BASIC MANAGEMENT OF MAJOR BLUNT TRAUMA

RESUSCITATION - Primary survey

  Assessment Life threats Management
Airway Air movement
Stridor
Paradoxical chest movement
Suprasternal recession
Airway obstruction Cx spine collar
+/- Jaw thrust
+ Guerdel's airway
+ ETT
Breathing Equality of breath sounds
Percussion note
Tracheal position
Open chest wound
SpO2%
ABG
Tension pneumothorax
Open pneumothorax
Massive haemothorax
High flow oxygen
Cover open wounds
+/- needle thorococentesis
+/- tube thorocostomy
+/- IPPV
Circulation Presence of radial pulse
Capillary refill
Continuous blood pressure
ECG monitor
Haemorrhagic shock*

Cardiac tamponade
16G IV x 2
FBC, EUC, Blood grouping/matching
Compress/Bandage wounds
Splint long bone fracture
Bind pelvic fracture
Pack torrential epistaxis
+/- IV fluids 20ml/kg
+/- Blood
+/- ED thorocotomy
Disability GCS
Pupil equality
Limb movements/equality
BSL
Raised ICP/Tonsillar herniation Maintain oxygenation, normocarbia and blood pressure 

+/- head elevation
+/- hyperventilate to pCO2 25-30mmHg
+/- mannitol

Exposure Remove all clothes and examine
Check temperature
Hypothermia Avoid prolonged exposure
Active warming if required

* Major sites of bleeding (obvious) - Long bone #, Compound #, Scalp laceration, Major facial fractures

* Major sites of bleeding (hidden) - thoraco-abdominal-pelvic

ANALGESIA

RADIOLOGY

HISTORY


SECONDARY SURVEY

ANATOMY MAJOR CONDITIONS * IMPORTANT FINDINGS
Head Skull #
Basal skull#
Scalp soft tissue wounds
Blood/CSF otorrhea and rhinorrhea
Battle's sign/Racoon's eyes
Face Orbital floor/Zygomatic arch/Maxillary/Mandibular fractures
Infraorbital nerve injury
Orbital soft tissue herniation
Soft tissue wounds
Bony tenderness
Malocclusion/Trismus
Mobile mid-facial skeleton
Dental trauma
Facial paraesthesia
Neck Cx spine#
Carotid dissection
Soft tissue injuries
Bruits
Soft tissue swelling/Bony deformity
Midline tenderness
Eyes Ocular disruption
Ocular entrapment
Visual acuity
Ocular integrity
Hyphaema
Pupillary irregularity
Eye movements
Chest Rib #
Flail chest
Chest wall injuries
Compression tenderness
Crepitus
Air entry/Percussion note
Abdo Solid visceral injury
Hollow visceral injury
Abdominal wall marks
Tenderness/Guarding
Pelvis Pelvic #
Urethral injury
Lower abdominal wall injuries
Pubic symphysis tenderness
Pelvic spring tenderness
Perineal/Scrotal haematoma
Meatal blood
Upper limb Displaced fractures with neurovascular involvement
Dislocations
Tenderness/Deformity over A-C joint, clavicle, shoulder
Neurovascular deficits
Decreased range of movement at shoulder, elbow, wrist, fingers
Lower limb Displaced fractures with neurovascular involvement
Dislocations
Decreased range of movement at hip, knee, ankle and foot
Neurovascular deficits
Back
Tx/Lx spine# Occipital scalp injuries
Tenderness/Deformity over spine, scapula
Renal angle tenderness
Rectum Pelvic #
Cord injury
Rectal wall injury
High riding prostate
Loss of anal tone
Rectal wall bogginess/integrity
Neurological Cord injury Examine for segmental level, sacral sparing

* Necessitates definitive management in major trauma centre

OTHER

FURTHER INVESTIGATIONS

Do all of the following if unconscious (or as indicated)