Preparation for a trauma call?
- Get equipments for ABC
- Trauma alert call
- Oxygen and suction
- Warmed IV fluids
- Local capabilities
Other information which might be required when expecting a trauma call?
- Vital signs (BP, HR & sats)
- GCS
- Treatment at scene
- ETA
What are the important pre-hospital interventions in trauma
- Airway maintenance
- Control of bleeding & shock
- Immobilization of patient
- Transfer to appropriate facility
- Minimization of scene time
What are the critical aspects of hospital preparation?
- Availability of a resuscitation area
- Functioning airway equipment
- Warm crystalloid fluids
- Protocol to summon additional assistance
- Agreement with verified trauma centres
Components of the initial assessment ?
- Preparation
- Triage
- Primary survey + Resuscitation (A-E)
- Adjuncts to primary survey
- Consider transfer
- Re-evaluation
Components of the secondary survey?
- Head to toe examination
- Patient history
- Adjuncts to secondary survey
Other components after Primary & Secondary survey?
- Post-resuscitation evaluation
- Definitive care
What are the important information required by the receiving facility ?
- Time of injury
- Events related to injury
- Patient history and vital signs
- Mechanism of injury
What are the pre-hospital interventions ?
- Supplemental oxygen
- 2 large bore cannulas
- IV fluids
- Immobilization of the spine
- Secure airway if required
What are the goals of primary survey ?
Identify and treat life threatening injuries in priority of threat to life and simultaneous resuscitation
What is the sequence of primary survey?
- Airway & C-spine
- Breathing & ventilation
- Circulation & haemorrhage control
- Disability: Neurological status
- Exposure & environmental control
The sequence of the 10 sec assessment ?
- Introduce yourself
- Ask what the patient’s name is ?
- Ask the patient what happened?
What are the major circulatory issues to consider in trauma patients?
- Blood volume
- Cardiac output
- Bleeding
What are the signs of compromised circulation?
- GCS
- Skin color & temperature
- Pulse rate & character
Assessment of disability?
- GCS
- Pupils
- Lateralizing signs
- Signs of spinal cord injury
What are the main goals of disability management?
- Prevention of secondary brain injury
- Maintaining oxygenation
- Maintaining perfusion
What tests should be performed pre-transfer?
- Only tests which facilitate safe transfer
- Investigations requested by receiving hospital
What caution should be taken when checking saturations in a patient suffering from inhalation injury?
Carboxyhaemoglobin could cause falsely high saturation
What are the adjuncts to primary survey?
- Vital signs
- ETCO2
- ABG
- Imaging (XR, CT, FAST & DPL)
- Urinary or gastric catheter
- Urine output
How do you exclude possible urethral or bladder injury?
Retrograde urethrogram before catheterization
What is the significance of urinary output?
- Volume status
- Renal perfusion
Indications and advantages of a gastric catheter ?
- Decreases abdominal distention & risk of aspiration
- Identification of hidden injury such as diaphragmatic herniation
- GI haemorrhage
What is the importance of XR investigations?
- Identification of occult injury not visible
- Chest & Pelvis only
How can we identify intra-abdominal blood?
- FAST & eFAST - Operator dependent
