Adult Major Trauma Guidelines

Adult Major Trauma Guidelines

University Hospital Southampton NHS Foundation Trust

Dr Mark Baxter Director of Major Trauma, Consultant in Older Persons Medicine

Prof Rob Crouch Deputy Director of Major Trauma, Consultant Nurse in Emergency Medicine

Emma Bowyer Major Trauma Centre and Wessex Trauma Network Manager

Amendment's log

Amendments Update Wessex Trauma Network Automatic acceptance tool

Page No. 24

Date Sept 2021

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NOTE: These guidelines are regularly updated. Check the intranet for the latest version. DO NOT PRINT HARD COPIES

Please note these Major Trauma Guidelines are for UHS Adult Major Trauma Patients.

The Wessex Children's Major Trauma Guidelines may be found at

nsMajorTraumaGuideline/WessexChildrensMajorTraumaGuidelines.pdf

NOTE:

If you are concerned about a patient under the age of 16 please contact

SORT (02380 775502) who will give valuable clinical advice and

assistance by phone to the Trauma Unit and coordinate any transfer required.



Please note current versions of individual University Hospital Southampton Major Trauma guidelines can be found by following the

link below.



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Table of Contents (Hyperlinked)

1 SECTION 1: PREPARATION FOR MAJOR TRAUMA ADMISSIONS .............................................................................6

1.1 PRE-HOSPITAL TRIAGE & TRAUMA UNIT BYPASS TOOL ............................................................................................. 6 1.2 ATMIST ...................................................................................................................................................... 8 1.3 ADULT MAJOR TRAUMA TEAM ACTIVATION........................................................................................................... 9 1.4 ADULT MAJOR TRAUMA TEAM COMPOSITION...................................................................................................... 10 1.5 RESPONSIBILITIES & ROLES OF TRAUMA TEAM MEMBERS........................................................................................ 11 1.6 HANDS-OFF HANDOVER.................................................................................................................................. 18 1.7 TRAUMA TEAM LEADER: EXECUTIVE ROLE ........................................................................................................... 19 1.8 SITE MANAGER ............................................................................................................................................ 20 1.9 SECONDARY TRAUMA TRANSFERS ..................................................................................................................... 21

2 SECTION 2: TRAUMA RESUSCITATION (ABCDE) ............................................................................................. 24

2.1 CATASTROPHIC HAEMORRHAGE ........................................................................................................................ 24 2.2 AIRWAY ..................................................................................................................................................... 34 2.3 BREATHING ................................................................................................................................................. 38 2.4 CIRCULATION............................................................................................................................................... 42 2.5 DISABILITY .................................................................................................................................................. 47 2.6 EXPOSURE & ENVIRONMENT............................................................................................................................ 56 2.7 TRAUMA IMAGING ........................................................................................................................................ 57 2.8 BURNS TRIAGE TOOL ..................................................................................................................................... 58 2.9 ADMISSION DESTINATION ............................................................................................................................... 59

3 TRAUMA RESUSCITATION SUPPORTING DOCUMENTS ........................................................................................ 60

3.1 APPLICATION OF CELOXTM GAUZE.................................................................................................................... 60 3.2 BELMONT RAPID INFUSER ............................................................................................................................... 61 3.3 RESUSCITATIVE THORACOTOMY ........................................................................................................................ 62 3.4 MAJOR TRAUMA AIRWAY ALGORITHM............................................................................................................... 65 3.5 FRONT OF NECK ACCESS PROCEDURE ................................................................................................................. 67 3.6 PRE-RSI CHECKLIST ....................................................................................................................................... 68 3.7 IMMEDIATE RSI CHECKLIST.............................................................................................................................. 69 3.8 TRAUMA BAY CHECKLIST................................................................................................................................. 70 3.9 RSI PACK LIST.............................................................................................................................................. 73 3.10 RIB FRACTURE PATHWAY ................................................................................................................................ 75 3.11 SCOOP STRETCHERS....................................................................................................................................... 79 3.12 MAJOR TRAUMA CT HOT REPORT..................................................................................................................... 81

4 STANDARD OPERATING PROCEDURES................................................................................................................ 83

4.1 UHS MANAGEMENT OF EXTREMITY BLEEDING & TOURNIQUET SOP .......................................................................... 83

4.2 UHS MAJOR HAEMORRHAGE PROTOCOL .............................................................................................................. 8

4.3

UHS GUIDELINE FOR THE MANAGEMENT OF CHEST INJURIES AND CHEST DECOMPRESSION IN ADULT MAJOR TRAUMA ............ 23

4.4 UHS MAJOR TRAUMA TEAM SOP .................................................................................................................... 33

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Introduction

`These guidelines are the current policies and practice for the management of adult major trauma patients at University Hospital Southampton. They have been designed to provide a day to day framework for the management of patients; including the roles and responsibilities of clinical teams and their members. The guidelines were produced to try and ensure timely, consistent, high-quality care for all patients whatever day or time of day they present, recognising that these are challenging and often stressful cases.

There will be situations when it is appropriate to deviate from the guidelines or where the guidelines do not cover the specific circumstances. In these cases it is essential that care of the patient is the foremost consideration, that senior staff are directly involved and that documentation is clear. If in doubt, seek senior advice and document their involvement.

This second edition of the guidelines reflects the changes in practice in major trauma over the last 6 years together with changing national guidance and policy. My personal thanks to all members of the clinical and support teams who have contributed to the development of excellent practice at UHS and who have contributed to this revision. Thanks in particular to Dr Liz Shewry and Dr Simon Hughes, who begun these revisions and to Major Alan Weir who continued with this unenviable task.

In addition, this second edition would not be possible without such a comprehensive first edition. Thanks for the first edition go to Dr Andy Eynon, Dr Liz Shewry and Dr Simon Hughes, who authored the first edition of these guidelines in 2012. The first edition has guided Major Trauma Care across Wessex and further afield for nearly a decade.'

Dr. Mark Baxter Director of Major Trauma, University Hospital Southampton,

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