Time critical guideline

Question 1

Name the 3 categories in the time critical guidelines

Answer 1

1. Actual
2. Emergent
3. Potential

Question 2

In the setting of potential major trauma an adult is considered time critical if they meet any of the following criteria

Answer 2

Actual Time Critical Criteria

• HR <60 - >120
• RR <10 - >30
• SBP <90
• GCS <13 (pt >16)
• GCS <15 (pt <16)
• SPO2 <90

Question 3

SPECIFIC INJURIES meeting Major Trauma Criteria (Emergent)

Answer 3

ALL PENETRATING INJURIES

(except isolated superficial limb)

BLUNT INJURIES

•Serious injury to a single body region such that specialist care or intervention may be required or such that life, limb or long-term quality may be at risk.

Significant injuries involving more than one body region•

SPECIFIC INJUIRES

Limb amputation or limb threatening injury

Suspected spinal cord injury or spinal fracture

Burns >20% TBSA (>10% if < 15yrs) or suspected respiratory tract burn

High Voltage (>1000 volts) burn injury

Serious crush injury

Major compound fracture or open dislocation

Fracture to two or more of femur/tibia/humerus

Fractured Pelvis

Question 4

High Risk Criteria for Major Trauma (MOI) Potential Time Critical

Answer 4

• Motor/cyclist impact >30kph
• Fall from height >3m
• Struck on head by falling object >3m
• High speed MCA >60kph
• Explosion
• Pedestrian impact
• Prolonged extrication
• Ejection from Vehicle

Question 5

Time critical co mobilities

Answer 5

• Age <12 or >55
• Pregnant
• Significant underlying medical condition
  
  • Poorly controlled HTN
  • Obesity
  • Controlled or uncontrolled CCF
  • Symptomatic COPD
  • Ischaemic Heart Disease
  • Chronic renal failure or liver disease

Question 6

Transport to the highest level trauma service is required when

Answer 6

• If they meet potential criteria and have co morbidities transport with in 60 minutes
• If they meet Emergent criteria and have co morbidities transport within 60 minutes
• If they meet any Actual major injury observations then transport to major trauma service in 60 minutes
• If the observation is a altered GCS in a patient > 65 related to a fall > 1m then transport to a major neurosurgery service

Question 7

Outline the expectation for Pregnancy and trauma

Answer 7

• All maternity patients who meet the time critical trauma criteria
• or any patient who is > 24 weeks gestation with any trauma or potential harm to the unborn child,
• Transport to the Royal Melbourne Hospital if within 45 minutes.
• If > 1 hour travel time, transport to the nearest alternative highest level of trauma service.
• Pregnant women must not be taken to The Alfred Hospital unless in cardiac arrest and the Alfred is closest

Question 8

Specific Red Flag observations

Answer 8

• HR > 120
• RR > 30
• SBP < 90
• GCS < 13 (GCS < 15 for 15yo and under)

Question 9

Specific red flag conditions

Answer 9

CNS

• First time Seizure
• Stroke TIA
• Sudden onset headache
• Unable to walk

Respiratory/ airway

• Stridor
• Post tonsillectomy bleeding

CVS

• Anaphylaxis
• ACS

Other

• Ectopic pregnancy
• Obstetric concern