skills Flashcards
Chest decompression
Indications:
- Suspected TPT including traumatic arrest
Considerations:
- Bilateral: right then left
- SMART AMBO
Neurovascular assessment
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.
CAT tourniquet
Indications:
- Haemorrhage uncontrolled by basic measures
Contraindications:
- Haemorrhage can be controlled using basic measures
SAM splint
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
Anatomical splint
Indications:
- suspected noff
- support pelvic splint
- leg injuries not otherwise managed
CT-6 splint
Indications:
- middle third femur fractures
- upper two third tibia fractures
Contraindications:
- knee trauma
- ankle/foot trauma
Slings
Standard arm sling: ulna, radius and wrist
High arm sling: upper arm and hand injuries
Cuff and collar sling: clavicle and shoulder injuries
Formable splint
Indications:
- ulna, radius, humerus fractures
- ankle and lower leg fractures
- knee
Rhythm analysis
P waves present and P-Q interval (0.12-0.2)
QRS complex
Traumatic CPR
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
Weight calculations
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
Joules calculations
Weight x 4 (round up)
Fluid calculation
Isolated spinal injury: 10mL/kg (<90mmHg)
TBI: 40mL/kg (aim >120mmHg)
Trauma arrest hypovolaemia: 20mL/kg
OPA
Indications:
- Need for airway by shifting tongue anteriorly
Contraindications:
- Trismus
- Intact gag reflex
- Suspected neurological injury
NPA
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
SGA
Indications:
- Unconscious patient needing airway support and requiring ventilations for >10 minutes
- Ineffective OPA with BVM
Contraindications:
- Gag reflex
- Upper airway obstruction
- Trismus
Ogastric insertion
Indications:
- Patient with SGA or intubation inserted
Time critical guidelines
Vital signs actual time critical
Specific injuries
Mechanism of injury
Co-morbidities
PILSDUCT
Pain Irregularity Loss of movement Swelling Deformity Unnatural movement Crepitus Tenderness
Nexus
Pass if:
- No posterior midline cervical spinal tenderness
- No evidence of intoxication
- Normal level of alertness
- No focal neurological deficit
- No painful distracting injuries
Modified Nexus
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
Ottowa Ankle Rules
- 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
PEEP
Indications:
- Any adult using a BVM
Contraindications:
- Paeds
- Adults in cardiac arrest
- TBT, current or decompressed
