Major trauma

Major trauma

Diagram shows AMPLE history as allergies, medications last ate and drank, events leading, and past medical history, ATOM-FC mnemonic, Spinal injury risk factors, NATMIST (name, age, time of injury, mechanism of injury, injuries sustained, signs and symptoms, treatments given), et cetera.

Major trauma is a leading cause of death and disability in all age groups worldwide. It is categorised by its mechanism into blunt (e.g. falls, road traffic collisions) or penetrating injury (stabbings, shootings). Initial management utilises the ABCDE approach to identify and treat life-threatening injuries, active haemorrhage, shock and coagulopathy. Guidelines for trauma management have been issued by NICE (2016)1,2


Practitioners should elicit a NATMIST (Table 44.1) and AMPLE handover3 (Box 44.1) from prehospital emergency services, witnesses and/or relatives as soon as possible after hospital admission.

Catastrophic haemorrhage

Haemorrhage causes 40% of trauma-related deaths. Rapid control of catastrophic haemorrhage is the immediate priority in trauma and can be achieved quickly by applying dressings, direct pressure and elevating the wound. Tourniquets and haemostatic dressings may be used if simple measures fail to stop bleeding. A pelvic binder should be applied to patients with suspected pelvic fracture with signs of shock.

Assessment and management

Airway with inline spinal immobilisation

Cervical spine injury occurs in 2% of trauma patients and should be assumed in patients with significant risk factors (Table 44.2). Manual inline stabilisation (MILS) should be used to immobilise the spine in these patients (Box 44.2). The patency of the airway should be established and maintained using basic and advanced airway manoeuvres (Chapters 8 and 9

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Apr 8, 2019 | Posted by in NURSING | Comments Off on Major trauma
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