trauma

Question 1

Adult

Answer 1

Vital signs (adult)

• HR <60 >120
• RR <10 >30
• BP < 90
• GCS if > = to 16 is < 13; < or = 15 - <15
• SpO2 < 90

Question 2

co-morbidities of trauma MOI (8)

Answer 2

• Systemic illness limiting normal activity / systemic illness constant threat to life. Examples include:
- Poorly controlled hypertension
- Obesity
- Controlled or uncontrolled CCF
- Symptomatic COPD
- Ischaemic heart disease
- Chronic renal failure or liver disease
• Pregnancy
• Age < 12 or > 55

Question 3

major trauma - what 3 things increase mortality:?

Answer 3

hypothermia, acidosis, coagulopathy

Question 4

what pt’s does the hemorhagic hypovolaemic guideline apply to? (3)

Answer 4

Suspected hypovolemia from a haemorrhagic
cause – e.g. GI, AAA, trauma

This guideline applies to patients with suspected
ruptured AAA, massive GIT haemorrhage, and pregnant trauma patients.

Question 5

what pt’s does the hemorhagic hypovolaemic guideline NOT apply to? (3)

Answer 5

This guideline DOES NOT apply to patients with TBI,

isolated SCI or PPH. Manage as per the relevant CPG

Question 6

SBP < ?? fluid mx? in hemorhagic hypovolaemia

Answer 6

• Normal Saline 250 mL IV

• Repeat 250 mL (max. 2000 mL) as required
• Titrate to SBP ≥ 70 mmHg

Question 7

ARS: Once inserted, if air escapes, or air and blood bubble through the cannula, or no air/blood
detected.. should it be removed or left in?

Answer 7

leave in situ.

Question 8

ARS: If copious blood flows out, what should you do ?

Answer 8

remove the cannula and cover the insertion site

with an occlusive dressing.

Question 9

indications for quick clot (4)

Answer 9

• Uncontrolled haemorrhage from a non-compressible wound site

• Any traumatic haemorrhage that is not controlled by basic haemorrhage control measures such as direct
pressure with a pad and bandage

• Severe limb wounds not controlled by two Combat Application Tourniquets

• Multiple casualty scenes where patient numbers dictate that simple haemorrhage control measures cannot
be individually applied

Question 10

CI for Quick Clot (3)

Answer 10

• Bleeding that can be controlled using basic first aid measures
• Ocular trauma
• Haemostatic dressings are not to be used for haemorrhages where they are unlikely to contact the point of bleeding such as PV or PR haemorrhage, or posterior epistaxis

Question 11

what area must the quick clot come into contact with?

Answer 11

1. into direct contact with the point of bleeding.

Question 12

how long should a quick clot be held in place, before removing direct pressure?

Answer 12

2 - 3 minutes; if it bleeds through remove and apply new pad

Question 13

CT6 indication

Answer 13

Indications

1. Middle third femur fractures
2. Upper two third tibia fractures

Question 14

indications for PIB

Answer 14

1. All Australian Snake Species (including Sea)
2.  Funnel Web spider
3.  Blue Ringed Octopus
4.  Cone fish

Question 15

CI for PIB

Answer 15

1.  Any other spider bite
2.  Jelly fish stings
3.  Stone fish and other fish stings
4.  Scorpion, centipede and beetle bites

Question 16

Pneumothorax SS (ULS)

Answer 16

1. Unequal breath sounds in spontaneously ventilating pt
2. Low spO2 on RA (< 92%)
3. Subcutaneous emphysema

Question 17

TPT SS (CLEPT-PJR)

Answer 17

1. < conscious state
2. Low SPO2 on O2 (< 92%)
3. < EtCO2
4. > peak inspiratory pressure (stiff bag)
5. tracheal shift
6. Poor perfusion (shock)
7. > JVP
8. > respiratory distress in awake pt

Question 18

if GCS is < ??? and BP < ??? in TPT what is the mx?

Answer 18

< 10; < 70; immediately decompress (Cardiac Arrest Imminent)

Question 19

perfusion mx in THI?? what is the BP to aim for??

Answer 19

• Normal Saline IV (max. 40 mL/kg) titrated to patient response (unless in the setting of penetrating truncal
trauma or uncontrolled overt bleeding)

• Aim for SBP > 120 mmHg If SBP < 100 mmHg after 40 mL/kg:

• Consult with appropriate trauma service
• If consult is unavailable, Normal Saline 20 mL/kg IV

Question 20

isoloated SCI: BP < ??? fluid mx?

Answer 20

If BP < 90 mmHg:

• Normal saline 10 mL/kg IV

Question 21

SS of airway burns (B-FRESSH)

Answer 21

• Evidence of burns to upper torso, neck and face
• Facial and upper airway oedema
• Sooty sputum
• Burns that occurred in an enclosed space
• Singed facial hair (nasal hair, eyebrows, eyelashes, beards)
• Respiratory distress (dyspnoea +/- wheeze and associated
  tachycardia, stridor)
• Hypoxia (restlessness, irritability, cyanosis, decreased GCS)

Question 22

how long should chemical burns be irrigated for?

Answer 22

for as long as pain persists (being mindful of hypothermia)

Question 23

partial or full thickness burns mx? include pt age and burn %

Answer 23

• Patients > 15 years with TBSA >15%
Normal Saline - % TBSA x Pt wt (kg) = vol (mL)
administered over 2 hours from time of the burn

• If Pt 12 – 15 years with TBSA >10%
Normal Saline IV fluid replacement 3 x %TBSA x Pt
weight (kg) = vol fluid (mL)
- Given over 24 hours from time of burn
- Administer half of the 24 hour fluid volume over
the first 8 hours

Question 24

if > than ??? from an ED consult with recieving hospital for advice regarding scene relocation

Answer 24

15 minutes

Question 25

DRE: pts with a temp < ??? should be warmed to what temperature to avoid arrythmias?

Answer 25

32; 32

Question 26

DRE: what is the concern with warming a pt with suspected dysbarism?

Answer 26

warming a pt will cause undissolved N2 to dissolve –> gas embolism

Question 27

DRE: perfusion mx if adequately perfused

Answer 27

• If adequately perfused and chest clear administer Normal Saline 1000 mL over 15 - 20 minutes to rehydrate Pt. Continue Normal Saline at 1000 mL
every 4 hr

Question 28

DRE: perfusion mx if pt NOT adequately perfused?

Answer 28

• Less than adequate perfusion: administer ambient temperature Normal Saline IV (max. 40 mL /kg) titrated to patient response.
• Consult Alfred Hospital ED for further advice and fluid. If consult unavailable repeat Normal Saline 20 mL / kg IV