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Major trauma (Pre-hospital
measures (Safety
Safe scene approach in all…
Major trauma
Pre-hospital
measures
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Catastrophic haemorrhage/C-spine
Haemorrhage
Control haemorrhage by applying CAT torniquet at single bone, proximal to the wound
C-spine protection
Manual (hand each side of head, hold steady without traction)
Collar (size by finger breadths from chin to shoulder, should match distance from black stud to bottom of yellow plastic);
continue manual stabilisation until blocks in place
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Breathing
RV FLAPS WET trauma chest assessment
Rate Vol breathing
Feel
Look
Armpits, Auscultate
Percuss, Press
Search (back, shoulders, sides)
Wounds (neck)
Emphysema (neck)
Tracheal deviation
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Management
cABCDE
Catestophic haemorrhage, C-spine
then normal ABCDE
cAB in the field, then CDE en route
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Secondary survey
Focussed examination, repeat ABCDE
Investigations
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In hospital
assessment
cABCDE
Airway and intubation
Circulation (BP, ECG, catheterisation, bloods)
Major haemorrhage protocol if needed
Secondary
survey
Urine
Dipstick, MCS, catheter (UO)
Imaging
FAST scan (pericardium, hepatorenall recess,
splenorenal recess, pelvis, thorax; indicates >500mL),
CXR, limb X-rays as needed
Bloods
Group+save/crossmatch, FBC,
CRP, U+E, LFT, clotting
Diagnostic peritoneal lavage (DPL)
If CT/USS unavailable, incision into peritoneum
aspirate fluid for analysis
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Immediate,
life threatening injuries
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