Approach to the Trauma Patient

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Table 1.2: Approach to Trauma Patient 

PREPARATION 
  • Mobilise medical emergency team 
  • Prepare equipment, examples; monitors, ultrasound
  • Consider high-risk mechanisms of injury 
  

High Risk Mechanisms of Injury 

  • High speed motor vehicle accident 
  • Pedestrian accidents 
  • Ejection   
  • Fall > 3m in height 
  • Penetrating injuries 

INITIAL RESUSCITATION

Airway: Protect as appropriate and ensure Cervical-spine immobilization. 

Breathing: Give oxygen and titrate to SpO2 (above 92%). If no air entry or if hyper-resonance present, insert chest drain. If patient is showing signs of obstructive shock or deviated trachea, needle decompression can be used initially before definitive decompression with a chest drain. 

Circulation: Insert 2 large bore IV Cannula. Resuscitate with crystalloid solutions according to BP. If not responding to crystalloids, patient should be resuscitated with blood. Control all external bleeding immediately. 

Disability: Check GCS and document this regularly to check for any changes in conscious state. Perform a brief neurological examination. Check pupillary response. Check RBG. 

Exposure: Expose patient to check for other injuries. Prevent against hypothermia.

SECONDARY SURVEY 

HEENT – check for scalp haematomas, depressed skull fractures, facial bony tenderness, eye injuries, otorrhea, haemotypanum, tracheal deviation. 

Spine – Must log-roll patient and palpate spinous processes of C/T/L-spine and check for any tenderness or stepping.

Chest– look, palpate, auscultate. Check for signs of pneumothorax, haemothorax, ribs fractures, flail chest. If failing to ventilate or oxygenate, consider NIV or intubation.

Pelvis – careful examination for bony pelvic ring movement. If concerns re pelvic fractures, a pelvic binder (sheet) must be placed on the patient. 

Abdomen – careful examination for guarding / tenderness / bruising in all quadrants. Ensure FAST examination performed in all trauma patients. 

Extremities – examine all peripheries for bony injury, compartment syndrome, muscular or soft tissue damage, neurological changes. 

CHECKLIST :( Before patient leaves EMD) make sure: 

  • Airway is patent/protected                                     
  • Tension pneumo-haemothorax? Sp02>92% 
  • Large-bore IV placed and fluid given                  
  • Control of external bleeding 
  • Pelvic fracture assessment done  
  • Assessment for internal bleeding done 
  • Spinal immobilization done                                   
  • Neurovascular status of all limbs assessed 
  • Does the patient need chest tube, NGT or catheter?