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Trauma & Stabilisation - Coggle Diagram

- - - - Rapid optimisation of
        
        Anaemia
        
        Anticoagulation
        
        Volume depletion
        
        Electrolytes
        
        Diabetes
        
        Chest infections
      - Orthogeri input
      - Individual rehab goals
      - Liason with related services
        
        MH
        
        Falls prevention
        
        GPs
        
        Social care
    - - THR for displaced intracapsular #s if fit, active and cognitively well
      - Extramedullary implant for trochanteric # above and including lesser trochanter
      - IMN for subtrochanteric #
  - - - Exacerbation COPD/Pneumonia
        
        ?RA preferred
    - - Tachy/brady arrhythmias, MI, valve disease, structural abnormalities
        
        Higher level monitoring if significant comorbidities
        
        ?Avoid neuroaxial if LVOTO
    - - Stroke, peripheral neuropathy, demnetia, PD, confusion
        
        All may complicate neuroaxial approach. Document any neuropathies
    - - Diabetes causing hypo/ketoacidosis
        
        Awake patient allows neuro assessment
    - - Polypharmacy - hypotension/electrolyte change/bradycardia
        
        Invasive monitoring
    - - Infection/immune response
        
        Sepsis ?avoid neuroaxial
    - - Arthritis
        
        Difficulty positioning for surgery & RA
- - - - Immediate release of blood components (RBCs & FFP) without haem approval
      - Communication to key personnel (anaesthetists/surgeons/porters/bloodbank)
      - Nominated person to liase with lab
    - - Recognise - concealed or revealed & start to control
      - A & B
        
        100% O2, definitive airway if indicated
        
        ?CS immobilisation
      - C
        
        Ealry haemorrhage control
        
        Pressure
        
        Tourniquets
        
        Immobilisation & splinting
        
        Large bore IV access
        
        Take blood - Xmatch, coag, FBC, U&Es, ABG
        
        Pressure infusers, blood warmers, cell salvage
        
        Hold crystalloids unless profound hypotension and no blood available
        
        Allow permissive hypotension
        
        O negative before matched blood available. O+ve can be used if adult male
        
        FFP:RBC 1:1
        
        Cryo 2 pools and platelets 1 pool until bleeding controlled
        
        TXA 1g
        
        Find if patient on anticoagulants and d/w haematologist to reverse
        
        Monitor resuscitation with POC
        
        FFP if INR > 1.5
        
        Cryo if fibrinogen < 1.5g/l
        
        Platelets if < 75x10^9/l
      - D
        
        Monitor neuro status
      - E
        
        Expose
        
        Warming
  - - - Haemolytic reaction
        
        Immediate ABO incompatability
        
        Delayed Rhesus, Kidd etc
      - Non haemolytic febrile reactions (donor leucocyte antigens)
      - Allergic reaction
      - TRALI - donor leucocyte antibodies reacting with HLA and HNA of recipient
      - Reaction due to bacterial contamination
      - TACO
      - Hyperkalaemia
      - Citrate toxicity
        
        Hypocalcaemia due to citrate binding
      - Acid-base disturbance
      - Hypothermia/air embolism/coagulation abnormalities
    - - Infection
        
        Viral
        
        Hep A/B/C
        
        HIV
        
        CMV
        
        Parasitic - malaria, toxoplasmosis
        
        Bacterial
      - Immune sensitisation
- - - - ?cause
    - - Drugs/alcohol
    - - Duration, contaminants, type of water, temperature
  - - - Assess patency, prepare for RSI - assume full stomach
      - ? Cspine control
    - - Mx other injuries
    - - Large bore access
      - Intravascular depletion due extravascation (pulmonary & systemic)
      - Warmed IVF
      - A line
        
        MAP>80mmHg
      - Ionotropes/Pressors
      - Catheterise
      - Monitor for arrhythmia
    - - 100% O2 NRBM, preoxygenation with tight fitting mask
      - Examine chest ?pneumothorax/FB
      - NG/OG tube to decompress stomach and improve vent
      - Lung protective ventilation (6ml/kg, high PEEP,high FiO2 intially)
    - - Manage brain injury risk
        
        Glucose 5-10mmol/l
        
        15-20 degree head up
        
        Observe for seizure - treat with benzos
        
        Loose tube ties
        
        Warm to 34 C (fully rewarm if not intubated)