Diagnosis, Management & Treatment

Question 1

What is the Major trauma?

Answer 1

A traumatic incident which may cause death or severe disability.

Question 2

Examples of Major trauma

Answer 2

• Amputation
• Severe knife wounds
• Gunshot wounds
• Multiple injuries
• Spinal injuries

Question 3

How is Major trauma measured?

Answer 3

Injury Severity Score (ISS):
1 - 8: Less severe trauma
9 - 15: Moderately severe trauma
> 15: Major trauma

Question 4

Initial patient assessment (non-radiographic)

Answer 4

• Glasgow Coma Scale (GCS):
  15-13:Mild, 12-9:Moderate, 8-3:Severe
• Oxygen Saturation
  95-100%
• Respiratory rate
  12-18
• Heart rate
  60-100bpm

Question 5

Importance of GCS

Answer 5

• Objectively describes extent of impaired consciousness
• Standardised; used all over the world

Question 6

Patient consent should be…

Answer 6

• Informed
• Voluntary
• Capacity

If not possible ‘Best interest decision’ is used by the doctor treating the patient. (Mental Capacity act; everyone is assumed to be able to provide consent unless they are assessed otherwise).

Question 7

What is polytrauma?

Answer 7

A traumatic incident which has caused injuries to at least 40% of the body.

Question 8

Members of the emergency trauma team

Answer 8

• Paramedic; usually first line of medical care for the patient
• Senior nurse; supervises other nurses
• HCA; porters, scribes
• Nurse; putting cannulas, administering drugs, places catheter if needed
• Doctor; Preps thoracotomy tray, and preps for procedures such as USS or FAST,
• Anaesthetist; assesses airways, reports to scribe, RSI, analgesia
• Rapid transfusion; Primes the RT with a small volume of crystalloid and have RBCs hanging
• Orthapaedic Surgeon; assessment of the limbs
• General Surgeon; performing fast scan
• Trauma. Team leader; hands off approach, stay with scribe, assembles team, manages resuscitation
• Radiographer; images chest and pelvis mostly

Question 9

Major Incident

Answer 9

Where you have 2 or more patients with major trauma

Question 10

Informed consent

Answer 10

Educate patient about risks, benefits and alternatives, patient should have voluntary consent

Question 11

Voluntary consent

Answer 11

Patient should make informed decision about their treatment with no pressure from staff, family or friends.

Question 12

Capacity to Consent

Answer 12

Assume anyone is able to provide consent unless assessed as otherwise.