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Adult Trauma Guidelines

Thoracostomy considerations

Needle thoracocentesis for tension pneumothorax In a patient with a suspected tension pneumothorax, traditional trauma teaching advocated for rapid decompression on the affected side with a 14-16G needle in the 2nd intercostal space in the mid clavicular line.   The issues There is a growing body of evidence that this Read more…
By jSdj2sn7eH, ago

Elderly patients

  Due to a decline in birth rates and increased life expectancy, New Zealand’s population is aging. In 2022, 1 in 6 New Zealanders were aged 65 years or older with the number likely to hit 1 million in 2028.   From https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/older-peoples-health-data-and-stats   This is significant as the elderly Read more…
By jSdj2sn7eH, ago

Bariatric patients

In 2016, worldwide 13% of adults, (650 million) were obese1, however  New Zealand had  the 4rd highest prevalence of obesity in the world at 32.3%  (behind USA and Mexico and Chile)2. Traditionally obesity has been defined as a BMI of >30 kg/m2, but recently redefined as “a chronic, relapsing, multifactorial, neurobehavioural Read more…
By jSdj2sn7eH, ago

Pregnancy

General principles Excellent maternal resuscitation is the best treatment for the fetus While fetal radiation exposure is an important consideration – this needs to be balanced with investigations which are in the best interests of the mother Even seemingly minor mechanisms (eg: fall from standing, low speed RTC) can cause Read more…
By jSdj2sn7eH, ago

Pericardiocentesis

Patients with cardiac tamponade following trauma require an urgent thoracotomy. If this is not immediately available, pericardiocentesis might be considered as a temporising measure, however it will not address the cause of bleeding and the patient will rapidly destabilise again.   Pericardiocentesis is more typically performed in medical causes of Read more…
By jSdj2sn7eH, ago

eFAST

Extended Focused Assessment with Sonography in Trauma The aim of eFAST is to rapidly identify life-threats in unstable trauma patients as part of the primary survey. Ultrasound is increasingly being performed on stable patients – this can confirm clinical impressions, aid in early identification of issues in patients who remain Read more…
By jSdj2sn7eH, ago

Intubation

  Indications   Indications for intubation in patients with trauma include: Loss of airway patency Airway burns Facial/neck trauma Foreign material in airway (teeth, vomit, blood) Loss of airway protection Decreased GCS Respiratory/cardiac arrest Poor oxygenation or ventilation Hypoventilation with hypoxia Traumatic brain injury High spinal trauma Severe chest trauma Read more…
By jSdj2sn7eH, ago