MVA Flashcards
A 29-year-old woman is brought in by ambulance having been extricated from a crashed motor vehicle. The paramedics tell you that she got herself out of the car before they arrived, but she seems confused and disorientated. They have placed her in a cervical collar. How would you assess and manage her?
Impression High-impact MVA, would conduct assessment and management as per all trauma presentations. Concerned about; - C-spine - Head and facial injuries - TBI - Intracranial bleed - Tension pneumothorax - intra-abdominal injuries (seat-belt)
Goals
- conduct thorough primary and secondary surveys to identify existing injuries
- institute appropriate emergent management of injuries, prevent complications
MVA - Assessment
Assessment
- begin with primary survey
- assemble team prior to patient arrival and assign roles (airway, circulation, leader, etc)
- conduct eFAST scan concurrently (looking for free fluid and pneumothoraces)
A - patient, maintaining - adjuncts
- suction
- c-spine protection - avoid chin lift
-
B - RR, sats - supplement
C - 2xIVC
- Take initial bloods: VBG, FBC, group + cross match, UEC
- ECG, CXR at bedside
- e FAST for internal bleeding
D - GCS
- utilise Canadian C-Spine rule for assessment
E - secondary survey assessing for other injuries
F - fluid replacement, like with like (if significant blood loss)
- activate MTP if required
MVA - History
History
- MIST AMPLE (mechanisms, injuries, symptoms, treatments, allergies, medications, PMHx, last meal, environment)
- collateral history as available
MVA - Examination/investigation
Examination/Investigation
- General obs + vitals
- Bedside: ECG, VBG, eFAST
- Bloods: FBC, group + crossmatch, UEC LFT, lipase, BSL
- Imaging: CXR, trauma series X-Ray, CT-B (once stable)
MVA - Management
Management
- Emergency assessment and resuscitation as above
- urgent transfer to theatre or retrieval to major trauma centre if required/ ongoing haemodynamic instability despite treatment
