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Trauma Team
Leader (Surgical Reg/SHO,ortho SHO, Reg)
Airway management (Anaesthetist)-
Circulation management (helping out FY1)
Communications (Nurses, later team leader)
Care for patients relatives
Calls specialists on instructions from team leader
 A- Airway and cervical spine control
Primary survey and
( remember jaw thrust if neck injury suspected, no
chin lift)
resuscitation
B- Breathing with high flow oxygen

C- Circulation and haemorrhage control

D- Disability with prevention of secondary injury

(BM, GCS, obvious neurological signs)

E- Exposure with temperature control

Signs in the neck indicating possible
life threatening thoracic conditions
Swellings and wounds- Vascular and airway injury
Distended neck veins- cardiac tamponade and
tension pneumothorax
Tracheal deviation- Tension Pneumothorax
Subcutaneous emphysema- Pneumomediastinum
Laryngeal crepitus- laryngeal cartilage fracture
Immediate life-threatening
thoracic conditions
Airway obstruction
Tension pneumothorax
Open chest wound
Massive haemothorax
Flail chest
Cardiac tamponade
Causes of hypoxaemia
Fire
Airway obstruction
Apnoea or hypoventilation (central(drugs, head
injury), spinal cord inj affecting diaphragm
Neuromuscular blocking agents
Mechanical- flail chest, tension pneumothorax,
haemothorax, obesity
Causes of hypoxaemia
Impaired diffusion across alveolar-capillary membrane
Pulmonary oedema
Lung collapse or consolidation
Aspiration of blood, fluid or vomit
Low cardiac output
Hypovolaemia
Myocardial contusion
Cardiac tamponade
Tension pneumothorax
Indications for intubation in
trauma
Airway obstruction
Hypoventilation
Severe hypoxaemia despite supplemental O2
Severe cognitive impairment (GCS <8)
Cardiac arrest
Severe haemorrhagic shock
Thorax
Blunt
Rapid deceleration or crushing in RTAs (70-80%)
Blasts
Shearing forces may disrupt the great vessels or bronchial tree
Changes in intra-thoracic pressure
Reduced venous return
Alveolar haemorrhage and oedema- interstitial fluid collection and
decreased alveolar membrane diffusion, increased pulm vascular resistance,
decreased pulmonary vascular flow, reduced lung compliance.
Penetrating
Haemorrhage due to damage to major blood vessels.
Flail chest
A segment of the thoracic cage is separated from
the rest of the chest wall.
This is usually defined as at least two fractures per
rib (producing a free segment), in at least two ribs.
A segment of the chest wall that is flail is unable to
contribute to lung expansion.
A flail chest is identified as paradoxical movement of
a segment of the chest wall - ie indrawing on
inspiration and moving outwards on expiration.
Logroll patient: Information
from rectal examination
Is sphincter tone present?

Has the rectal wall been breached?

Can spicules of bone be felt?

Is the prostate in a normal position?

Is there blood on finger?

Signs of urethral injury in a
male patient
Bruising around the scrotum

Blood at the end of urethral meatus

High riding prostate

Mental check at the end of
the primary survey and resus
phase
Is the airway still secure?

Is the patient receiving high-flow oxygen?

Is the patient receiving high-flow oxygen?
Are all the tubes and lines secure?

Have the bloods send off to the lab?

Are all the monitors working?

Vitals being recorded?

ABG done?

Has radiographer been called?

Signs of a base skull
fracture
Bruising over the mastoid (Battles sign)
Haemotympanum
Blood and CSF ottorrhoea
Blood and CSF rhinorrhoea
Panda eyes- bilateral periorbital bruising
Scleral haemorrhage with no posterior margin
Subhyloid haemorrhage
Trauma patient care
Good analgesia and fluid management

Secondary survey

Adjunct- X-ray, CT

Documentations
Factors affecting the priority
of an injury
Are the injuries immediately life threatening?
Are the injuries potentially life-threatening?
Are the injuries limb-threatening?
What is the physiological state of the patient?
What resources are available in the hospital?
Will patient require transfer for further specialist
care?
Cautions
Young pts- may not mount a tachycardia as have
good reserve
Pts physiological abnormalities needs to be
corrected before transfer
Always examine every bit of the patient, feel every
bone and look in the holes as part of secondary
survey- missed injuries are the cause for complaints!
Reassess after giving treatment.
 Go to trauma calls and see how it all happens.