impossible due to swelling. Nasal intubation, inserting an endotracheal tube through the nose, may be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube could be forced through it and into the brain. If facial injuries prevent oraotracheal or nasotracheal intubation, a surgical airway can be placed to provide an adequate airway. Although cricothyrotomy and tracheostomy can secure an airway when other methods fail, they are used only as a last resort because of potential complications and the difficulty of the procedures.

A dressing can be placed over wounds to keep them clean and to facilitate healing, and antibiotics may be used in cases where infection is likely. People with contaminated wounds who have not been immunized against tetanus within five years may be given a tetanus vaccination. Lacerations may require stitches to stop bleeding and facilitate wound healing with as little scarring as possible. Although it is not common for bleeding from the maxillofacial region to be profuse enough to be life-threatening, it is still necessary to control such bleeding. Severe bleeding occurs as the result of facial trauma in 1–11% of patients, and the origin of this bleeding can be difficult to locate. Nasal packing can be used to control nose bleeds and hematomas that may form on the septum between the nostrils. Such hematomas need to be drained. Mild nasal fractures need nothing more than ice and pain killers, while breaks with severe deformities or associated lacerations may need further treatment, such as moving the bones back into alignment and antibiotic treatment.

Treatment aims to repair the face's natural bony architecture and to leave as little apparent trace of the injury as possible. Fractures may be repaired with metal plates and screws. They may also be wired into place. Bone grafting is another option to repair the bone's architecture, to fill out missing sections, and to provide structural support. Medical literature suggests that early repair of facial injuries, within hours or days, results in better outcomes for function and appearance.

Surgical specialists who commonly treat specific aspects of facial trauma are oral and maxillofacial surgeons. These surgeons are trained in the comprehensive management of trauma to the lower, middle and upper face and have to take written and oral board examinations covering the management of facial injuries.

The initial management of liver trauma generally follows the same procedures for all traumas with a focus on maintaining airway, breathing, and circulation. A physical examination is a corner stone of the assessment of which there are various non-invasive means of diagnostic tools that can be utilized. An invasive diagnostic peritoneal lavage can also be used to diagnose and classify the extent of the damage. A large majority of liver injuries are minor and require only observation. Generally if there is estimated to be less than 300mL of free floating fluid, no injury to surrounding organs, and no need for blood transfusion, there is a low risk of complication from nonoperative management. In special cases where there is a higher risk with surgery, such as in the elderly, nonoperative management would include the infusion of packed red blood cells in an intensive care unit. Typically hepatic injuries resulting from stab wounds cause little damage unless a vital part of the liver is injured such as the hepatic portal vein, with gunshot wounds, the damage is worse.

The degree of tissue disruption caused by a projectile is related to the size of the temporary versus permanent cavity it creates as it passes through tissue. The extent of cavitation, in turn, is related to the following characteristics of the projectile:

- Kinetic energy: KE = 1/2"mv" (where "m" is mass and "v" is velocity). This helps to explain why wounds produced by missiles of higher mass and/or higher velocity produce greater tissue disruption than missiles of lower mass and velocity.

- Impulse: IMP = "mv". The impulse is working in a couple with kinetic energy, featuring the same characteristics

- Yaw

- Deformation

- Fragmentation

The immediate damaging effect of a gunshot wound is typically severe bleeding, and with it the potential for hypovolemic shock, a condition characterized by inadequate delivery of oxygen to vital organs. In the case of traumatic hypovolemic shock, this failure of adequate oxygen delivery is due to blood loss, as blood is the means of delivering oxygen to the body's constituent parts. Devastating effects can result when a bullet strikes a vital organ such as the heart or lungs, or damages a component of the central nervous system such as the spine or brain.

Common causes of death following gunshot injury include exsanguination, hypoxia caused by pneumothorax, catastrophic injury to the heart and larger blood vessels, and damage to the brain or central nervous system. Additionally, gunshot wounds typically involve a large degree of nearby tissue disruption and destruction due to the physical effects of the projectile. Non-fatal gunshot wounds frequently have severe and long-lasting effects, typically some form of major disfigurement and/or permanent disability.

Gunshot injuries can vary widely from case to case since the location of the injury can be in any part of the body, with wide variations in entry point. Also, the path and possible fragmentation of the bullet within the body is unpredictable. The study of the dynamics of bullets in gunshot injuries is called terminal ballistics.

As a rule, all gunshot wounds are considered medical emergencies that require immediate treatment. Hospitals are generally required to report all gunshot wounds to police.

Measures to reduce facial trauma include laws enforcing seat belt use and public education to increase awareness about the importance of seat belts and motorcycle helmets. Efforts to reduce drunk driving are other preventative measures; changes to laws and their enforcement have been proposed, as well as changes to societal attitudes toward the activity. Information obtained from biomechanics studies can be used to design automobiles with a view toward preventing facial injuries. While seat belts reduce the number and severity of facial injuries that occur in crashes, airbags alone are not very effective at preventing the injuries. In sports, safety devices including helmets have been found to reduce the risk of severe facial injury. Additional attachments such as face guards may be added to sports helmets to prevent orofacial injury (injury to the mouth or face); mouth guards also used.

Available evidence suggests that treatment depends on the part of the femur that is fractured. Traction may be useful for femoral shaft fractures because it counteracts the force of the muscle pulling the two separated parts together, and thus may decrease bleeding and pain. Traction should not be used in femoral neck fractures or when there is any other trauma to the leg or pelvis. It is typically only a temporary measure used before surgery. It only considered definitive treatment for patients with significant comorbidities that contraindicate surgical management.

When there is no pancreatic duct injury, typically hemostasis and surgical drainage are the main form of treatment. Surgical repair is undertaken when there is evidence or suspicion of ductal injury. The type of surgery depends on the degree of the injury and its proximity to the mesenteric blood vessels that serve the pancreas. When injuries are not close to the mesenteric vessels, a distal pancreatectomy may be done; this procedure preserves much of the pancreas and usually avoids loss of its endocrine and exocrine functions. In severe cases of pancreaticoduodenal injury, a pancreaticoduodenectomy can be used. Common complications after surgery include pancreatitis, pancreatic fistula, abscess, and pseudocyst formation. Initial management of hemorrhage includes controlling it by packing the wound.

A 2015 Cochrane review found that available evidence for treatment options of distal femur fractures is insufficient to inform clinical practice and that there is a priority for a high-quality trial to be undertaken. Open fractures must undergo urgent surgery to clean and repair them, but closed fractures can be maintained until the patient is stable and ready for surgery.

The injury severity score (ISS) is a medical score to assess trauma severity. It correlates with mortality, morbidity, and hospitalization time after trauma. It is used to define the term "major trauma" (polytrauma), recognized when the ISS is greater than 15. The AIS Committee of the Association for the Advancement of Automotive Medicine designed and updates the scale.

Since the diaphragm is in constant motion with respiration, and because it is under tension, lacerations will not heal on their own. Surgery is needed to repair a torn diaphragm. Most of the time, the injury is repaired during laparotomy. Other injuries, such as hemothorax, may present a more immediate threat and may need to be treated first if they accompany diaphragmatic rupture. Video-assisted thoracoscopy may be used.

The aim of treatment is to minimize pain and to restore as much normal function as possible. Most humerus fractures do not require surgical intervention. One-part and two-part proximal fractures can be treated with a collar and cuff sling, adequate pain medicine, and follow up therapy. Two-part proximal fractures may require open or closed reduction depending on neurovascular injury, rotator cuff injury, dislocation, likelihood of union, and function. For three- and four-part proximal fractures, standard practice is to have open reduction and internal fixation to realign the separate parts of the proximal humerus. A humeral hemiarthroplasty may be required in proximal cases in which the blood supply to the region is compromised. Fractures of the humerus shaft and distal part of the humerus are most often uncomplicated, closed fractures that require nothing more than pain medicine and wearing a cast or sling for a few weeks. In shaft and distal cases in which complications such as damage to the neurovascular bundle exist, then surgical repair is required.

In children with uncomplicated minor head injuries the risk of intra cranial bleeding over the next year is rare at 2 cases per 1 million. In some cases transient neurological disturbances may occur, lasting minutes to hours. Malignant post traumatic cerebral swelling can develop unexpectedly in stable patients after an injury, as can post traumatic seizures. Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover, while those who are vegetative for months are less likely to improve. Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer's disease later in life.

Head injury may be associated with a neck injury. Bruises on the back or neck, neck pain, or pain radiating to the arms are signs of cervical spine injury and merit spinal immobilization via application of a cervical collar and possibly a long board.If the neurological exam is normal this is reassuring. Reassessment is needed if there is a worsening headache, seizure, one sided weakness, or has persistent vomiting.

To combat overuse of Head CT Scans yielding negative intracranial hemorrhage, which unnecessarily expose patients to radiation and increase time in the hospital and cost of the visit, multiple clinical decision support rules have been developed to help clinicians weigh the option to scan a patient with a head injury. Among these are the Canadian Head CT rule, the PECARN Head Injury/Trauma Algorithm, and the New Orleans/Charity Head Injury/Trauma Rule all help clinicians make these decisions using easily obtained information and noninvasive practices.

The World Health Organization (WHO) 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. These codes allow the identification of distributions of injuries in specific populations and case identification for more detailed research on causes and preventive efforts.

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.

The Orchard Sports Injury Classification System (OSICS) is used to classify injuries to enable research into specific sports injuries.

Despite the success of goggles and lenses against ballistic and secondary trauma, BLPS, SPECS, and SWDG forms of eye armor do not protect against primary-blast injuries. The space between the lenses and the eyes promotes sonic wave diffraction, and current efforts to eradicate ocular trauma due to the primary blast wave have been unsuccessful due to this lens-eye air interface.

Vehicle occupants who wear seat belts have a lower incidence of TBI after a motor vehicle accident. However, if the strap is situated across the front of the neck (instead of the chest), this increases the risk of tracheal injury. Design of medical instruments can be modified to prevent iatrogenic TBI, and medical practitioners can use techniques that reduce the risk of injury with procedures such as tracheotomy.

A number of psychotherapy approaches have been designed with the treatment of trauma in mind—EMDR, progressive counting (PC), somatic experiencing, biofeedback, Internal Family Systems Therapy, and sensorimotor psychotherapy.

There is a large body of empirical support for the use of cognitive behavioral therapy for the treatment of trauma-related symptoms, including posttraumatic stress disorder. Institute of Medicine guidelines identify cognitive behavioral therapies as the most effective treatments for PTSD. Two of these cognitive behavioral therapies, prolonged exposure and cognitive processing therapy, are being disseminated nationally by the Department of Veterans Affairs for the treatment of PTSD. Recent studies show that a combination of treatments involving dialectical behavior therapy (DBT), often used for borderline personality disorder, and exposure therapy is highly effective in treating psychological trauma. If, however, psychological trauma has caused dissociative disorders or complex PTSD, the trauma model approach (also known as phase-oriented treatment of structural dissociation) has been proven to work better than simple cognitive approach. Studies funded by pharmaceuticals have also shown that medications such as the new anti-depressants are effective when used in combination with other psychological approaches.

Trauma therapy allows processing trauma-related memories and allows growth towards more adaptive psychological functioning. It helps to develop positive coping instead of negative coping and allows the individual to integrate upsetting-distressing material (thoughts, feelings and memories) resolve internally. It also aids in growth of personal skills like resilience, ego regulation, empathy...etc.

Process' involved in trauma therapy are:

- Psychoeducation: Information dissemination and educating in vulnerabilities and adoptable coping mechanisms.

- Emotional regulation: Identifying, countering discriminating, grounding thoughts and emotions from internal construction to an external representation.

- Cognitive processing: Transforming negative perceptions and beliefs to positive ones about self, others and environment through cognitive reconsideration or re-framing.

- Trauma processing: Systematic desensitization, response activation and counter-conditioning, titrated extinction of emotional response, deconstructing disparity (emotional vs. reality state), resolution of traumatic material (state in which triggers don't produce the harmful distress and able to express relief.)

- Emotional processing: Reconstructing perceptions, beliefs and erroneous expectations like trauma-related fears are auto-activated and habituated in new life contexts, providing crisis cards with coded emotions and appropriate cognition's. (This stage is only initiated in pre-termination phase from clinical assessment & judgement of the mental health professional.)

- Experiential processing: Visualization of achieved relief state and relaxation methods.

The first line of treatment is often to treat the patients pain with neuropathic drugs such as tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants. The second lines of drugs to treat pain are non-steroidal anti-inflammatories, tramadol, and opioids. Other techniques used to facilitate healing of the nerve and pain are either static or dynamic splinting that can both help protect the injured part as well as improve function. Sometimes surgery is an option, although the prognosis is still very poor of regaining function of the affected nerve. The goal of surgery is to join healthy nerve to unhealthy nerve. The most common surgical techniques include external neurolysis, end-to-end repair, nerve grafting, and nerve transfer from somewhere else in the body.

Post-operative care for patients with blast-related ocular trauma occurs in tertiary care facilities. Patients with closed globe injuries require observation and follow-up examination with an optometrist, including slit lamp microscope and dilated fundus inspection. Those who have been treated for open-globe repairs often experience a delay of post-operative treatment that ranges from 10–14 days after injury. This period is due to the treatment of other life-threatening injuries, as well as the necessity for accurate estimation of visual acuity outside of inflammation due to injury and surgical intervention.

In patients with facial burns, exposure keratopathy, or chronic epiphora, an ophthalmologist may suggest eyelid reconstruction surgery. Depending on the severity of physical trauma sustained, surgical realignment of the extraocular muscles may relieve strabismus. Realignment of the extraocular muscles is also indicated in chronic diplopia that occurs within 20-degrees of the visual field. All patients that have sustained a traumatic brain injury in the absence of ocular trauma are still recommended to obtain examination by an optometrist. Outside of the treatment facility, these patients must monitor any signs of late-onset ocular pathologies secondary to the bTBI, including decreased visual/reading ability and speed, photophobia, blurred vision, reduced accommodation abilities, and headaches.

Non-septic prepatellar bursitis can be treated with rest, the application of ice to the affected area, and anti-inflammatory drugs, particularly ibuprofen. Elevation of the affected leg during rest may also expedite the recovery process. Severe cases may require fine-needle aspiration of the bursa fluid, sometimes coupled with cortisone injections. However, some studies have shown that steroid injections may not be an effective treatment option. After the bursitis has been treated, rehabilitative exercise may help improve joint mechanics and reduce chronic pain.

Opinions vary as to which treatment options are most effective for septic prepatellar bursitis. McAfee and Smith recommend a course of oral antibiotics, usually oxacillin sodium or cephradine, and assert that surgery and drainage are unnecessary. Wilson-MacDonald argues that oral antibiotics are "inadequate", and recommends intravenous antibiotics for managing the infection. Some authors suggest surgical irrigation of the bursa by means of a subcutaneous tube. Others suggest that bursectomy may be necessary for intractable cases; the operation is an outpatient procedure that can be performed in less than half an hour.

Treatment of TBI varies based on the location and severity of injury and whether the patient is stable or having trouble breathing, but ensuring that the airway is patent so that the patient can breathe is always of paramount importance. Ensuring an open airway and adequate ventilation may be difficult in people with TBI. Intubation, one method to secure the airway, may be used to bypass a disruption in the airway in order to send air to the lungs. If necessary, a tube can be placed into the uninjured bronchus, and a single lung can be ventilated. If there is a penetrating injury to the neck through which air is escaping, the trachea may be intubated through the wound. Multiple unsuccessful attempts at conventional (direct) laryngoscopy may threaten the airway, so alternative techniques to visualize the airway, such as fiberoptic or video laryngoscopy, may be employed to facilitate tracheal intubation. If the upper trachea is injured, an incision can be made in the trachea (tracheotomy) or the cricothyroid membrane (cricothyrotomy, or cricothyroidotomy) in order to ensure an open airway. However, cricothyrotomy may not be useful if the trachea is lacerated below the site of the artificial airway. Tracheotomy is used sparingly because it can cause complications such as infections and narrowing of the trachea and larynx. When it is impossible to establish a sufficient airway, or when complicated surgery must be performed, cardiopulmonary bypass may be used—blood is pumped out of the body, oxygenated by a machine, and pumped back in. If a pneumothorax occurs, a chest tube may be inserted into the pleural cavity to remove the air.

People with TBI are provided with supplemental oxygen and may need mechanical ventilation. Employment of certain measures such as Positive end-expiratory pressure (PEEP) and ventilation at higher-than-normal pressures may be helpful in maintaining adequate oxygenation. However, such measures can also increase leakage of air through a tear, and can stress the sutures in a tear that has been surgically repaired; therefore the lowest possible airway pressures that still maintain oxygenation are typically used. Mechanical ventilation can also cause pulmonary barotrauma when high pressure is required to ventilate the lungs. Techniques such as pulmonary toilet (removal of secretions), fluid management, and treatment of pneumonia are employed to improve pulmonary compliance (the elasticity of the lungs).

While TBI may be managed without surgery, surgical repair of the tear is considered standard in the treatment of most TBI. It is required if a tear interferes with ventilation; if mediastinitis (inflammation of the tissues in the mid-chest) occurs; or if subcutaneous or mediastinal emphysema progresses rapidly; or if air leak or large pneumothorax is persistent despite chest tube placement. Other indications for surgery are a tear more than one third the circumference of the airway, tears with loss of tissue, and a need for positive pressure ventilation. Damaged tissue around a rupture (e.g. torn or scarred tissue) may be removed in order to obtain clean edges that can be surgically repaired. Debridement of damaged tissue can shorten the trachea by as much as 50%. Repair of extensive tears can include sewing a flap of tissue taken from the membranes surrounding the heart or lungs (the pericardium and pleura, respectively) over the sutures to protect them. When lung tissue is destroyed as a result of TBI complications, pneumonectomy or lobectomy (removal of a lung or of one lobe, respectively) may be required. Pneumonectomy is avoided whenever possible due to the high rate of death associated with the procedure. Surgery to repair a tear in the tracheobronchial tree can be successful even when it is performed months after the trauma, as can occur if the diagnosis of TBI is delayed. When airway stenosis results after delayed diagnosis, surgery is similar to that performed after early diagnosis: the stenotic section is removed and the cut airway is repaired.