Trauma triage Flashcards
clinical RED Flags in trauma triage
- GCS<13
- RR <10 or > 30
- Spo2 <90%
- HR <60 or >120
- SBP <90
2 Immediate life threats at commencement of trauma triage
- Airway compromise or threat that cannot be corrected
- Severe external bleeding that cannot be adequately controlled
Pattern of injury
- Penetrating trauma (except isolated superficial limb injuries)
- Blunt Trauma- serious injury to a single region of the body such that specialised care or intervention maybe required or such that life, limb or long term quality of life may be at risk.
- Significant injuries involving more then one body region
- Specific Injuries such as:
- limb amputation or limb threatening injury
- Suspected spinal cord injury or spinal fracture
- Burns > 20% TBSA
- Suspected respiratory tract burns
- High voltage burn injury (1000 volts)
- Major crush injury
- Major compound fracture of open dislocation
- Facture to 2 or more of Femur/Tibia/humerus
- Fractured pelvis
Mechanism of injury AND vulnerability
- motor cyclist/cyclist impact >30 km/hr
- High speed MCA >60km/hr
- pedestrian impact
- ejection from vehicle
- prolonged extraction
- fall from height >3m
- struck on head by object falling greater then 3m
- explosion
AND - age >55
OR - Pregnant
OR
SIGNIFICANT underlying medical condition - Poorly controlled hypertension
- Obesity
- Controlled or uncontrolled CCF
- symptomatic COPD
- Ischaemic heart disease
- Chronic Renal Failure or liver disease
Action for meeting Mechanism of injury and vulnerability
- Closest trauma service
- Consider escalation of care
- Consider notification
Action for meeting Pattern of injury
- Highest level of trauma service within 60minutes
- Escalate care
- Consider HEMS if >60 minutes transport time
- Signal 1 notification
- Notify ARV (if destination is not a MTS)
Action if meeting trauma triage clinical red flags
Highest level of trauma service within 60minutes
- Escalate care
- Consider HEMS if >60 minutes transport time
- Signal 1 notification
- Notify ARV (if destination is not a MTS)
–IF Isolated head injury due to low fall <1 m and >65 yo
- Closest MTS or neurosurgical service
Action required if meeting Immediate life threat
- Closest trauma service
- Escalate care
- Signal one notification
- Notify ARV (if destination not a major trauma service)
Pneumothorax definition
Infiltration of air into the pleural cavity leading to partial collapse of the lung on the affected side. May be open (external wound allowing air into the pleural space) or closed (wound to visceral pleura allowing air to enter pleural space) A pneumothorax does not impact on other structures within the chest cavity
Definition of Haemothorax
Infiltration of blood into the pleural cavity leading to partial collapse of the lung on the affected side.
Massive haemothorax (>1500ml) can lead to complications of tension pneumothorax and hypovolaemia
Tension Pneumothroax
A pneumothorax where a segment of damaged tissue creates a valve that allows air to enter the pleural space but inhibits its escape creating progressive expansion and impairing ventilatory function. the pressure can shift mediastinal structures laterally away from the affected side leading to compression or kinking of the large vessels, obstructive shock and cardiac arrest
Symptoms of a pneumothorax
- unequal breath sounds
- SPO2 <90% on room air
- Subcutaneous emphysema
Consider mechanism of injury
- Traumatic
- Spontaneous
- Iatrogenic (related illness caused by medical examination or treatment)
Tension Pneumothorax Symptoms
- Inadequate perfusion
- Increasing respiratory distress
- Spo2 <92% despite O2
- distended neck veins and tracheal deviation (late and unreliable signs)
- If ventilating
- stiff bag and increased PIP
- decreased EtCo2
Management of any chest injury
Position
Oxygenation
Pain relief
- if open chest wound leave open unless hemorrhage risk
monitor closely - Remove any chest seals if evidence of TPT
- Needle thoracostomy
Penetrating injury definition
Penetrating injury (except isolated superficial limb injuries)
