SAQ 1 - Trauma - Model Answer:
1- Life threatening massive pelvic diastasis (open book fracture, APC II) that requires immediate reduction and radiological investigation to identify any ongoing pelvic haemorrhage.
2- Pelvis arterial or venous haemorrhage
Intra-abdominal haemorrhage
Spinal injury causing neurogenic shock
Long bone fracture
Tension pneumothorax
Massive haemo-thorax
3- Activate Full trauma team including surgeon , orthopaedics and interventional radiologist
A/B – give o2 15L/min via Hudson mask.
C – wide bore iv acces x2 – give NSaline or O negative blood – 20ml- 40/kg ; Control of external haemorrhage
Apply pelvic blinder
Call blood bank - Activation of massive blood transfusion protocol
Keep patient normothermic – warm all fluid – use warming blanket
4- O –ve blood transfusion initialy
Then use cross matched blood aiming for SPB > 90
Massive blood transfusion blood products in a ratio of: 1:1:1 FFP, Platelets, packed cells
Tranexamic acid 2 g IV
5. If FAST +ve, need expedite theatre for damage control surgery and pelvic packing.
If FAST –ve, expedite Interventional Radiology for embolization
Knowledge Required:
· Classification of pelvic fracture
· Signs of pelvic fracture
· Investigation of pelvic fracture
· Major Pelvic trauma algorithms
· Complications of pelvic fracture
1- Life threatening massive pelvic diastasis (open book fracture, APC II) that requires immediate reduction and radiological investigation to identify any ongoing pelvic haemorrhage.
2- Pelvis arterial or venous haemorrhage
Intra-abdominal haemorrhage
Spinal injury causing neurogenic shock
Long bone fracture
Tension pneumothorax
Massive haemo-thorax
3- Activate Full trauma team including surgeon , orthopaedics and interventional radiologist
A/B – give o2 15L/min via Hudson mask.
C – wide bore iv acces x2 – give NSaline or O negative blood – 20ml- 40/kg ; Control of external haemorrhage
Apply pelvic blinder
Call blood bank - Activation of massive blood transfusion protocol
Keep patient normothermic – warm all fluid – use warming blanket
4- O –ve blood transfusion initialy
Then use cross matched blood aiming for SPB > 90
Massive blood transfusion blood products in a ratio of: 1:1:1 FFP, Platelets, packed cells
Tranexamic acid 2 g IV
5. If FAST +ve, need expedite theatre for damage control surgery and pelvic packing.
If FAST –ve, expedite Interventional Radiology for embolization
Knowledge Required:
· Classification of pelvic fracture
· Signs of pelvic fracture
· Investigation of pelvic fracture
· Major Pelvic trauma algorithms
· Complications of pelvic fracture