TRAUMA - ADULT
GENERAL TRAUMA MANAGEMENT
Prompt5 priorities in preparation for arrival of sick polytrauma patient
ResponseAssemble trauma team, call external members to attend – ie surgeon, radiographer, anaesthetist, orthopaedics
Clarify plan and disposition for current patients in resuscitation area
Prepare analgesia
Prepare equipment for possible interventions – Airway: intubation, Beathing: ICC, Circulation: large bore access, haemorrhage control, FASTmscan
ONeg blood ready in trauma room, consider TXA
Clarify plan and disposition for current patients in resuscitation area
Prepare analgesia
Prepare equipment for possible interventions – Airway: intubation, Beathing: ICC, Circulation: large bore access, haemorrhage control, FASTmscan
ONeg blood ready in trauma room, consider TXA
PromptManagement priorities on big sick trauma patient arrival
ResponseConfirm tube placement- ETC02, CXR
Improve IV access - 2 large bore IV access
Minimal fluid resuscitation- blood products only. Aim MAP < 60
Neuroprotective measures - Hyperventilate to aim PCO2 35mmHg, 3mls/kg
Hypertonic 3% saline or Mannitol 1g/kg IV, Head up 30 degrees
FAST scan for source of haemodynamic instability, OR CT if stabilises with resuscitation measures
Other acceptable options- blood for group X match, control any external haemorrhage, trauma call, neurosurgical call, Ensure C-spine control
Improve IV access - 2 large bore IV access
Minimal fluid resuscitation- blood products only. Aim MAP < 60
Neuroprotective measures - Hyperventilate to aim PCO2 35mmHg, 3mls/kg
Hypertonic 3% saline or Mannitol 1g/kg IV, Head up 30 degrees
FAST scan for source of haemodynamic instability, OR CT if stabilises with resuscitation measures
Other acceptable options- blood for group X match, control any external haemorrhage, trauma call, neurosurgical call, Ensure C-spine control
PromptCauses for deterioration in polytrauma and intervention to treat (Question was weird)
ResponseHaemo/pneumothorax = Chest decompression with ICC
Intra-abdominal bleeding = FAST scanIf positive – rapid transfer to OT Damage control surgery
Pelvic fracture = Pelvic binder +/- CTA Pelvis Interventional radiology
External haemorrhage or Long bone fracture = Splinting/traction, External compression of bleeding
Intra-abdominal bleeding = FAST scanIf positive – rapid transfer to OT Damage control surgery
Pelvic fracture = Pelvic binder +/- CTA Pelvis Interventional radiology
External haemorrhage or Long bone fracture = Splinting/traction, External compression of bleeding
PromptList causes of hypotension other than haemorrhagic shock in trauma (Stem was MVA)
ResponseBlunt cardiac injury/myocardial contusion
Tamponade
Tension pneumothorax
Spinal/neurogenic-vasoplegic shock
Brain injury
Impact apnoea leading to hypoxic arrest/cardiac dysfunction
SIRS response from tissue injury
Fat/other embolism from fractures
Could also list conditions related to the cause of the trauma e.g. STEMI/dysrhythmia, drug use
Tamponade
Tension pneumothorax
Spinal/neurogenic-vasoplegic shock
Brain injury
Impact apnoea leading to hypoxic arrest/cardiac dysfunction
SIRS response from tissue injury
Fat/other embolism from fractures
Could also list conditions related to the cause of the trauma e.g. STEMI/dysrhythmia, drug use
PromptGoals of resuscitation in trauma
ResponseMaintain perfusion to vital organs (target SBP 80-100mmHg depending on concern of head injury.)
Correct or prevent development of coagulopathy (minimise crystalloid use, targeted blood product use directed by ROTEM or 1:1:1 ratio based approach)
Avoid hypothermia (by warming fluids)
Avoid acidosis (minimise crystalloid use)
Correct or prevent development of coagulopathy (minimise crystalloid use, targeted blood product use directed by ROTEM or 1:1:1 ratio based approach)
Avoid hypothermia (by warming fluids)
Avoid acidosis (minimise crystalloid use)
PromptPrinciples of fluid resuscitation in trauma (With haemorrhagic shock)
ResponseBlood Only
Matched components 1:1:1 PRBCs:Plts:FFP
Aim for maintenance of cerebral perfusion, SBP approx. 80
Identify and correct Trauma Induced Coagulopathy (ie ROTEM guided fibrinogen replacement)
TXA
Matched components 1:1:1 PRBCs:Plts:FFP
Aim for maintenance of cerebral perfusion, SBP approx. 80
Identify and correct Trauma Induced Coagulopathy (ie ROTEM guided fibrinogen replacement)
TXA
PromptMeasures to minimise coagulopathy in trauma
ResponseNormothermia / warm
Correct respiratory acidosis
(Restore volume is acceptable)
Resuscitate with blood products aiming for 1:1:1 RBC:FFP:platelets
Use ROTEM to target coagulopathy
Normal ionised Ca
Correct respiratory acidosis
(Restore volume is acceptable)
Resuscitate with blood products aiming for 1:1:1 RBC:FFP:platelets
Use ROTEM to target coagulopathy
Normal ionised Ca
PromptStem states GCS 7 post MBA. FAST +, PXR = Pelvic fracture, CXR clear. List 3 injuries
ResponseIntraabdominal fluid (FAST scan)
Major pelvic fracture with bleeding (XR)
Traumatic brain injury + intracranial haemorrhage (GCS 13>>7) - THIS WAS NOT AN IMAGE FINDING, WAS IN THE STEM. Don’t get distracted by pretty pictures!!
Major pelvic fracture with bleeding (XR)
Traumatic brain injury + intracranial haemorrhage (GCS 13>>7) - THIS WAS NOT AN IMAGE FINDING, WAS IN THE STEM. Don’t get distracted by pretty pictures!!