Top Ten Trauma Principles

1. Minimize Scene Time

• 5-10 mins max
• All non-ABC interventions enroute 

2. Keep Patient Warm

• Heat on in back of car
• Don't cut clothes until inside
• Blanket
• Warm IV fluids if possible

3. Spinal Motion Restriction

• Follow current BCEHS guidelines
  • Adult SMR
  • Pediatric SMR
• Avoid gross neck movement
• More important in blunt multi-system
• Not performed in penetrating trauma
• Not at the expense of scene time

4. Near-Routine Pelvic Restriction

• Based on pain and/or mechanism
• Traditional pelvic assessment may worsen #
• Avoid aggressive pelvic assessment
• When in doubt, bind with TPOD
• See CPG H08: Pelvic Trauma

5. Control ALL Bleeding

• Tourniquets
• Compression bandages
• Wound packing, if trained
• Small bleeds add up

6. Oxygen

• Routine nasal cannula
• High flow for unresponsive / hypoxia / SOB

7. IV Fluids

• Warm fluids if possible
• 2 large bore IVs
• Resuscitate to perfusion / mentation
• Target 70-90 mmHg in non-Head Injured patients
• Target to above 110 mmHg systolic in Head Injuries (or MAP of 80 mmHg)

8. Head Injury

• Target Blood Pressure ET of 110 mmHg systolic (or MAP of 80 mmHg)
• Avoid hypoxia
• Maximize non-invasive airway management intubation as per AIME
• Head of bed up 30^o
• See CPG H03: Head Trauma

^{9. TXA Infusion}

• Signs of shock / hypo-perfusion / uncontrolled bleeding
• Trauma <3 hours old
• 1 g over 10 mins
• Add 1 g to 50 mL bag / 10 gtts set / 1 gtt/s
• TXA Monograph

10. Airway Management

• Per AIME principles
• Maximize non-invasive airway management intubation as per AIME
• Attempt 2 person BVM prior to intubation
• High Flow Nasal Cannula during attempt
• Intubation Checklist
• Avoid hypotension <90 mmHg
• Avoid hypoxia <90%