Trauma Teams &

Management
or the ABC of Trauma

Terry Jongen
Clinical Nurse Specialist
Emergency Dept
March 04
 What is a trauma?
• Any injury or wound that requires
intervention to aid recovery
• Major & Minor
– Major ISS 16+
– Minor uncomplicated- single organ / limb
• RPH
– Majors – 400 pa
– Minors – 3500 pa
 Trauma Response

• Notification
– St John Ambulance- radio / phone
– RFDS phone
– Occasionally just turning up and ringing the
door bell
 Set Up
• Form a Trauma Team
– Airway Doctor & Nurse (may be nurse 3 as well)
– Doctor 2 & Nurse 2
– Doctor 3 & Nurse 3
– Team Leader Doctor & Nurse
– PCA (gopher)
– Radiographer x2
 Set Up

• Resus
– Cover existing patients
– Airway equipment
– Fluids
– Drugs
– Equipment
 On Arrival
Trauma Team Criteria
• History
– Mechanism – Injuries
• MBA >30kph • Crush injury
• MVA >60kph • 2 or more limbs broken
• Fall >3m • 2 or more body parts
• Pedestrian • Spinal pain
• Death in same accident • Burns >15%
• Ejection • Penetration of torso
• No Seat belt – Haemodynamics
• Cyclist • BP <100mmHg
• Roll over • P <50, >130
• Penetrating • RR <10, >29
• Ejection/extrication • GCS <12
 Airway
• Response talking?
• Clear & open airway
– Suction
– Position
• Oxygen 100% NRB
• Intubation
• Surgical airway
• Protect cervical spine
 Breathing
• Quantity
• Quality
– Sounds & fields
– Accessory muscles
• Supplement
– Bagging
– Oxy log
• Find any problems – correct them
 Circulation
• Two wide bore IV cannula’s 14 g or better
• Fluids
– 1 litre crystalloids
– 500ml colloid
– Uncross matched blood
• Collect blood (grouping & x match)
• Mast
• Bandage bleeding
• Control fractures
• Remember the ABC is the primary
assessment
• Identifies life threats that require
immediate correction
 The D to H of trauma
Secondary Survey

• D= Disability / Dysfunction / Drugs

– Rapid assessment of brain & spinal cord
– GCS
– The Wiggles
– Immediate drug needs
• Analgesia / antiemetics
• Sedation
• E= Exposure
– Put the whole patient on display
– Cut of clothing if required

• F= Freezing
– Keep warm
– Cover and recover
• G= Get Vital signs
– Full observations
• TPR & BP, NVO, GCS
• Bloods, BSL, haemoque
• ECG
• TV, Air pressure O2 Sats. FiO2
• Pain score
• AMPLE
• ?tetanus status
• Forensic evidence protection
• H= Head to Toe assessment
– Systematic assessment of whole patient
– Identifying other or new injuries
– Log roll & PR (remember the rule)
– Followed by a focused assessment
– Commencement of treatments
• Splint fractures
• Dressings / suturing
• IDC
 Meanwhile

• Radiographers are shooting a trauma

series of x-rays
• Continuous reassessment of vital signs
• Calling in consults
• Expanded drug regime
• Gastro view
• Other diagnostics
– DPL
– CT
– Interventional radiology
 Scary Stuff
• Thoracotomy
– Only good for
penetrating trauma or
controlling abdo
bleeding
– Cross clamp aorta
– Fix holes
 More Scary Stuff
• Penetrating wounds
• Burns
Limb injuries
 Interesting practices

• Hypotensive management
– Some evidence that maintaining a BP 85 to 90
systolic has improved outcomes
– Needs farther research
• Use of Clotting factors
– Factor 7a
– Early use of platelets & FFP
 Be aware

• Shock is not just low BP and elevated

pulse
• Subtle signs more important
• High index of suspicion
• Stick to the plan
Major Incident Response

• West Health Plan

– Based on MIMMS approach
– Medical Teams from the hospitals
• Single retrievals
– entrapment