CPG's & management

Question 1

As per the Trauma time critical guidelines, list all specific injuries (3 sections +9)

Answer 1

1) All penetrating injuries (except isolated superficial limb injuries)
2) Blunt injuries
-Serious injury to single body region such that specialised care or intervention may be required or such that life, limb or long term quality of life may be at risk
-Significant injuries involving >1 body region
3) Specific injuries
-Limb amputation or limb threatening injury
-Suspected SCI or spinal #
-Burns >20% TBSA (>10% if <15yo)
-Suspected airway tract burns
-High voltage (>1000 volts) burn injury
-Serious crush injury
-Major compound # or open dislocation
-2 or more femur/tibia/humerus #
-Pelvic #

Question 2

As per the Trauma time critical guidelines, list all high risk criteria (8+3)

Answer 2

MOI:
-Motorbike/cyclist impact >30km/hr
-High speed MCA >60km/hr
-Pedestrian impact
-Ejection from vehicle
-Prolonged extrication
-Fall from height >3m
-Struck on head by falling object >3m
-Explosion
AND Co-morbidities:
Age <12yo or >55yo
Pregnant
Significant underlying medical condition

Question 3

In the time critical trauma guidelines, what does significant medical condition refer to?

Answer 3

Poorly controlled HTN
Obesity
Controlled & uncontrolled CCF
Symptomatic COPD
IHD
Chronic renal failure or liver disease

Question 4

In the Time critical guidelines what does Actual, emergent & potential mean & what do they indicate in terms of transport?

Answer 4

Actual: At the time of VSS the patient is in actual physiological distress.
-If only vital is reduction in GCS in pt >65yo post fall <1m in metro= tx to nearest metro NSurg facility
**Otherwise transport to highest level trauma service within 60min (<15yo paed major trauma service)
Emergent: Not currently in physiological distress however has a pattern of injury or significant medical condition which has high probability of deterioration.
**Tx to highest level trauma service <60min (<15yo Paed major trauma service)
Potential: Not in distress & no significant pattern of injury but MOI has potential to deteriorate to actual distress.
**Transport to highest level trauma service <60min (<15yo paed major trauma service)

Question 5

How do you manage suspected epiglottitis?

Answer 5

• Do not examine throat.
• Do not distress this child.
• Only attempt a full vital signs survey if the child is willing. -Oxygen (if the child is compliant).
  -Position - sit up on parent’s lap.
• Transport rapidly to a Paediatric facility with notification.

Question 6

What is the management for a patient with severe croup

Answer 6

• Rest and reassurance (this is so important for both parent and child in this case. If the child is distressed with your assessment then they are likely to have an increased workload and therefore and increased oxygen demand).
• +/- MICA
• Oxygen therapy 15L via NRB (if the child will tolerate it).
  -Position (with parent and upright)
• 5mg/5ml Adrenaline nebulised 5/60 until symptoms improve
  -Reassess
  -150mcg/kg or 600mcg/kg Dexamethasone oral
  -Reassess
  -Extricate to warm environment
  -Transport with notification
  -Reassess 5/60

Question 7

What techniques can we use to clear a foreign object obstruction from a choking child?

Answer 7

If foreign body and partial obstruction - do not attempt removal, maintain basic care and prepare for transport.
If foreign body and complete obstruction - attempt manual removal techniques.
-Gravity.
-Finger sweep.
-Back slaps – not on newborns. -
Lateral chest thrusts.
-Laryngoscope (only adults) and magills forceps.

Question 8

For paediatric chest injuries what is the preferred position & in what circumstance would you not have them in this position?

Answer 8

< Adequate perfusion
Altered conscious state
Associated barotrauma
Potential SCI

Question 9

As per CPG P-Chest injury, what is the mx for flail segment/rib #’s?

Answer 9

1. Rapport & reassurance
2. Reposition upright
   UNLESS < adequate perfusion, altered conscious state, associated barotrauma or potential SCI
3. MICA - analgesia & risk of deterioration
4. 15L 02 via NRB (Major Trauma)
5. +/- Assisted ventilation with BVM if flail segment/rib #’s
6. -Fentanyl IN
   Small child (10-17kg) 25mcg
   Medium child (18-39kg) 25-50mcg
   -Methoxyflurane 3ml inhaler (moderate-severe)
   -Paracetamol 15mg/kg suspension (if 10-11 tablet)
7. Reassess pt
8. Extrication
   -Evac mat
   -Pat slides
   -WC
   -Stretcher
9. Time to MICA
10. Notify receiving hospital
11. Reassess 5/60

Question 10

As per the CPG P-Chest injury, what is the mx for open chest wound

Answer 10

1. Rapport & reassurance
2. Reposition upright
   UNLESS < adequate perfusion, altered conscious state, associated barotrauma or potential SCI
3. MICA - analgesia & risk of deterioration
4. 15L 02 via NRB (Major Trauma)
5. Apply dressing- rolled gauze or trauma pad (quick clot) 3min direct pressure then bandage if open chest wound
   DO NOT OCCLUDE OPEN PNEUMOTHORAX
6. -Fentanyl IN
   Small child (10-17kg) 25mcg
   Medium child (18-39kg) 25-50mcg
   -Methoxyflurane 3ml inhaler (moderate-severe)
   -Paracetamol 15mg/kg suspension (if 10-11 tablet)
7. Reassess pt
8. Extrication
   -Evac mat
   -Pat slides
   -WC
   -Stretcher
9. Time to MICA
10. Notify receiving hospital
11. Reassess 5/60