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Updated:
10 October, 2024
Acute management of trauma cases is characterized by a quick and well-structured securing of the patient's vital parameters in a team effort. The work is led by a team leader in collaboration with other staff from the emergency department and anesthesia personnel. The composition of the team responsible for the patient depends on the severity of the injuries (often color-coded based on the principle of grade 1, 2, 3, etc.) and local procedures depending on the resources of the department and the hospital. The team leader is usually a specialist in surgery.
Acute management of trauma cases is characterized by a quick and well-structured securing of the patient’s vital parameters in a team effort. The work is led by a team leader in collaboration with other staff from the emergency department, ortopedic surgeon and anesthesia personnel. The composition of the team responsible for the patient depends on the severity of the injuries (often color-coded based on the principle of level 1, 2, 3.) and local procedures depending on the resources of the department and the hospital. The team leader is usually a specialist in surgery.
The management usually starts with a report on what has happened and the patient’s condition given by the transferring ambulance personnel or anesthesia personnel (prehospital staff).
The acute management is based on well-known principles according to the A, B, C, D, and E model. Afterward, a Sign Out can be performed, and the patient is taken for further diagnostics or care and treatment.
Sign In
The situation is described by the emergency department nurse
- Patient ID when available, otherwise the patient receives a temporary ID as Unknown.
- Gender, age
- Mechanism of injury
Background described by the emergency department nurse
- Patient background
- Known vital parameters: Pulse, Blood Pressure, Saturation, Respiratory Rate, Temperature
Analysis described by the trauma leader
- Expected or obvious injuries
- Expected procedures
Recommendation described by the trauma leader
- Role distribution
- Plan for the work
- Is additional staffing or expertise needed? Disaster plan? Are more injured expected?
- Opinions from the team?
A – Airway
Airway with cervical spine control
- Look in the throat
- Listen to how the patient speaks, breathing sounds
- Feel the larynx and mandible, does the bite fit?
- Action for the airway
- Stabilize the cervical spine – collar/sandbags/manual
- Additional if needed: Suction clean, remove foreign body, chin lift, jaw thrust/oropharyngeal airway/intubation/cricothyroidotomy
B – Breathing
Breathing with ventilation
- Look at the chest, respiratory movements, trachea, jugular veins
- Listen, auscultate apically and basally
- Feel the sternum/chest, percuss
- Action for breathing
- Oxygen, saturation, and count respiratory rate (RR)
- Additional if needed: ventilate with a mask, needle decompress tension pneumothorax, place chest drain, cover open chest wound
C – Circulation
Circulation with bleeding control
- Look at skin color
- Listen to consciousness
- Feel the pulse, skin temperature, measure blood pressure
- Action for bleeding
- Stop obvious external bleeding, insert large IV lines, for major trauma at least 3 lines, crystalloid fluid bolus doses such as Ringer’s Acetate or PlasmaLyte, ECG, blood tests
- Additional if needed: look for the cause of the C-problem (chest, abdomen, pelvis), place intraosseous needle if needed, pelvic binder, assess fluid response (R-Ac), blood transfusion according to the bleeding protocol
D – Disability
Neurological overview
- Look at the eyes, assess pupil reflex
- Listen, talk to the patient
- Feel, ask them to move feet and hands
- Action for consciousness impairment
- Assess consciousness GCS/RLS and pupil reflexes
- Additional if needed: Pain stimulation
E – Exposure
Exposure with hypothermia control
- Look at the entire patient, cut off clothes
- Listen , talk to the patient, pain?
- Numbness? Sensory loss?
- Feel the extremities, spine, per rectum (PR)
- Action for hypothermia
- Expose the entire body but then cover with warm blankets
- Logroll
- Additional if needed: Foley catheter, NG tube, temperature catheter
Sign Out
Summary by the Trauma Leader
- Summary of the management
- Main problem/working diagnosis
- Care plan
- Care level: Where is the patient going? ICU/Radiology/Operation/Ward. Another hospital?
- Urgent treatments? Contact the next unit
- Urgent investigations? X-ray? CT?
- Intrahospital report checklist complete?
- Who is accompanying the patient? Does anesthesia personnel need to follow?
- Possible risks and problems during transport
- Done?
- Opinions from the team?
In case of a patient in shock or with unmeasurable vital parameters, immediately address reversible causes and work simultaneously in the team.
- Hypovolemia/bleeding – Stop external bleeding
- Hypoxemia – secure the airway and maximize oxygenation
- Tension pneumothorax – bilateral thoracic decompression
- Cardiac tamponade – pericardiocentesis or thoracotomy
- Adequate infusion and transfusion treatment
Protocol for transfusions and treatment of traumatic bleeding
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