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Issues in providing trauma management in the small rural setting. • Sharon Tonkin RN, East Wimmera Health Service,
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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
Retrieval service notification
Transport Time
Persisting hypovolaemic shock
Types of Transfers
Inter-Hospital Transfer
Key Messages
Clinical emphasis points
Rapid Reference Guideline
Introduction
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
Coordination
Movement ‘up the chain of care’
Need for retrieval systems
Retrieval Coordination
Choice of Transport Vehicle
Process of Transfer
Pre-transport communication and coordination:
Ensuring patient readiness for transfer
Patient Preparation
Airway
Breathing
Circulation
Documentation
Alert
Other
References
Teamwork and Communication
Key Messages
Clinical emphasis points
Introduction
Trauma team structure
Trauma team positions
Modified trauma team positions
The role of the team leader
What is situational awareness?
Zero-Point Survey
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
Catastrophic Haemorrhage
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
Primary injury
Secondary injury
Spinal Considerations
Early Activation
Primary Survey
Catastrophic Haemorrhage
Airway with cervical spine protection
Breathing and ventilation
Circulation with haemorrhage control
Disability: neurological status
Exposure and environmental
Secondary Survey
History
Head-to-toe examination
Neurological assessment
Head and face
Neck
Chest
Abdomen
Limbs
Back
Planning and Communication
Indications for ARV consultation and / or transfer to a major trauma service
Early Management
Airway management
CT scan/x-ray/FAST
Tranexamic Acid (TXA)
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
Additional management points for the rapidly deteriorating patient
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
Early activation
Primary survey
Airway with cervical spine protection
Breathing and Ventilation
Circulation with haemorrhage control
Disability
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
Anatomical and Physiological changes with ageing
Mechanism of Injury
Early Activation
Primary Survey
Airway
Breathing
Circulation
Disability
Exposure/Environmental Control
Secondary Survey
History
Head-to-toe examination
Planning and Communication
Limitation of Treatment Orders
Early Management
Diagnostic imaging
ECG
Optimising oxygenation
Volume Replacement
Insert
Monitor
Administer
Monitor blood results
Wound Care
Psychological health
Transfer and Retrieval
References
Home
News
Learning Management System
Moderated Tutorials
Videos
Podcasts
Resources
App
Courses and Conferences
Links
Contact Us
Acknowledgements
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