The Multiply Injured Patient

Question 1

Paramedic Handover

Answer 1

• Time of injury
• Mechanism of injury
• Suspected serious injuries
• Vital signs
• Interventions carried out

Question 2

Trauma Assessment

Answer 2

• Primary survey
  
  • ABC - detects and treats immediate threats to life
• Secondary survey
  
  • Identification of all injuries and more detailed history

Question 3

ATLS (advanced trauma life support)

Answer 3

• Airway with C-spine control
• Breathing with O2
• Circulation with haemorrhage control
• Disability
• Expose and environment
• Glucose

Question 4

BATLS (battlefield advanced training life support)

Answer 4

• “C ABCs”
• catastrophic haemorrhage control

Question 5

Catastrophic haemorrhage control

Answer 5

• Haemorrhage leading cause of death in military trauma (ballistic/explosive)
• Delays in treating haemorrhage while assessing A and B led to deterioration
• Novel ways of stopping/reducing haemorrhage led to large increase in survival

Question 6

Airway and C-spine control

Assessment

Answer 6

• Noises
  
  • Speech
  • Gurgling
  • Stridor
• Visual
  
  • Swelling/deformity
  • Vomit/blood/debris

Question 7

Airway management

Answer 7

• Manoeuvres
• Suction
• Adjuncts
• Advanced procedures (intubation checklists)

Question 8

C-spine - assume injury in:

Answer 8

• Dangerous mechanism
• Reduced conscious level
• Injury above clavicles
• Neurological signs
• If distracting injury(s)

Question 9

Breathing and oxygen examination

Answer 9

• Expose the chest
• Look
  
  • Visible injuries
  • RR
  • Expansion
• Feel
  
  • Palpate
  • Percuss
• Auscultate

Question 10

Breathing and oxygen management

Answer 10

• oxygen
• analgesia
• drain

Question 11

Circulation - assessment

Answer 11

• Clinical
  
  • Heart rate
  • Palpable radial pulse
  • CRT
  • BP
  • Pulse pressure narrows
  • Urine output
  • Confusion
• Blood tests
  
  • HB
  • Lactate
• Imaging
  
  • Ultrasound
  • CT

Question 12

Circulation - Sites for blood loss

Answer 12

• Floor
• Chest
• Abdomen
• Pelvis
• Long bones

Question 13

Circulation Volume replacement

Answer 13

• IV access
• IO access
• Type of fluid
• Amount of fluid
• Massive transfusion protocols

Question 14

Circulation - Monitoring volume replacement

Answer 14

• Vital signs
• Urine output
• Lactate

Question 15

Circulation- lethal triad

Answer 15

• Coagulopathy
• Acidosis
• Hypothermia

Question 16

Disability

Answer 16

Neurological examination

• AVPU
• GCS
• Pupils
• Tone and reflexes
• Log roll

Question 17

Expose and environment

Answer 17

• expose to allow full examination
• then cover up to keep warm

Question 18

Bed side tests

Answer 18

• ECG
• Arterial blood gas
• Urine dipstick

Question 19

Trauma investigations and secondary survey

Answer 19

• ultrasound
• CT
• minimal handling
  
  • Possibly no log roll
  • Trauma mattress
  • Don’t spring the pelvis