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07 TraumScenario Short New May2023

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33 views4 pages

07 TraumScenario Short New May2023

Uploaded by

Amruth
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Sample Trauma/Burn Case Scenarios.

Instructors can make up more cases


1. Marathon runner hit by a car. Pulse 45, increases by 10 every �me reassessment done. Final P
90-95, Internal hemorrhage

2. Hemorrhage + Breathing (Tension Pneumothorax)

a. Can vary the case if more students by changing to hemothorax or open pneumothorax
(first manage with 3-sided gauze dressing)
b. Both need ICD also
3. Hemorrhage + Circula�on target 90, then brain trauma in stage D of HABCDE- so increase target
SBP to 110

4. Hemorrhage + Circula�on in a 7 y old


a. Expected target SBP is 7 x2 +70 = 84. First round give SBP of 80, needing bolus, next
round sbp is 86 needing only maintenance.

5. Burns pa�ents with 10% burns- Signs of upper airway injury- early intubate- if delays intuba�on
fails- force them to do cric
a. A�er target SBP achieved fluid rate is 500 ml in adults, 250 ml in children and 125 ml in
very small children or alterna�vely they can calculate using parkland formula.
7. Trauma Scenario Teaching

Appendix A: Summary of Trauma Protocol: Primary Survey


Before patient arrives Seconds to minutes 2-20 minutes 10-30 minutes 10-30 minutes

Prepare JeevaRaksha Walk REASSESS REASSESS REASSESS

H - Gloves - Stabilise neck, Switch - Bleeding? Tourniquet, OK? - Bleeding? - Bleeding?


- Gauze Cotton - Direct pressure Write Time - Tourniquet, OK? Time - Tourniquet, OK? Time noted?
- Tourniquet - Pressure dressing - Other (H) site noted?
- + /- tourniquet (time) - Wound packing?
A - Hard neck collar - Order O2 - Burns: Intubate early - AVPU - AVPU
- Airway: O2 tubing - Stabilize neck, place collar - Manual In-line - check O2 saturation - check O2 saturation
- OPA, NPA, Suction - Assess AVPU. If P/U Jaw stabilization intubate - If ET Placed: tape/fix - If ET Placed: tape/fix
- LMA, ET tube, Thrust, NPA, OPA - if fail, prepare Cric kit - If Intubation fails - If Intubation fails
- Cricothyroid - Place LMA, Order ETT Cricothyroidotomy Cricothyroidotomy
B - O2 , BVM (AMBU) - Look for Tension PTX - Insert ICD - ICD: check water - ICD: check water seal/valve
- Needle, ICD, - Insert needle: psssss?! - Connect water seal or seal/valve Do NOT clamp ICD tube
- Water seal/valve - Order for ICD set valve - BVM / ET-12/ min - BVM / ET-12/ min
C - IV Green-18G; Grey-16G. - Order 2 IV lines (IO) - Confirm 2 IV / IO - Check BP - Check BP
IO set, warm IVF - Blood group - Determine target BP - Bolus or drip - Bolus or Maintenance
- Blood grouping - BP improves if tension TX is - Bolus or not? - Tranexamic acid if - Tranexamic acid if low BP
 Tranexamic Acid treated - Check bleed: 4 places haemorrhagic shock due to bleeding.
- Torch - D: AVPU? - E: Expose, cover, Front: Head
D - Scissor, Bed sheet/s - Pupils to toe; Log Roll: Head to
- LOG roll helpers, Gel - Gross Motor & Sensory? Heel; Roll Back
- Gloves, Pelvic binder - Reassess target BP - 3-point stabilization
Note: If intubation needed
- Spine board - Permissive hypotension: Y/ - Cover patient
E in Tension pneumothorax
- 3 point: neck: 2 straps N: Bolus or maintenance? - Reassess HABCDE 
patient, relieve tension
& 2 sandbags Secondary Survey, ISBAR
before intubating
- -REASSESS HABCDE, Secondary Survey (if there is time), talk to family, Call receiving facility (ISBAR); Instructions to transport team in HABCDE sequence
- ISBAR: Identify, Situation, Background, Assessment, Recommendations. The time intervals are suggestive and not prescriptive.

© Copyright JeevaRaksha Trust ECLS Skills Instructor Guide Apr21 Trauma Scenario 17 of 26

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