Orthopaedic doctor – manage pelvis and other bone injuries
General surgery doctor – manage spleen/gut/chest
Intensive care doctor – decide upon ICU admission
Emergency medicine nurses x 2 – one for patient care (observations etc) and one for code red
Health care assistant – help with getting things etc
Operating department practitioner – organise theatre if required
Trauma handover – ATMIST
Age
Time everything happens
Mechanism
Injuries
Signs – observations, capillary refill
Treatment so far – e.g. triple immobilised, pelvic binder, oxygen, tranexamic acid
Prioritising injuries in polytrauma
Life-threatening bleeding wounds e.g. splenic rupture, pelvic/thoracic injury
Limb threatening injuries e.g. vascular injury, extensive limb bleeding requiring tourniquet to control blood loss
Fractures, dislocations and wounds atrisk of complications (e.g. infection, neurovascular damage, bleeding)
Stable fractures and other non-urgent injuries are managed later and may even be best left until swelling has resolved
Preparation and triage
Advance planning
Gather equipment e.g. goggles, gloves, gowns, shoe covers, masks
Call trauma team
Primary survey – C-ABCDE
Catastrophic haemorrhage
Sources: external (usually from neck) or pericardial
Management
Emergency thoracotomy for penetrating chest trauma causing cardiac arrest
Pressure over bleeding points
Warmed blood transfusion
Airway maintenance with C-spine protection
Look for causes of airway compromise: maxilla fracture (bleeds +++, ask to bite down to assess), laryngeal fracture (hanging), burns/inhalation, neck haematoma, GCS less than or equal to 8, neuromuscular paralysis, vomiting, stridor
Management
Airway manoeuvres e.g. jaw thrust
Artificial airway e.g. nasopharyngeal/oropharyngeal, intubation, surgical cricothyroidotomy (see artificial airways notes)
Remove foreign bodies
Suction
Triple immobilisation for C-spine until cleared by cervical spine X-rays and/or CT scan
Commendable