CPG Special Notes

Question 1

What is the target scene time for a non-trapped major trauma patient?

Answer 1

<20mins

Question 2

What alternative signs can you use to measure a rough BP?

Answer 2

Absence of radial pulses and decreased alertness indicate a BP of <70

Question 3

What are the co-morbidities for potential time criticality?

Answer 3

• Age <12 or >55
• Pregnancy
• Systemic illness limiting normal activity
• – Poorly controlled hypertension
• – Obesity
• – Controlled or uncontrolled CCF
• – Symptomatic COPD
• – IHD
• – CRF or liver disease

Question 4

What are the vital signs for Actual Time Critical guidelines?

Answer 4

• HR < 60 or > 120
• RR < 10 or > 30
• Systolic BP < 90mmHg
• SpO2 < 90%
• If >/= 16 then GCS < 13
• If < 16 then GCS < 15

Question 5

What are the criteria for Emergent Time Critical patients?

Answer 5

• All penetrating injuries
• Serious blunt injury to a single body region
• Significant blunt injuries involving more than one body system
• Limb amputation/threatening injury
• Suspected SCI or spinal fracture
• Burns > 20% TBSA (> 10% if <16yo) or suspected respiratory tract burns
• High voltage (1000V) burn injuries
• Serious crush injuries
• Major compound fracture or open dislocation
• Fracture to 2 or more of femur/tibia/humerus
• Fractured pelvis

Question 6

What are the criteria for Potential Time Critical patients?

Answer 6

• Motor/cyclist impact > 30kph
• High speed MVA > 60kph
• Pedestrian impact
• Ejection from vehicle
• Prolonged extrication (> 30mins)
• Fall from height > 3m
• Struck on head by object falling > 3m
• Explosion

Question 7

What are the time critical guidelines for a small infant?

Answer 7

HR <100 or >180
RR >60
BP <50
SpO2 <90%
GCS <15

Question 8

What are the time critical guidelines for a large infant?

Answer 8

HR <100 or >180
RR >50
BP <60
SpO2 <90%
GCS <15

Question 9

What are the time critical guidelines for a small child?

Answer 9

HR <90 or >160
RR >40
BP <700
SpO2 <90%
GCS <15

Question 10

What are the time critical guidelines for a medium child?

Answer 10

HR <80 or >140
RR >30
BP <80
SpO2 <90%
GCS <15

Question 11

When should burn cooling be stopped?

Answer 11

-If patient begins to shiver or their temp is = 35

Question 12

When can a serious blunt head injury be suspected, with or without LOC and GCS 13-15?

Answer 12

• any LOC >5mins
• skull fracture
• vomiting more than once
• neurological deficits
• seizure

Question 13

What should be done when combativeness is preventing preoxygenation?

Answer 13

• all other preparations for RSI should be undertaken

- small (20-40mg) bolus of ketamine may be given

Question 14

Which vertebral disease and spinal abnormalities should you be wary of when assessing a potential spinal injury?

Answer 14

• Ankylosing spondylitis
• Spinal stenosis
• Spinal fusion
• Previous c-spine injury
• Rheumatoid arthritis

Question 15

What is the breakdown of the rule of 9s?

Answer 15

• Head = 9%
• Torso = 18% front + 18% back
• Arm = 9% each (total circumference)
• Leg = 18% each (total circumference)
• Groin = 1%

Question 16

What is the major trauma criteria with respect to burns?

Answer 16

• > 20% TBSA (adults)
• > 10% TBSA (<15yo)
• suspected airway burns
• > 1000V electrical burns

Question 17

What signs indicate neurological or vascular compromise in a fracture or dislocation scenario?

Answer 17

• altered sensation
• loss of pulse
• cold/dusky skin

Question 18

What are the general principles of reducing a fracture?

Answer 18

• provide procedural analgesia
• irrigate with 500mL - 1L of NS prior to reduction
• apply traction and gentle counter-traction in the line of the limb
• if required, further manipulation should be done while the limb is still under traction
• splint the limb following reduction

Question 19

What are the general principles of relocating a dislocation?

Answer 19

• provide procedural analgesia
• apply sustained traction in the longitudinal direction away from the joint
• have an assistant providing counter-traction above the site of injury