BEH TCGs Flashcards
Define the 3 Time Criticality definitions and their relation to trauma and medical guidelines
Actual - VSS shows actual physiological distress
Emergent - Pattern of injury or significant medical condition
Potential - Mechanism of Injury
Trauma uses all three
Medical uses Actual and emergent
To reach the criteria for Major Trauma patients with a MOI must also have co-morbidities constituting:
- Pregnancy
- Age <15 or >55
- Systemic illness limiting normal activity or a systemic illness constant threat to life eg:
Poorly controlled HT
Morbid obesity
Congestive Cardiac Failure
Ischemic Heart Disease
Chronic renal failure or liver disease
An Adult patient having suffered a major trauma would require what vital signs to be considered
Actual TIme Critical
Adult Actual Time Critical VSS
Respiratory Rate <12 or > 24
BP < 90 mmHg sytolic
Pulse > 124
GCS < 13
O2 Saturation < 90%
Any patient fitting the criteria for Actual Trauma Time Critical whould require what action?
Actual Trauma Time Critical Action
Triage to the highest level of trauma service within 30 min
Consider MICA/ Aeromedical Support
For a patient paediatric or adult to fit the Emergent Trauma TCGs what pattern of injuries are required:
First describe the three styles of injury and then their constituents.
Emergent TCGs POI
Penetrating Injuries
Head/ Neck/ Chest/ Abdomen/ Pelvis/ Axilla/ Groin
Blunt Injuries
Significant injury to a single region:
- Head/ Chest/ Abdo/ Axilla/ Groin
Injuries involving two or more of the above body regions
Specific Injuries
Limb amputations/ limb threatening injuries
Suspected spinal cord injury
Burns >20% or involving respiratory tract
Serious Crash injury
Major compound fracture or open dislocation
Fracture of two or more of: Femur/ Tibia/ Humerus
Fractured Pelvis
Any patient paediatric or adult fitting the Emergent Trauma TCGs with normal VS would require what action?
Emergent Trauma TCG Action
Triage to the highest level of trauma service within 30 min
Consider MICA/ Aeromedical support
What Mechanisms of Injury MOI contribute to a potentially time critical classification:
Describe the Adult MOIs and then the three additional MOIs that apply to paediatrics
MOIs
Paediatric and Adult
- Ejection from vehicle
- Motor/ cyclist impact > 30km/h
- Fall from hight > 3m
- Stuck on head by falling object > 3m
- Explosion
- High Speed MCA > 60km/h
- Pedestrian Impact
- Prolonged Extraction > 30min
Exclusively Paediatric
- Vehicle rollover
- Fatality in same vehicle
If an adult has normal VS and no POI but postive MOI and positive Co-morbidities
OR
A paediatric has normal VS and no POI but postive MOI
What action is required?
Potentially TC Action
Triage to the Highest level of trauam service within 30min
If a paediatric or adult pateint has normal VS, no pattern of injury and no MOI
What action is required?
Potential Time Critical No MOI
Triage to nearest appropriate facility if required
An adult patient shows positive MOI and no co-morbidities with normal VSS and no POI
What action is require?
Potentially TC: MOI, no Co-morb
Triage to nearest appropriate facility with notification
A Newborn (<2/ 52) would be considered actual time critical with what vital signs:
Newborn (<2/52) Actual Time Critical VSS
- RespR - < 40 or > 60
- BP - NA
- Pulse - <100 or >170
- ConSt - GCS < 15
- O2Sat - NA
- Skin - Cold/ Pale/ Clammy
An Infant (<1 year) to be Actual trauma TC would present with what Vital Signs:
Infant (<1 year) Actual Time Critical VSS
- RespR - < 20 or > 50
- BP - <60mmHg
- Pulse - <90 or >170
- ConSt - GCS < 15
- O2Sat - NA
- Skin - Cold/ Pale/ Clammy
A Child (1-8 yrs) after sustaining a major trauma would be classified as Actual Time Critical with what Vital Signs:
Child (1 - 8 yrs) Actual Time Critical VSS
- RespR - < 20 or > 35
- BP - <70mmHg
- Pulse - <75 or >130
- ConSt - GCS < 15
- O2Sat - NA
- Skin - Cold/ Pale/ Clammy
A large child (9 - 15 years) presenting after a major trauma would require what VS to be categorised as Actual Time Critical
Large Child (9 -15 yrs) Actual Time Critical VSS
- RespR - < 15 or > 25
- BP - <80mmHg
- Pulse - <65 or >100
- ConSt - GCS < 15
- O2Sat - <90%
- Skin - Cold/ Pale/ Clammy
To be classified as actual medical time critical what vital signs would warrent such as classification:
Actual Medical Time Critical
- Moderate or Severe Respiratory Disetress
- O2 Saturation <90% RA or <93% sup O2
- < Adequate Perfusion
- GCS < 13 (unless normal for pateint)
A patient with normal VS what medical conditions would class a patient as Emergent Medical Time Critical:
Emergent Medical Time Critical
Hypothermia / Hyperthermia
Need for possible hyperbaric treatment
Medical Symptoms or Syndromes:
- Acute coronary syndrome
- Acute Stroke
- Sever Sepsis inc suspected meningoccocal disease
- Possible Abdominal Aoritic Aneurysm
- Undiagnosed sever pain
For both Actual and Emergent Medical Time critical guidlines what actions are required for a paitient that meets these classifications:
Medical TCG Action
Triage to nearest appropriate facility with notification
Consider MICA/ Aeromedical Support
Describe the Golden Hour and the Trimodal Distribution of death
Describe the 5 types of motor vehicle collision patterns:
Motor Vehicle Collision Patterns
- Head on/ frontal impact
- Rear
- Lateral
- Rotational
- Rollover
Describe the Three phases of pedestrian impact:
AND
Describe the Waddells triad of padestrian impact
Three phases of pedestrian impact MOI:
- *1:** Bumper hits lower extremity
- *2:** Pedestrian hits bonnet of car (chest, abdo, head)
- *3:** Pedestrain falls to ground (further head, chest, extermity injuries)
Weddells Triad or Pedestrian impact injuries:
- *1:** knee/ femur
- *2:** Chest
- *3:** Head
Name the injury stages of blast injuries
Blast Injuries
Primary Injury
Associated with pressure waves in air. Eg myocardial contusion, shearing of cardiac vessel, ruptured eardrum
Secondary Injury
Due to fragments. Eg penetrating injuries, lacerations, abrasions, contusions, fractures, avulsions and amputations
Teritary Injury
Results from person being displaced
Quaternary Injury
Due to building collapse, hypothermia, toxic effects of chemicals
Children can have a delayed shock response, once the limit of compensation is reached, a child will deteriorate very rapidly.
Number of anatomical differences cause this, describe these:
MOI and Paediatrics
- Large head on weak neck
- Large hands relative to body
- Smaller airways
- Soft laryngeal cartilage
- Ribs more compliant (therefore greater risk of damage to underlying structures.)
- Large abdo
Describe the Important components and structure of a SITREP
SITREP
- Call Sign
- Request Code
- Patient Particulars
- Main Presenting Problem
- Observations - relevant ones
- Mx Interventions
- Your current/ next actions
- Location considerations
- Request ETA from back up - as required
Seasme street style say the Phonic Alphabet!!
Phonic Alphabet
- *A**lpha
- *B**ravo
- *C**harlie
- *D**elta
- *E**cho
- *F**oxtrot
- *G**olf
- *H**otel
- *I**ndia
- *J**uliet
- *K**ilo
- *L**ima
- *M**ike
- *N**ovember
- *O**scar
- *P**apa
- *Q**uebec
- *R**omeo
- *S**ierra
- *T**ango
- *U**niform
- *V**ictor
- *W**hiskey
- *X**-Ray
- *Y**ankee
- *Z**ulu
