Trauma

Question 1

1. Rx for haemorrhagic hypovolaemia:

Answer 1

• Control of major haemorrhage
• Mx mimics: TPT, significant pain, environmental exposure
• SBP<70: prioritise Tx, NS 250 mL/kg, repeat as required max 2000mL, consult for further, consider availability of blood products
• SBP≥70: tolerate hypotension up to 2hrs, prep for deterioration, consult for Mx if: long prehospital time, prolonged extrication, elderly/frail pt

Question 2

2. What is the Rx for traumatic chest injuries?

Answer 2

O2, pain relief, position upright unless perfusion < adeq, ACS or associated barotrauma or potential spinal injury
- Cardiac arrest imminent following TPT: GCS < 10 and BP < 70 - immediate chest decompression

Question 3

3. What is the criteria for simple pneumothorax?

Answer 3

Any of the following:

• Unequal breath sounds in spontaneously ventilating pt
• SpO2 <92% on RA
• Subcut emphysema

Question 4

4. What is the criteria for TPT?

Answer 4

• Any of the following +/- signs of simple:
  Poor perfusion - increased HR or decreased BP
  Respiratory distress in awake pt
  O2 sats decreasing <92% despite O2
  JVP increasing
  EtCO2 decreasing
  Conscious state decreasing
  Tracheal shift
  Stiff bag/increased peak inspiratory pressure

Question 5

5. What is the insertion site for chest decompression?

Answer 5

Second intercostal space
Mid-clavicular line
Above rib below
Right angles to chest
Towards body of vertebrae

Question 6

6. What is the Rx for traumatic head injury?

Answer 6

• Airway: if patent don’t insert OPA/NPA, if not consider airway position and mask seal if ventilating, suction if required and NPA
• Ventilation: 6-7mL/kg, SpO2 >95%, EtCO2 30-35
• Perfusion: NS 40mL/kg titrated unless in setting of penetrating truncal or uncontrolled overt bleeding - aim for SBP >120
  If SBP <100 after 40mL/kg, consult trauma service, or extra 20mL/kg

Question 7

7. What is the criteria for serious blunt head injury with/without LOC/amnesia and GCS 13-15:

Answer 7

1. Any LOC greater than 5mins
2. Skull fracture (depressed, open or base of skull)
3. Vomiting more than once
4. Neuro deficit
5. Seizure

Question 8

8. What is the Rx for Spinal injury?

Answer 8

• Does the pt have either major trauma criteria after blunt force to head/trunk or neuro deficit/changes?
• Apply cervical collar, extricate on combi-carrier, immobilise on vacuum/stretcher, Tx without delay
• Isolated SCI and BP <90 - NS 10mL/kg

Question 9

9. What is the modified NEXUS criteria? 7

Answer 9

• Age ≥65
• Hx of bone/muscle weakening disease/injury
• Altered conscious state
• Intoxication
• Significant distracting injury
• Midline pain/tenderness on palpation
• Unable to actively rotate neck 45deg left and right without pain

Question 10

10. What is the Rx for burns?

Answer 10

• > 15 with TBSA >15%: NS %TBSA x Pt wt = vol mL (administered over 2hrs from time of burn)
• 12-15yrs with TBSA >10%: 3 x %TBSA x Pt wt = mL (over 24hrs, first half over first 8hrs)
• Pain relief, cool burn/warm pt, appropriate dressing

Question 11

11. What is the Rx for Diving related emergencies?

Answer 11

• If onset of symptoms soon after surfacing or any cvs or neuro compromise - consider AAV support and rapid Tx to recompression facility
• Position supine/lateral
• If conscious, O2 15 L/min with NRB, unconscious use BVM
• Chest clear: NS 1000mL over 15-20mins, repeated every 4hrs

Question 12

12. What are s/s of DCI?

Answer 12

• Neurological changes
• Respiratory complaints
• Musculoskeletal pain
• Itching/blotchy rash

Question 13

13. What are the s/s of CAGE?

Answer 13

GCS<15 at any point, any seizure, any LOC - onset of symptoms up to about half an hour after resurfacing

Question 14

14. What is the specific Hx after diving emergency?

Answer 14

• No. of dives
• Surface interval between dives
• Max depth and time at bottom
• Type of ascent - controlled or rapid?
• Decompression or safety stops
• Gas mixture used
• Level of exertion during or after dive
• Symptoms presenting
• First aid provided

Question 15

15. What are the main considerations for elderly/frail fall?

Answer 15

• Low threshold for Tx for pt on anti-coagulants, if head strike pt should be Tx
• Does pt have full recollection?
• Likely due to mechanical/environmental issue that can be resolved?
• Pt able to get up without assistance?
• Are they low risk to have a subsequent fall?

Question 16

16. What are the three broad categories of fall?

Answer 16

• Environmental/mechanical: uneven ground, poor lighting, ill-suited footwear
• Known medical/pharmacological factor: postural hypotension, poor gait, confused pt, change of medication
• Unanticipated event: AMI or seizure