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Best Practice Top 10
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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%