PRIORITISING MANAGEMENT IN MAJOR TRAUMA

RESUSCITATION

• Airway Protection - head injuries with GCS < 8, Severe oral-maxillofacial trauma, Neck injuries, Significant airway burns

• Breathing - Ventilate respiratory failure (any cause), Relieve tension pneumothorax

• Circulation - Compress/Bandage open wounds, Splint long bone fracture, Stabilize open book pelvic fractures, Fluid/Blood resuscitation until radial pulse returns (the treatment for haemorrhagic shock is to STOP the bleeding)

INDICATIONS FOR ED THORACOTOMY

• Stab wound to chest with < 5 min cardiac arrest

• ?ED cardiac arrest in blunt cardiac trauma

INDICATIONS FOR IMMEDIATE THORACOTOMY

Haemodynamic instability with:

• Thorocostomy tube loss - > 1500ml initial, > 200ml/hr ongoing

• Pericardial tamponade on FAST or echo

INDICATIONS FOR IMMEDIATE LAPAROTOMY

Haemodynamic instability with:

• FAST +ve

• Diagnostic peritoneal lavage - 10ml frank blood aspirate, 100,000 RBCs/mm3

INDICATIONS FOR IMMEDIATE ANGIOGRAPHY

• Open book fracture unresponsive to pelvic binding and fluid resuscitation

• Uncontrolled epistaxis

• Failed operative control of bleeding

DEFINITIVE MANAGEMENT

In order:

• Exsanguinating thoraco-abdominal injuries

• Open book pelvic fractures unresponsive to initial stabilization / resuscitation

• Expanding intracranial lesions

• Limb vascular injuries

• Limb orthopaedic injuries