Time Critical Guidelines

Question 1

Adult time critical VSS in the setting of potential major trauma (AKA actual time critical)

Answer 1

• HR <60 or >120
• RR <10 or >30
• SBP <90
• SpO2 <90%
• If 16 yrs and older and GCS <13
• If 15yrs and younger and GCS <15

Question 2

Specific injuries meeting potential major trauma criteria (adults)

Answer 2

1. All penetrating injuries except isolated superficial limb injuries
2. Blunt injuries
   - Serious injury to a single body region that may require specialised care or intervention, or that may risk, life, limb, or quality of life.
   - Significant injuries involving more than one body region
3. Specific injuries
   - Limb amputation or limb threatening injury
   - Suspected SCI or fracture
   - Burns >20% or >10% if 15yrs and under, or resp tract burns
   - High voltage (>1000 volts) burn injury
   - Serious crush injury
   - Major compound fracture or open dislocation
   - # to 2 or more of femur/tibia/humerus
   - # pelvis

Question 3

High risk criteria for adults (emergent)

Answer 3

MOI:
- motor/cyclist impact >30km/hr
- MVA >60km
- Pedestrian impact
- Ejection from vehicle 
- Prolonged extrication 
- Fall from height >3m
- Struck on head by object falling >3m
- Explosion 
WITH CO-MORBIDITIES: 
- Age <12 or >55
- Pregnant 
- Significant underlying medical condition

Question 4

Examples of significant underlying medical conditions in emergent criteria for adults

Answer 4

• Poorly controlled HTN
• Obesity
• CCF
• Symptomatic COPD
• IHD
• Chronic renal failure or liver disease

Question 5

Abnormal VSS meeting major trauma criteria in paediatrics <12yrs

Age 0-3mths

Answer 5

• HR <100 or >180
• RR >60
• SBP <50
• SpO2 <90%
• GCS <15 or less than Alert

Question 6

Abnormal VSS meeting major trauma criteria in paediatrics <12yrs

Age 4-12mths

Answer 6

• HR <100 or >180
• RR >50
• SBP <60
• SpO2 <90%
• GCS <15 or less than Alert

Question 7

Abnormal VSS meeting major trauma criteria in paediatrics <12yrs

Age 1-4yrs

Answer 7

• HR <90 or >160
• RR >40
• SBP <70
• SpO2 <90%
• GCS <15 or less than Alert

Question 8

Abnormal VSS meeting major trauma criteria in paediatrics <12yrs

Age 5-11yrs

Answer 8

• HR <80 or >140
• RR >30
• SBP <80
• SpO2 <90%
• GCS <15 or less than Alert

Question 9

Paediatric specific injuries meeting potential major trauma

Answer 9

1. All penetrating injuries except isolated superficial limb injuries
2. Blunt injuries
   - Serious injury to a single body region that may require specialised care or intervention, or that may risk, life, limb, or quality of life.
   - Significant injuries involving more than one body region
3. Specific Injuries
   - Limb amputations or limb threatening injuries
   - Serious crush injury
   - Suspected SCI or fracture
   - Burns >10% or suspected resp tract burns
   - High voltage burn injury
   - Major compound fracture or open dislocation
   - Fracture to 2 or more of femur/tibia/humerus
   - Fractured pelvis

Question 10

Paediatric high risk criteria for major trauma

Answer 10

• Motor/cyclist impact >30km/hr
• MVA >60km
• Pedestrian impat
• Ejection from vehicle
• Prolonged extrication
• Fall from height >3m
• Struck on head by object falling >3m
• Explosion