Major Trauma Assessment

Ambulance personnel will usually radio ahead and request a “Stand By” (For self –presenters the triage nurse will notify the middle grade or consultant of any worrying mechanism of injury so a decision can be made whether to begin the assessment of these patients in resus).

Prepare resuscitation area, (ideally Bay 2 in resus), see pre-arrival checklist
Trauma Team Alert & pre-arrival notification of ED cons if appropriate
Check airway equipment and oxygen supply, and red trauma trolley at Bay 2
Ensure IV fluids/blood warmer/A line are run through, warming underblanket is prepared, and tasks and tabards are assigned
Prepare 2 grey/brown venflons and blood bottles, VBG
Switch on the monitors + ensure ultrasound machine is switched on and in the bay

A Trauma Team Call should be instigated via a 2222 call to switchboard stating “Trauma Call GRI Emergency Department”. Team members should include Team Leader (ED), ED registrar, Anaesthetic registrar (+/- consultant), ICU registrar (+/- consultant), General Surgical registrar +/- junior. Please use the Trauma sheets for documentation.

ICU and Plastics Surgery registrar should be asked to attend for any significant Burns Trauma pre-alerts.

Primary Survey and simultaneous resuscitation (First 1-5 minutes)

A           Airway with cervical spine control

             Suction, airway adjuncts, immobilise the neck, RSI

B           Breathing and Ventilation

             Treat tension pneumothorax, administer 100% O2

C           Circulation

             Trigger Major Haemorrhage protocol and request Pack A from the laboratory.

             Give 1 g of Tranexamic Acid over 10 mins.

             Stop external bleeding, tourniquets, temporary wound closures

             Use warmed O negative blood boluses to maintain a perfusing BP.

             Consider pelvic binder.

D           Disability usually assessed by the intubating anaesthetist

E           Exposure & Radiology

             FAST Scan/CXR/Pelvis XRay/CT

Do not move on to the next priority until you are satisfied that you have identified any life threatening conditions and treated them appropriately. If there are signs of shock then the patient is exsanguinating into one or more of the following areas: the chest, abdomen, pelvis, long bones or externally and must undergo surgery for further resuscitation and haemorrhage control. Remember to consider cardiac tamponade and tension pneumothorax as other causes of shock.

Secondary survey (Usually after CT)

Full head to toe examination. Arrange ongoing definitive care.

Arrange ongoing definitive care

In trauma resuscitation, as well as following ATLS principles, the following additional points should be remembered:

When the paramedic gives the history, where practical, all hands off patient and everybody listen in as the mechanism of the injury will often give more reliable clues to the injuries and their severity than the initial findings on exam
The assessment of circulation includes recording blood pressure – beware inaccuracies in automatic readings especially first automatic measurement and at extremes of rate.
Stop external bleeding and suture wounds and splint fractured limbs with plaster

Target times for all patients

Within 10 minutes: primary survey, and CXR in all patients, report A-E assessment to team leader, establish iv access and send bloods including XM, give Tranexamic acid, apply warmer.
Within 20 minutes: decision for CT/Theatre/Ward
Within 60 minutes: ABG, ECG, full set of obs including GCS, antibiotics in open #s
Discuss all significant head injuries with neurosurgery, and all spinal injuries with ortho/spinal

SPOC advice

WEST OF SCOTLAND MAJOR TRAUMA NETWORK
MAJOR TRAUMA CENTRE – QUEEN ELIZABETH UNIVERSITY HOSPITAL

SINGLE POINT OF CONTACT (SPOC) Advice for all Major Trauma

PRIMARY SAS
Modified Primary use the SAS NOW guidance

URGENT TRANSFER
These are ED to ED transfers that are time critical

SPOC 24hrs: QEUH ED Cons in Charge 0141 452 2828
(or 0141 452 2844 for Resus Consultant/Registrar if no answer)

NON URGENT TRANSFER
These are patients who require transfer to MTC level care within 24hrs

SPOC 8am to 6pm: Major Trauma Consultant 0141 452 3909
Co-ordinator 0141 452 2149 (or 2150)
SPOC 6pm to 8am: Surgical Registrar On Call 0141 452 2315

Major Trauma Assessment