![]() ![]() It is also widely said that patients with a GCS score of eight or less cannot maintain their airway (“GCS eight – intubate!”). If they have a hoarse voice, or you can hear stridor (a harsh sounding inspiratory noise) or a snoring sound, this indicates partial airway compromise. If this is the case, you can move on to assessing the c-spine. If they are talking normally, then their airway is patent. These include significant facial trauma, facial burns, and haemorrhage. In major trauma, certain injuries are more likely to be associated with airway compromise. Without moving the patient, visibly inspect the neck for any obvious injuries. Airway (with c-spine protection) Clinical assessment (airway) Look ![]() This could involve direct pressure, haemostatic dressing application, or tourniquets. If any large bleeds are present, take immediate action to promote haemostasis. Look for any obvious high-volume blood loss. While we will look more closely at haemorrhage management in the second “C” section of this assessment, it is important to identify any large volume external bleeding at this stage. Catastrophic haemorrhage Clinical assessment In the context of major trauma, this may not be possible due to impaired consciousness. Introduce yourself to the patient including your name and role. Maintaining a calm and quiet environment around the patient avoids causing them further stress and allows for better communication within the team. This may be in SBAR or ATMIST and should include the patient’s details (if known), the circumstances of their injury, and any information gathered from prehospital/nursing assessment.ĭuring the handover, everyone should remain quiet and still if possible to ensure nothing is missed, this is known as a “ hands-off handover” (although it may be necessary to initiate treatment immediately). Usually, you will receive a brief handover from a team member about the patient. If feasible, it is sensible to have a team brief before the arrival of a trauma patient, where everyone introduces themselves, makes an initial plan, and divides up management (for instance, in real-life settings, major trauma calls are usually attended by an anaesthetist – it would be sensible for airway management to be handled by them!) Handover In an OSCE scenario, you may be fulfilling both roles. In practice, there is usually a team leader who is separate from the doctor carrying out the primary survey. Introduce yourself to the team, including your name and role. You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of ABCDE assessment and emergency stations □ Initial steps Introduction These cases are sometimes referred to as “ silver trauma.” Therefore, the threshold for considering something a major trauma, and initiating a trauma assessment, should be lower in such patients. Smaller traumas, such as falls from standing height, may not cause significant trauma in young healthy patients but can cause significant injury to older, more frail patients with multiple comorbidities. However, in defining major trauma, it is important to consider frailty and comorbidity. Major trauma is the leading cause of death in people under the age of 45. Injuries from sports or extreme sports or equestrianism.Hence, anything causing injury or injuries that threaten life would be considered major trauma. Major trauma can be defined as “an injury or combination of injuries that are life-threatening and could be life-changing because it may result in long-term disability.” 1 You may also be interested in our guide to prehospital handovers and our other emergency management guides. ![]()
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