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- Victorian State Trauma System

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  • Key Messages
    •  Clinical emphasis points
  • Rapid Reference Guideline
    • Introduction
      • Changes in pregnancy
      • Complications associated with trauma
    • Early Activation
      • Primary Survey
        •  Airway with cervical spine protection
        •  Breathing and ventilation
        •  Circulation with haemorrhage control
        •  Disability: neurological status
        •  Exposure/environmental control
      • Secondary Survey
        • History
        • Head-to-toe examination
      • Planning and Communication
        • Pre-hospital triage
        • Inter-hospital transfer
      • Early Management
        • Patient positioning
        • Airway management
        • Radiology
        • Pathology tests
        • Preventing hypothermia
        • Analgesia and antiemetics
        • Sedation
        • Monitoring
        • Wound care
        • In-dwelling catheter
        • Nasogastric tube
        • Tetanus prophylaxis
        • Antibiotics
        • Cardiac arrest
        • Blood matters
        • Reassess
      • Retrieval and Transfer
        • References

          Rapid Reference Guideline

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          • Trauma System Guidelines
          • Victorian Trauma System
          • Pre-Hospital Triage
          • Inter-Hospital Transfer
          • Preparation for Retrieval
          • Teamwork and Communication
          • Specialist Clinical Guidelines
          • Early Trauma Care
          • Burns
          • Obstetric Trauma
          • The Deteriorating Trauma Patient
          • Traumatic Brain Injury
          • Spinal Trauma
          • Anticoagulation Trauma
          • Paediatric Trauma
          • Cardiac Arrest in Trauma
          • Imaging in Trauma
          • Older Person Trauma
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          • ©2023 Victorian Department of Health
          • Last Update: 20 January 2023
          • Trauma System Guidelines
            • Victorian Trauma System
              • Key Messages
                • Clinical emphasis points
              • Introduction
                • Definition of Major Trauma
                  • Key features of the Victorian State Trauma System
                    • Victorian State Trauma System Outcomes
                      • Resources
                        • References
                        • Pre-Hospital Triage
                          • Key Messages
                            • Clinical emphasis points
                          • Rapid Reference Guide
                            • Identification of Potential Major Trauma
                              •  Vital signs
                              •  Injuries found or suspected
                              • Isolated head injury in older people
                              •  High-risk criteria
                            • On Scene
                              • Scene Time
                              • ARV Notification
                            • Transport Time
                              • Persisting hypovolaemic shock
                            • References
                            • Inter-Hospital Transfer
                              • Key Messages
                                • Clinical emphasis points
                              • Rapid Reference Guideline
                                • Identification of Potential Major Trauma
                                  •  Vital signs
                                  •  Injuries found or suspected
                                  • Specialised trauma transfer indications
                                  •  High-risk criteria
                                • Deterioration
                                  • Contact Retrieval Service
                                    • Telemedicine
                                    • Pre-transport communication and coordination
                                  • Retrieval and transfer
                                    • Ensuring patient readiness for transfer
                                  • References
                                  • Preparation for Retrieval
                                    • Key Messages
                                      • Clinical emphasis points 
                                    • Rapid Reference Guide
                                      • Introduction
                                        • Retrieval Coordination
                                          • Choice of Transport Vehicle
                                            • Process of Transfer
                                              • Pre-transport communication and coordination
                                              • Ensuring patient readiness for transfer
                                            • Patient Preparation
                                              •  Airway
                                              •  Breathing
                                              •  Circulation and C-spine
                                              •  Documentation
                                              •  Alert
                                              • Other
                                            • References
                                            • Teamwork and Communication
                                              • Key Messages
                                                • Clinical emphasis points
                                              • Key attributes of an effective team
                                                • Trauma team structure
                                                  • Trauma team positions
                                                  • Modified trauma team positions
                                                • The role of the team leader
                                                  • What is situational awareness?
                                                • Effective Communication
                                                  • What is a shared mental model?
                                                  • Briefing the team
                                                  • Tacit vs explicit communication
                                                  • Closed-loop communication
                                                  • Handover
                                                  • Remote support and communication
                                                • Dealing with issues
                                                  • Graded assertiveness
                                                  • Five-step advocacy
                                                • Trauma Team Training
                                                  • References
                                                • Specialist Cinical Guidelines
                                                  • Early Trauma Care
                                                    • Key Messages
                                                      • Clinical emphasis points
                                                    • Rapid Reference Guideline
                                                      • Introduction
                                                        • Early Activation
                                                          • Ambulance handover
                                                          • Reception and resuscitation
                                                        • Primary Survey
                                                          • Airway with cervical spine protection
                                                          •  Breathing and ventilation
                                                          •  Circulation with haemorrhage control
                                                          •  Disability
                                                          •  Exposure and environment
                                                        • Secondary Survey
                                                          • History
                                                          • Head-to-toe examination
                                                          • Head and face
                                                          • Neck
                                                          • Chest
                                                          • Abdomen
                                                          • Limbs
                                                          • Back
                                                          • Buttocks and perineum
                                                          • Genitalia
                                                        • Planning and Communication
                                                          • Early Management
                                                            • Airway management
                                                            • Fluid resuscitation
                                                            • Analgesia
                                                            • Fractures and dislocations
                                                            • Prevent hypothermia
                                                            • In-dwelling catheter
                                                            • Monitoring
                                                            • Glasgow Coma Scale
                                                            • Pathology tests
                                                            • X-ray or FAST scan
                                                            • Naso/orogastric tube (N/OGT)
                                                            • Wound care
                                                            • Tetanus immunisation
                                                            • Antibiotics
                                                            • Reassess
                                                          • Retrieval and Transfer
                                                            • References
                                                            • Burns
                                                              • Key Messages
                                                                • Clinical emphasis points:
                                                              • Rapid Reference Guideline
                                                                • Introduction
                                                                  • Early Activation
                                                                    • Primary Survey
                                                                      •  Airway with cervical spine protection
                                                                      •  Breathing and ventilation
                                                                      •  Circulation with haemorrhage control
                                                                      •  Disability: neurological status
                                                                      •  Exposure/environmental control
                                                                    • Secondary Survey
                                                                      • History
                                                                      • Head-to-toe examination
                                                                      • Measuring burns
                                                                      • Head-to-toe examination
                                                                    • Planning and Communication
                                                                      • Early Management
                                                                        • Airway management
                                                                        • Fluid resuscitation
                                                                        • Compartment Syndrome
                                                                        • Analgesia
                                                                        • Wound care
                                                                        • Minimise heat loss
                                                                        • In-dwelling catheter
                                                                        • Monitoring
                                                                        • Glasgow Coma Scale
                                                                        • Pathology tests
                                                                        • X-ray/FAST scan
                                                                        • Naso/orogastric tube (N/OGT)
                                                                        • Tetanus immunisation
                                                                        • Antibiotics
                                                                        • Reassess
                                                                      • Retrieval and Transfer
                                                                        • References
                                                                        • Obstetric Trauma
                                                                          • Key Messages
                                                                            •  Clinical emphasis points
                                                                          • Rapid Reference Guideline
                                                                            • Introduction
                                                                              • Changes in pregnancy
                                                                              • Complications associated with trauma
                                                                            • Early Activation
                                                                              • Primary Survey
                                                                                •  Airway with cervical spine protection
                                                                                •  Breathing and ventilation
                                                                                •  Circulation with haemorrhage control
                                                                                •  Disability: neurological status
                                                                                •  Exposure/environmental control
                                                                              • Secondary Survey
                                                                                • History
                                                                                • Head-to-toe examination
                                                                              • Planning and Communication
                                                                                • Pre-hospital triage
                                                                                • Inter-hospital transfer
                                                                              • Early Management
                                                                                • Patient positioning
                                                                                • Airway management
                                                                                • Radiology
                                                                                • Pathology tests
                                                                                • Preventing hypothermia
                                                                                • Analgesia and antiemetics
                                                                                • Sedation
                                                                                • Monitoring
                                                                                • Wound care
                                                                                • In-dwelling catheter
                                                                                • Nasogastric tube
                                                                                • Tetanus prophylaxis
                                                                                • Antibiotics
                                                                                • Cardiac arrest
                                                                                • Blood matters
                                                                                • Reassess
                                                                              • Retrieval and Transfer
                                                                                • References
                                                                                • The Deteriorating Trauma Patient
                                                                                  • Key Messages
                                                                                    • Clinical emphasis points
                                                                                  • Rapid Reference Guideline
                                                                                    • Introduction
                                                                                      • Deteriorating trauma patients
                                                                                      • Track and Trigger
                                                                                    • Clinical Observation of Major Trauma Patient
                                                                                      • Recognising and responding to clinical deterioration
                                                                                    • Team Role in Recognising Deterioration
                                                                                      • ABCDEFG for deteriorating patients
                                                                                    • Early Activation or Consultation
                                                                                      • Further Information
                                                                                        • References
                                                                                        • Traumatic Brain Injury
                                                                                          • Key Messages
                                                                                            • Clinical emphasis points
                                                                                          • Rapid Reference Guideline
                                                                                            • Introduction
                                                                                              • Early Activation
                                                                                                • Primary Survey
                                                                                                  •  Airway with cervical spine protection
                                                                                                  •  Breathing and ventilation
                                                                                                  •  Circulation with haemorrhage control
                                                                                                  •  Disability: neurological status
                                                                                                  •  Exposure/environmental control
                                                                                                • Secondary Survey
                                                                                                  • History
                                                                                                  • Neurological assessment
                                                                                                  • Head-to-toe examination
                                                                                                • Planning and Communication
                                                                                                  • Indications for ARV consultation and/or transfer to a major trauma service
                                                                                                • Early Management
                                                                                                  • Airway management
                                                                                                  • Imaging
                                                                                                  • The intoxicated patient with head trauma
                                                                                                  • Anticoagulation and head trauma
                                                                                                  • Patient positioning
                                                                                                  • Seizure Prophylaxis
                                                                                                  • Pathology tests
                                                                                                  • Thermoregulation
                                                                                                  • Analgesia
                                                                                                  • Sedation
                                                                                                  • Monitoring
                                                                                                  • Wound care
                                                                                                  • In-dwelling catheter
                                                                                                  • Nasogastric tube
                                                                                                  • Tetanus immunisation
                                                                                                  • Antibiotics
                                                                                                  • Steroids
                                                                                                  • Reassess
                                                                                                • The Rapidly Deteriorating TBI Patient
                                                                                                  • Additional management points
                                                                                                  • Hyperventilation
                                                                                                  • Osmotherapy
                                                                                                  • Burr hole evacuation
                                                                                                • Retrieval and Transfer
                                                                                                  • References
                                                                                                  • Spinal Trauma
                                                                                                    • Key Messages
                                                                                                      • Clinical emphasis points
                                                                                                    • Rapid Reference Guideline
                                                                                                      • Introduction
                                                                                                        • Early Activation
                                                                                                          • Early rapid neurological assessment
                                                                                                            • Primary Survey
                                                                                                              •  Airway with cervical spine protection
                                                                                                              •  Breathing and ventilation
                                                                                                              •  Circulation with haemorrhage control
                                                                                                              •  Disability: neurological status
                                                                                                              •  Exposure/environmental control
                                                                                                            • Secondary Survey
                                                                                                              • History
                                                                                                              • Head-to-toe examination
                                                                                                              • Neck
                                                                                                              • Chest
                                                                                                              • Abdomen
                                                                                                              • Limbs
                                                                                                              • Back
                                                                                                              • Buttocks and perineum
                                                                                                              • Genitalia
                                                                                                            • Planning and Communication
                                                                                                              • Early Management
                                                                                                                • Airway management
                                                                                                                • Fluid resuscitation
                                                                                                                • Monitoring
                                                                                                                • Medical imaging
                                                                                                                • Wound care
                                                                                                                • Pressure area care
                                                                                                                • Analgesia
                                                                                                                • Prevent hypothermia
                                                                                                                • Glasgow Coma Scale
                                                                                                                • Pathology
                                                                                                                • In-dwelling catheter
                                                                                                                • Nasogastric tube
                                                                                                                • Antibiotics
                                                                                                                • Reassess
                                                                                                                • Other
                                                                                                              • Retrieval and Transfer
                                                                                                                • Isolated spinal cord injury
                                                                                                                • Potential multi-trauma
                                                                                                              • References
                                                                                                              • Thoracic Trauma
                                                                                                                • Key Messages
                                                                                                                  • Clinical Emphasis Points
                                                                                                                • Rapid Reference Guideline
                                                                                                                  • Introduction
                                                                                                                    • Immediately life threatening injuries
                                                                                                                      • Tension pneumothorax
                                                                                                                      • Massive Haemothorax
                                                                                                                      • Cardiac Tamponade
                                                                                                                      • Open pneumothorax
                                                                                                                      • Flail Chest & Pulmonary Contusions
                                                                                                                      • Major tracheobronchial injuries – larynx/ trachea
                                                                                                                    • Early activation
                                                                                                                      • Primary survey
                                                                                                                        • Airway with cervical spine protection 
                                                                                                                        • Breathing and Ventilation
                                                                                                                        • Circulation with haemorrhage control
                                                                                                                        • Disability: Neurological status
                                                                                                                        • Exposure and environmental control
                                                                                                                        • Investigations
                                                                                                                        • Analgesia
                                                                                                                      • Secondary survey
                                                                                                                        • History
                                                                                                                        • Head-to-toe examination
                                                                                                                      • Planning and Communication
                                                                                                                        • Early management
                                                                                                                          • Airway management
                                                                                                                          • Fluid resuscitation
                                                                                                                          • Monitor
                                                                                                                          • Administer
                                                                                                                          • Wound Care
                                                                                                                        • Retrieval and Transfer
                                                                                                                          • References
                                                                                                                          • Anticoagulation in Trauma
                                                                                                                            • Key Messages
                                                                                                                              • Clinical Emphasis Points
                                                                                                                            • Rapid Reference Guideline
                                                                                                                              • Introduction
                                                                                                                                • Types of Oral Anticoagulation
                                                                                                                                  • Vitamin K Antagonists
                                                                                                                                  • Direct (or Novel) Oral Anticoagulants (DOAC’s/NOAC’s)
                                                                                                                                  • Half-life and Elimination
                                                                                                                                • Monitoring and Pathology Tests
                                                                                                                                  • Interpretation of coagulation screen
                                                                                                                                • Management Agents
                                                                                                                                  • Transfusion support
                                                                                                                                  • Anti-fibrinolytic agents
                                                                                                                                  • Pro-haemostatic agents
                                                                                                                                  • Reversal agents
                                                                                                                                • Early Management
                                                                                                                                  • Head Injury and Oral Anticoagulants
                                                                                                                                    • Retrieval and Transfer
                                                                                                                                      • References
                                                                                                                                      • Paediatric Trauma
                                                                                                                                        • Key Messages
                                                                                                                                          • Clinical emphasis points
                                                                                                                                        • Rapid Reference Guideline
                                                                                                                                          • Introduction
                                                                                                                                            • Early Activation
                                                                                                                                              • Primary Survey and Early Management
                                                                                                                                                •  Airway with cervical spine protection
                                                                                                                                                •  Breathing and ventilation
                                                                                                                                                •  Circulation with haemorrhage control
                                                                                                                                                •  Disability: neurological status
                                                                                                                                                •  Exposure/environmental control
                                                                                                                                              • Secondary Survey
                                                                                                                                                • History
                                                                                                                                                • Neurological exam
                                                                                                                                                • Head-to-toe examination
                                                                                                                                              • Additional points for early management
                                                                                                                                                • Trauma imaging
                                                                                                                                                • Analgesia
                                                                                                                                                • In-dwelling catheter
                                                                                                                                                • Orogastric tube (OGT)
                                                                                                                                                • Antibiotics
                                                                                                                                                • Tetanus immunisation
                                                                                                                                                • Reassess
                                                                                                                                              • Planning and Communication
                                                                                                                                                • Paediatric Burns Sub Guideline
                                                                                                                                                  • Overview
                                                                                                                                                  • Assessment
                                                                                                                                                  • Management
                                                                                                                                                • Paediatric Spinal Sub Guideline
                                                                                                                                                  • Overview
                                                                                                                                                  • Assessment
                                                                                                                                                  • Management
                                                                                                                                                • Paediatric Traumatic Brain Injury Sub-Guideline
                                                                                                                                                  • Overview
                                                                                                                                                  • Advice and Retrieval
                                                                                                                                                  • Primary Survey Assessment
                                                                                                                                                  • Management
                                                                                                                                                  • CT scanning
                                                                                                                                                • Retrieval and Transfer
                                                                                                                                                  • References
                                                                                                                                                  • Abdominal Trauma
                                                                                                                                                    • Key Messages
                                                                                                                                                      • Clinical Emphasis Points
                                                                                                                                                    • Rapid Reference Guideline
                                                                                                                                                      • Introduction
                                                                                                                                                        • Blunt abdominal trauma
                                                                                                                                                        • Angioembolisation
                                                                                                                                                        • Penetrating abdominal trauma
                                                                                                                                                        • Solid organ versus hollow viscus injury
                                                                                                                                                      • Early Activation
                                                                                                                                                        • Primary Survey
                                                                                                                                                          • Airway with cervical spine protection 
                                                                                                                                                          • Breathing and ventilation 
                                                                                                                                                          • Circulation with haemorrhage control 
                                                                                                                                                          • Disability: Neurological status 
                                                                                                                                                          • Exposure and environment 
                                                                                                                                                          • Emergency Laparotomy
                                                                                                                                                          • Imaging
                                                                                                                                                        • Secondary Survey
                                                                                                                                                          • History
                                                                                                                                                          • Head-to-toe examination
                                                                                                                                                        • Planning and Communication
                                                                                                                                                          • Early Management
                                                                                                                                                            • Haemostatic resuscitation
                                                                                                                                                            • Permissive hypotension
                                                                                                                                                            • Damage control surgery
                                                                                                                                                            • Naso/orogastric tube (N/OGT)
                                                                                                                                                            • Urinalysis
                                                                                                                                                            • Imaging
                                                                                                                                                            • Blunt trauma
                                                                                                                                                            • Penetrating wounds
                                                                                                                                                            • Laboratory tests
                                                                                                                                                            • Fluid resuscitation
                                                                                                                                                            • Analgesia
                                                                                                                                                            • Prevent hypothermia
                                                                                                                                                            • Monitoring
                                                                                                                                                            • Glasgow Coma Scale
                                                                                                                                                            • Tetanus immunisation
                                                                                                                                                            • Antibiotics
                                                                                                                                                            • Reassess
                                                                                                                                                          • Retrieval and Transfer
                                                                                                                                                            • References
                                                                                                                                                            • Traumatic Cardiac Arrest
                                                                                                                                                              • Key Messages
                                                                                                                                                                • Clinical Emphasis Points:
                                                                                                                                                              • Rapid Reference Guideline
                                                                                                                                                                • Introduction
                                                                                                                                                                  • Pre-hospital considerations
                                                                                                                                                                    • Management
                                                                                                                                                                      • Haemorrhage
                                                                                                                                                                      • Tension pneumothorax
                                                                                                                                                                      • Airway obstruction
                                                                                                                                                                    • Conventional BLS and ALS considerations
                                                                                                                                                                      • External chest compressions & ventilation
                                                                                                                                                                      • Adrenaline
                                                                                                                                                                      • Defibrillation
                                                                                                                                                                      • Reversible causes
                                                                                                                                                                    • Resuscitation procedures
                                                                                                                                                                      • Ultrasonography
                                                                                                                                                                      • Pericardiocentesis
                                                                                                                                                                      • Resuscitative Thoracotomy
                                                                                                                                                                    • Resource Limited Facility
                                                                                                                                                                      • Return of Spontaneous Circulation ROSC
                                                                                                                                                                        • Damage control resuscitation
                                                                                                                                                                      • Endpoint to Resuscitation
                                                                                                                                                                        • Debriefing
                                                                                                                                                                          • Paediatric Considerations
                                                                                                                                                                            • References
                                                                                                                                                                            • Imaging in Trauma
                                                                                                                                                                              • Key Messages
                                                                                                                                                                                • Clinical Emphasis Points:
                                                                                                                                                                              • Introduction
                                                                                                                                                                                • Modalities of Imaging
                                                                                                                                                                                  • Plain film X-rays
                                                                                                                                                                                  • Ultrasound
                                                                                                                                                                                  • CT scanning
                                                                                                                                                                                  • MRI
                                                                                                                                                                                • Early Activation
                                                                                                                                                                                  • Indications for Imaging
                                                                                                                                                                                    • Head
                                                                                                                                                                                    • Spine
                                                                                                                                                                                    • Chest
                                                                                                                                                                                    • Abdomen
                                                                                                                                                                                  • Radiation and contrast considerations
                                                                                                                                                                                    • Paediatric considerations
                                                                                                                                                                                      • Trauma imaging
                                                                                                                                                                                    • Education Modules
                                                                                                                                                                                      • Adult
                                                                                                                                                                                      • Paediatric
                                                                                                                                                                                    • References
                                                                                                                                                                                    • Older Person Trauma
                                                                                                                                                                                      • Key Messages
                                                                                                                                                                                        • Clinical Emphasis Points
                                                                                                                                                                                      • Rapid Reference Guideline
                                                                                                                                                                                        • Introduction
                                                                                                                                                                                          • Older person Anatomy and Physiology
                                                                                                                                                                                          • Mechanism of Injury
                                                                                                                                                                                        • Early Activation
                                                                                                                                                                                          • Primary Survey
                                                                                                                                                                                            • Airway with cervical spine protection 
                                                                                                                                                                                            • Breathing and ventilation 
                                                                                                                                                                                            • Circulation with haemorrhage control 
                                                                                                                                                                                            • Disability: neurological status 
                                                                                                                                                                                            • Exposure/Environmental Control 
                                                                                                                                                                                          • Secondary Survey
                                                                                                                                                                                            • History
                                                                                                                                                                                            • Head-to-toe examination
                                                                                                                                                                                          • Planning and Communication
                                                                                                                                                                                            • Limitation of Treatment Orders
                                                                                                                                                                                              • Early Management
                                                                                                                                                                                                • Diagnostic imaging
                                                                                                                                                                                                • ECG
                                                                                                                                                                                                • Optimising oxygenation
                                                                                                                                                                                                • Fluid resuscitation
                                                                                                                                                                                                • Insert
                                                                                                                                                                                                • Monitor
                                                                                                                                                                                                • Administer
                                                                                                                                                                                                • Monitor blood results
                                                                                                                                                                                                • Wound Care
                                                                                                                                                                                                • Psychological health
                                                                                                                                                                                              • Transfer and Retrieval
                                                                                                                                                                                                • References
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