Trauma

Front 1

3 things that increase mortality in trauma

Back 1

1. Hypothermia

2. Acidosis

3. Coagulopathy

Front 2

What is the cornerstone of trauma care (2)

Back 2

Pain management

Minimise time from injury to definitive care

Front 3

Life threatening injuries to be managed as an immediate priority

Back 3

Airway

Chest

Haemorrhage

Pelvis

Spinal trauma

Front 4

Target scene time for non-trapped major trauma patients

Back 4

Less than 20 mins- begin moving towards definitive care once the most life saving measures are completed

Front 5

Things to be considered/ completed during rapid transport to hospital

Back 5

Splinting

IV access

Analgesia

Fluid administration

Patient warming

Front 6

When should a spinal injury be strongly suspected

Back 6

In the unconcious patient

In the concious patient complaining of spinal pain and/or neurological symptoms

Front 7

What patients are not managed under the haemorrhagic hypovolaemia CPG

Back 7

TBI

Isolated SCI

APH

PPH

Front 8

Patients with a BP of <70 generally present with

Back 8

Absent radial pulse and decreased alertness

Front 9

In patient with chest injuries and IPPV or persistent hypotension despite fluid always consider

Back 9

Tension pneumothorax

Front 10

Should you delay transport for IV therapy in haemorrhagic hypovolaemia?

Back 10

No

Front 11

Haemorrhagic hypovolaemia guideline applies to:

Back 11

Suspected AAA rupture

GIT haemorrhage

And pregnant trauma (consult PIPER for APH associated with trauma)

Front 12

First priority of haemorrhagic hypovolaemia

Back 12

Prioritise control of major haemorrhage over all other interventions

Front 13

Potential mimics of hypovolaemia that should be managed

Back 13

TPT

Pain

Environmental exposure (heat/cold)

Front 14

Management of a patient with a SBP >70mmHg with suspected haemorrhagic hypovolaemia

Back 14

Tolerate hypotension without fluid replacement for up to 2 hours

Prepare for deterioration

Consult with clinician if:

- Long pre hospital times

- prolonged extrication

- elderly/ frail pts

Front 15

Management of patient with SBP <70mmHg with suspected haemorrhagic hypovolaemia

Back 15

Prioritise immediate Tx

N/Saline 250ml IV

- Repeat 250ml as required (max 2L)

- Titrate to SBP >70mmHg

Consult for further Mx if inadequate response

Consider availability of blood products

Front 16

Management of pain associated with rib fractures

Back 16

May lead to hypoventilation

Carefully titrate analgesia

Front 17

TPT is highly likely in patients with...

Back 17

Generic signs and symptoms of TPT

And

Subsequent deterioration in respiratory status and/or concious state

Front 18

TPT in the ventilated the patient is more likely to

Back 18

Develop rapidly with a sudden drop in BP and Sp02

Front 19

Patients with chest injuries recieving IPPV have a high risk of TPT. What should first be done prior to managing decreased perfusion?

Back 19

Bilateral chest decompression

Front 20

Does equal air entry exclude the possibility of TPT?

Back 20

No

Front 21

Insertion site for intercostal catheter/ ARS

Back 21

S econd intercostal space

M id clavicular line

A bove the 3rd rib below

R ight angle to the chest

T owards the spine

A ir ✔

M ix ✔

B lood ❌

Out

Front 22

Catheter troubleshooting

Back 22

Catheter may kink off as lung inflates and patient may re tension

Catheter may clott off: flush with normal saline

Front 23

Initial management of chest injury patients:

Back 23

O2 as per CPG

Pain relief

Position upright of possible (less than adequate perfusion, SCI, barotrauma etc.)

Front 24

Management of flail segment/ rib fractures

Back 24

May require ventilatory support if tidal volume inadequate

Front 25

Definition of flail segment

Back 25

3 or more contiguous ribs fractured in 2 or more places

Front 26

Management of open chest wound

Back 26

Do not occlude open pneumothorax

Appropriate dressing only if required for haemorrhage

Front 27

Criteria for simple pneumothorax and Mx

Back 27

Unequal breath sounds in spontaneously ventilating patient

Sp02 <92% on RA

Subcutaneous emphysema

Mx as per chest injuries and monitor closely for TPT

Front 28

Criteria for TPT

Back 28

Any of the following with or without signs of simple PT:

Respiratory distress

Sp02 <92% despite 02

Decreasing conscious stae

Increasing HR and Decreasing BP

Stiff bag when ventilating

Decreasing EtC02

Increased JVP

Tracheal shift

Front 29

Management of TPT

Back 29

Cardiac arrest imminent (GCS <10 and SBP <70mmHg):

Immediate chest decompression

Front 30

Main care objectives in patient with traumatic head injury

Back 30

Optimise oxygenation, ventilation and cerebral perfusion pressure

Front 31

Trauma time critical guidelines are met if patient has serious blunt trauma to a single body region. A patient is considered to have a serious blunt head injury when:

Back 31

With or without LOC and GCS 13-15 with any of:

5 mins LOC

H head/ skull fracture

E misis (more than once)

D eficit (neuro)

S eizure activity

Front 32

Patients who are at high risk and should not be underestimated:

Back 32

Elderly/ frail standing height falls on anticoagulants or antiplatelt therapy and/or have a bleeding disorder

Intoxicated patients standing height falls

Front 33

How to manage combativeness and severe agitation:

Back 33

Judicious opioid pain relief

Or

ketamine as per Severe agitation

Front 34

Assessment of head injury

Back 34

Time critical head injury

Or

Other head injury

Pupil response

Front 35

Airway management of traumatic head injury

Back 35

If airway patent: do not insert airway

If airway not patent, consider:

- Airway positioning/ mask seal

- suction

-NPA

- MICA for intubation

If intubation not available and no gag reflex: insert SGA

Front 36

Traumatic head injury ventilation and oxygenation

Back 36

Tidal volume: 6-7ml/kg

Sp02: aim for >95%

EtC02: 35-45 mHg

Reverse causes of hypoxia and avoid hypo/ercapnia

Front 37

Traumatic head injury perfusion management

Back 37

N/Saline 40ml/kg IV titrated to pt response (unless penetrating trauma or uncontrolled bleeding)

Aim for SBP >120mmHg

If SBP <100mmHg after 40ml/kg:

- Consult trauma service

- If not available, 20ml/kg IV

Front 38

Additional general care of traumatic head injury

Back 38

Reverse seizures

Manage pain

Monitor for hypoglycaemia

Tx to major trauma service if meeting criteria

Front 39

If collar is not achieving desired support (pt anatomy, agitation):

Back 39

Adjust, loosen, remove collar or support patient in a position of comfort

(if patient cannot be calmed)

Front 40

Assessment of any MOI with the potential to cause SCI

Back 40

Do they meet major trauma criteria afyer major blunt force trauma to head or trunk

Do they have any neurological deficits or changes?

Front 41

Management of suspected SCI or major trauma

Back 41

Prophylactic antiemetic

C-collar

Extricate on combi carrier

Immobilise on stretcher

Tx as per TTCG

Front 42

Mx of isolated SCI with SBP <90mmHg

Back 42

N/Saline 10ml/kg IV

Front 43

Nexus criteria

Back 43

Age >65

Significant distracting injury

Muscle or bone weakening disease

Intoxication

Altered conscious state

Midline pain on palpation

Pt unable to rotate neck 45 degrees L or R

Front 44

Mx of patient merting any 1 of NEXUS criteria

Back 44

Prophylactic antiemetic

C- collar

Co sider self extrication

Immobilise on stretcher