Major Trauma (Adult) CPG Notes Flashcards
(33 cards)
What are the key care objectives in managing major trauma?
Immediate haemorrhage control, maintain airway/breathing/circulation, prioritise transport, and provide supportive care.
What is the main patient group for this guideline?
Patients aged ≥ 16 with traumatic injuries.
When should scene time be minimised?
For all major trauma patients, especially with shock or penetrating truncal trauma.
Should IV access delay transport in shocked trauma patients?
No. Delaying transport for IV access is considered detrimental.
What should always be prioritised in trauma care?
Control of major haemorrhage, with continuous reassessment.
Why is reassessment of bleeding crucial?
Because bleeding may resume or haemorrhage control measures may fail/dislodge.
What is the preferred airway adjunct?
NPA if required. Avoid OPA unless absolutely necessary due to gag reflex increasing ICP.
When should RSI be planned?
Early in the scene, especially during extrication and team planning.
In shocked trauma patients with a patent airway, should RSI delay transport?
No. Prioritise transport.
When should oxygen be administered?
In all critically ill or unstable trauma patients.
When is nasal ETCO2 useful?
In major trauma patients not needing airway intervention, to track respiratory trends.
When should chest decompression be considered?
As per CPG A0802 Chest Injury.
What is the target SBP for shock without TBI?
70-90 mmHg.
What informs choosing the right SBP target in shock without TBI?
Radial pulse, mentation, bleeding severity, age, comorbidities, and transport time.
What is permissive hypotension?
Controlled hypotension to avoid worsening bleeding and complications until haemorrhage control.
What is the target SBP for trauma with TBI?
120 mmHg to prevent secondary brain injury.
When to initiate vasopressors in TBI?
Only after fluid resuscitation has failed to achieve BP targets.
When can PRBC be used in trauma?
When administered by a credentialed MICA paramedic. Preferred over saline when available.
What are the consent requirements for PRBC in patients < 18 yrs?
Parent/guardian consent or doctor approval (preferably AV Medical Advisor).
Before using vasopressors, what must be ruled out?
Inadequate fluid resuscitation, haemorrhage control failure, ventilatory causes, and chest injury.
Should vasopressors be reduced before stopping fluids?
Yes, taper vasopressors first once target BP is met.
What are key components of supportive care in trauma?
Warming, pain relief, spinal immobilisation, wound/fracture management, and pressure care.
How to prevent hypothermia in trauma?
Use blankets, warm ambulance, dry patient, consider chemical blankets for high-risk patients.
When is TXA indicated?
Within 2 hrs of injury and either COAST score ≥ 3 or suspected severe injuries + hypotension.
