What is the definition of trauma?
- injury to living tissue caused by extrinsic forces
- a disordered psychic or behavioural state resulting from severe mental or emotional stress or physical injury
- an agent, force or mechanism that causes trauma
What is the definition of an injury?
physical damage that results when a human body is suddenly subjected to energy that exceed the threshold of physiological tolerance.
what are some consequences of injuries and violence?
physical injuries
mental consequences
behavioural changes
HIV, STD’s, unwanted pregnancies
what are the leading causes of deaths trending from 2012 - 2030?
Road traffic injuries increasing
Suicide will decrease
Falls going to increase
Who is more at risk at road traffic, suicide and homicide from men and women?
Men
what are the largest causes of death for people aged 15-29 globally?
- road traffic
2. suicide
What is the WHO plan for road safety?
- prehospital care system
2 - Hospital trauma care systems
3 - early rehabilitation and support to trauma patients and those bereaved
what categorises major trauma in the state trauma system?
- death after injury
- admission to ICU for more than 24 hours, requiring period of assisted ventilation
- serious injury to two or more body systems
- urgent surgery to intracranial, intrathoracic or intraabdominal injury
- fixation for pelvic or spinal fractures
- paediatric trauma for all children up to 16 years old
What hospitals are vicotiras major trauma centres?
- the alfred
- the royal melbourne
- the royal childrens
what are the pre hospital vital signs for major trauma?
Adult: HR <60 - >120 RR <10 - >30 BP <90 Spo2 <90% GCS <13
What are the actual TCG value?
Adult: HR <60 - >120 RR <10 - >30 BP <90 Spo2 <90% >16 :GCS <13 <16: GCS <15
What are the emergent injury types for the TCGs?
Blunt injuries:
- serious injury to a single body region
- significant injuries involving more than one body region
Specific injuries:
- Limb amputation or limb threatening injury
- spinal cord injury or spinal fracture
- burns >20%
- respiratory tract burns
- High voltage burns
- Serious crush injury
- major compound fracture or open dislocation
- Fracture to 2 or more long bones
- Fractured pelvis
Crush Limb amputation Open dislocation Burns Blunt injury Spinal cord LIGHTING
What are the potential mechanisms in the TCGS?
Motor/cyclist impact >30kph High speed MVA >60kph Pedestrian impact Ejection from vehicle Prolonged extrication Fall from height >3 Struck on head >3m Explosion
+ age <12 >55
Preggers or
significant co-morbidity
3, 3, 30, 30, 60, P, E, E
what are the barriers to adequate pain management?
Caregiver’s belief
Characteristics of pain management
System barriers
What is the dose of paracetamol for paeds?
15mg/kg
What is the fentanyl IN dose for paeds?
small child (10-17kg) = 25mcg IN medium child (18 - 39kg) = 25-50mcg IN
Repeat dose every 5 - 10 minutes
Consult after 3 doses
What are the contraindications of paracetemol?
- hypersensitivity
- <1 month
- administered already in last 4 hrs
- intake in last 24hrs exceeds 4g or 60mg/kg (paeds)
- chest pain in suspected ACS
What is the presentation of paracetemol?
500mg tablet
120mg in 5ml liquid (24mg/ml)
What is the presentation of methxyflurane?
3mL glass ampule
What are the contras for methoxy?
- renal disease
- concurrent use of tetracycline antibiotics
- total dose of 6mL in last 24 hrs
- Malignant hyperthermia history
- muscular dystrophy
what are the side effects of methoxy?
drowsiness
decrease in BP
Bradycardia
exceeding max dose may lead to renal toxicity
What are the side effects of paracetemol?
hypersensitivity reactions
haematological reactions
What is the presentation of Morphine?
10mg in 1mL
What are the contraindications of morphine?
- renal disease/failure
- hypersensitivity
- late second stage labour
