skills

Question 1

Chest decompression

Answer 1

Indications:
- Suspected TPT including traumatic arrest

Considerations:

• Bilateral: right then left
• SMART AMBO

Question 2

Neurovascular assessment

Answer 2

Indications: assess after applying a sling or splint to ensure adequate perfusion to the limb, also checking if the injury has affected the perfusion to that region.

Includes:
Distal pulse, temperature of skin, colour of skin, capillary refill time, sensation, movement.

Question 3

CAT tourniquet

Answer 3

Indications:
- Haemorrhage uncontrolled by basic measures

Contraindications:
- Haemorrhage can be controlled using basic measures

Question 4

SAM splint

Answer 4

Indications:

• suspected pelvic fracture
• patient complaining of groin/abdo/back pain
• unconscious patient with serious mechanism of injury
• traumatic arrest

Contraindications:
- penetrating injury to pelvis affecting application

Question 5

Anatomical splint

Answer 5

Indications:

• suspected noff
• support pelvic splint
• leg injuries not otherwise managed

Question 6

CT-6 splint

Answer 6

Indications:

• middle third femur fractures
• upper two third tibia fractures

Contraindications:

• knee trauma
• ankle/foot trauma

Question 7

Slings

Answer 7

Standard arm sling: ulna, radius and wrist
High arm sling: upper arm and hand injuries
Cuff and collar sling: clavicle and shoulder injuries

Question 8

Formable splint

Answer 8

Indications:

• ulna, radius, humerus fractures
• ankle and lower leg fractures
• knee

Question 9

Rhythm analysis

Answer 9

P waves present and P-Q interval (0.12-0.2)

QRS complex

Question 10

Traumatic CPR

Answer 10

MARCH
Major trauma: CAT, SAM, quick-clot etc
Airway: insertion of SGA
Respirations: ventilate with BVM
Chest decompressions: bilateral right to left
Hypovolaemia management: administer 20mL/kg

Nil response: continue as medical cardiac arrest

Question 11

Weight calculations

Answer 11

PAEDS

<24 hours: 3.5kg
3 months: 6kg
6 months: 8kg
1 year: 10kg
1-9: age x2 +8
10-11: age x 3.3

Question 12

Joules calculations

Answer 12

Weight x 4 (round up)

Question 13

Fluid calculation

Answer 13

Isolated spinal injury: 10mL/kg (<90mmHg)
TBI: 40mL/kg (aim >120mmHg)
Trauma arrest hypovolaemia: 20mL/kg

Question 14

OPA

Answer 14

Indications:
- Need for airway by shifting tongue anteriorly

Contraindications:

• Trismus
• Intact gag reflex
• Suspected neurological injury

Question 15

NPA

Answer 15

Indications:
- Need for airway control in unconscious patient with trismus

Contraindications:

• Middle third facial trauma
• Nasal trauma
• TBI or neurological injury where airway+tidal are fine

Question 16

SGA

Answer 16

Indications:

• Unconscious patient needing airway support and requiring ventilations for >10 minutes
• Ineffective OPA with BVM

Contraindications:

• Gag reflex
• Upper airway obstruction
• Trismus

Question 17

Ogastric insertion

Answer 17

Indications:

- Patient with SGA or intubation inserted

Question 18

Time critical guidelines

Answer 18

Vital signs actual time critical

Specific injuries

Mechanism of injury

Co-morbidities

Question 19

PILSDUCT

Answer 19

Pain
Irregularity
Loss of movement
Swelling
Deformity
Unnatural movement
Crepitus
Tenderness

Question 20

Nexus

Answer 20

Pass if:

• No posterior midline cervical spinal tenderness
• No evidence of intoxication
• Normal level of alertness
• No focal neurological deficit
• No painful distracting injuries

Question 21

Modified Nexus

Answer 21

Increased risk: >65 years old, bone/muscle disease
Difficult assessment: unconscious, intoxicated, distracting injury
Actual evidence: midline pain, tenderness, palp
Neck motion: unable to look 45º L+R without pain

Question 22

Ottowa Ankle Rules

Answer 22

• Unable to bear weight on the foot
• Bony tenderness in the following
  1. Posterior edge of the lateral malleous
  2. Posterior edge of the medial malleous
  3. Base of the 5th metatarsal
  4. Navicular

Question 23

PEEP

Answer 23

Indications:
- Any adult using a BVM

Contraindications:

• Paeds
• Adults in cardiac arrest
• TBT, current or decompressed