Trauma

Question 1

Categories of trauma call out criteria

Answer 1

mechanism

injuries

signs

treatment (pre-hospital)

other

Question 2

Trauma call out criteria: mechanism

Answer 2

MBA/cyclist >30km/h

Pedestrian impact >30km/h

Extrication >30 mins

vehicle roll-over

fatality in same vehicle

ejection from vehicle

fall >3m

explosion

Question 3

Trauma call out criteria: injuries

Answer 3

• all significant injuries assessed by ambulance
• all penetrating injuries (excluding limbs)
• all injuries involving:
  
  • suspected spinal
  • traumatic limb amputation (proximal to carpus/tarsus)
  • fractured pelvis / pulseless limb / fracture-dislocation
  • evisceration
  • crush injury
  • burns >20% TBSA or facial

Question 4

Trauma call out criteria: signs

Answer 4

SaO2 <90%

RR <10 or >30

SBP <100mmHg

GCS <14

Question 5

Trauma call out criteria: treatment

Answer 5

any airway manoeuvre

assisted ventillation

pleural decompression

haemostatic dressing/torniquet

>1000mL IV fluids

Question 6

Trauma call out criteria: other

Answer 6

mass casualty incident

>1 patient simultaneously

all inter-hospital transfers

pregnancy

significant co-morbidity

anticoagulants

Question 7

NEXUS criteria

Answer 7

“NSAID”

(focal) neurological deficit
(midline) spinal tenderness

altered mental status

intoxication

distracting injury

excludes cervical spine fracture without CT

Question 8

Canadian C spine rule

Answer 8

1. No high risk factors
   
   • ≥65 years old
   • dangerous mechanism
     
     • fall >1m/5 stairs
     • axial loading
     • MVA >100km/h, rollover or ejection
     • motorized recreational vehicle
     • bicycle
   • paraesthesias in extremities
2. ≥1 low risk factor
   
   • simple rear-end
   • sitting position
   • ambulatory at any time
   • delayed-onset neck pain
   • no midline cervical tenderness
3. Active neck rotation ≥45°

Excludes cervical spine fracture without CT

Question 9

Canadian C spine rule: test characteristics

Answer 9

Sensitivity: 100%

Specificity: 42.5%

(for clinically significant spinal fracture)

Question 10

NEXUS criteria: test characteristics

Answer 10

Sensitivity: 90.7%

Specificity: 13%

For clinically significant spinal fracture

Source

Question 11

Body surface area (Wallace formula)

Answer 11

Source

Question 12

Goals of massive transfusion resuscitation

Answer 12

platelets >50

INR <2

fibrinogen ≥1

haemoglobin >80

temperature >35ºC

Question 13

Initial products to be administered in massive transfusion

Answer 13

4 units PRBC

2 units FFP

1 unit platelets

cryoprecipitate if fibrinogen <1g/L

tranexamic acid 1g stat then 500mg/hour IV