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- Victorian State Trauma System

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Ambulance Victoria Clinical Matters

  • 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
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  • The Deteriorating Trauma Patient
  • Traumatic Brain Injury
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  • ©2021 Victorian Department of Health
  • Last Update: 15 January 2021
  • 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 Guideline
                    • 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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