Acute management of Trauma - Sarah

Management of Trauma

• Preparation
o Plan, team, equipment, warning

• Triage – MIST
o Mechanism – much stronger factor in paediatrics then in adults.
o Injury
o Signs and symptoms
o Treatment

• Primary survey (ABCDE)

• Resuscitation

• Secondary survey (head to toe)

• Monitoring and re-evaluation
o Urine output, kidney function

• Definitive care
o –Comprehensive management, fracture stabilisation, any operative intervention, transfer to an appropriate facility

• Tertiary survey
o –Identify injuries not initially apparent
o –Treat other conditions

ABCD – the expanded version
• A - Airway maintenance with cervical spine control
o –Cervical spine immobilisation
o –Protect the airway (clear mouth/nose, jaw thrust, Guedel airway)
o –Check trachea
• Administer oxygen

• B – Breathing and ventilation
o Symmetry, flail chest, spontaneous ventilation, air entry, breath sounds

• C- Circulation with haemorrhage control
o –Perfusion, Pulse & BP
o –IV access
o –Resuscitate
o Put in urinary catheter – measure urinary output

• D – Neurological disability
o –A Alert
o –V Voice
o –P Pain
o –U Unresponsive
o –GCS (score E+V+M=3-15)
o Observe over time – intracranial head injury

• E – Exposure, completely undress but prevent hypothermia.
o –Environmental control
o –Active warming required;
o –space blankets maintain temperature DO NOT warm the patient

Communicate and Handover (ISBAR)
• I – Identification/introduction
• S – Situation
• B – background
o e.g. Epilepsy, diabetes; find out from wife at road side, treatment of other illnesses.
• A – assessment
• R – Recommendation/request
o What you expect to happen next in the patient