major trauma and triage Flashcards
What should be done if a patient has a life-threatening problem requiring immediate intervention that cannot be provided by personnel on scene?
Transport the patient to the closest appropriate medical facility.
Activation of staging via Comms is required if the medical facility is not a major trauma hospital.
What are the clinical features indicating a patient with severe traumatic brain injury (TBI) should be transported to a major trauma hospital?
- RSI is indicated for severe TBI
- Lateralising neurological signs
- Clinically obvious penetrating brain injury
Define multi-system trauma.
Major injuries to more than one body region.
Examples include multiple long bone fractures and severe facial injury.
What clinical features necessitate transport to the most appropriate major trauma hospital?
- Manageable airway obstruction
- Respiratory distress
- Shock
- Motor score less than or equal to five
- Penetrating injury to the neck or torso
- Flail chest
- Clinically obvious pelvic fracture
What is required for clinical judgement when determining manageable airway obstruction?
It must be determined that airway obstruction is manageable rather than life-threatening requiring immediate intervention.
What are the signs of shock?
- Tachycardia
- Narrowed pulse pressure
- Vasoconstriction
- Altered level of consciousness
True or False: Blood pressure is a reliable guide to the severity of shock.
False.
Blood pressure may only begin to fall when shock is severe and varies with age, sex, and other factors.
What is a motor score of the GCS that indicates a high probability of clinically important TBI?
Less than or equal to five.
What constitutes a penetrating injury to the neck or torso?
There must be a strong clinical impression that the injury has penetrated the deep tissues of the neck, thoracic cavity, or abdominal cavity.
What defines a clinically obvious pelvic fracture?
An obvious major deformity or clear evidence of a pelvic fracture visible through a wound.
What is required for a severe limb injury to meet criteria for major trauma?
Amputation or severe limb injury must occur proximal to the wrist or ankle.
What are some additional risk factors that may warrant transport to a major trauma hospital?
- Severe abdominal pain
- Severe spinal pain
- Signs of limb ischaemia
- Ejection from a vehicle
- Fall greater than three metres
- Elderly
What should be considered when determining the most appropriate major trauma hospital?
- Information within guidelines
- Patient’s expected treatment requirements
- Transport time to relevant hospitals
What is the purpose of staging in patient transport?
To provide immediate resuscitation/treatment and prepare the patient for immediate onward transport.
What is required if the patient does not meet criteria to be transported directly to a major trauma hospital?
Transport to the most appropriate medical facility capable of meeting their anticipated healthcare needs.
What should be done if a patient rapidly improves without treatment?
Assess if the patient still meets criteria for major trauma; if they do not, transport to the appropriate medical facility.
What is the clinical definition of flail chest?
Paradoxical chest wall movement with breathing.
What type of injuries does multi-system trauma include?
Major injuries to more than one body region.
What should personnel do if transport to a tertiary major trauma hospital will be prolonged?
Seek clinical advice prior to commencing transport.
What are the criteria for severe tissue disruption?
- Severe disruption of bones and/or tissue
- Poor or absent distal perfusion
Fill in the blank: Patients with __________ should be transported to a major trauma hospital with neurosurgical facilities.
[severe traumatic brain injury (TBI)]
What should be done if the medical facility is being used as a staging point?
Notify Comms and personnel in the staging facility as soon as possible.
What is the expected treatment for patients who have experienced hanging?
Transport to the most appropriate hospital, which may not be a major trauma hospital.
