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- Victorian State Trauma System

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  • 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

      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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