Tasty Morsels of EM 130 – #FRCEM NICE Trauma Guidance and scoring

26 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

Describe some important recommendations from the NICE 2016 Trauma Guidance

  • pre hospital
    • RSI at scene within 45 mins of call
    • thoracostomy and drain is preferred over needle decompression is skills available
  • in hospital
    • don’t routinely CT chest as firstline in kids
    • use TXA (but not after 3 hrs)
    • be gentle with the fluids (“restrictive approach”)
    • 1:1 for resuscitative blood and always use blood instead of fluids if you have it
    • CT if heamodynamically normal or “responding to resuscitation”
    • FAST has its place in the unstable, not suitable for immediate CT. If you’re planning immediate CT then just skip it
    • morphine first line and ketmaine second line analgesic
    • if no IV access then intranasal diamorph or ketmaine

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What about thoracotomy in trauma units?

from the recent RCEM guidance

  • ERC guidance regarding thoracotomy
    • do the usual stuff first
    • bilateral chest decompression
    • if <10mins from arrest then “consider” (go for it!)
  • RCEM suggests that thoracotomy for penetrating arrest should still be considered even in trauma units but is a bit skeptical of doing so for blunt (I of course paraphrase here)

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How do we grade major trauma?

  • the ISS (no not that one…)
  • scored 1-75
  • of the body areas involved take the three highest scores one. Square each of them and add them together.
  • Each body area injury is scored (using an injury dictionary)
    • 1 – minor
    • 2 – moderate
    • 3 – serious
    • 4 – severe
    • 5 – critical
    • 6 – unsurvivable (note if you get a 6 in any body area then you score 75 automatically
  • Body areas
    • Head and Neck
    • Face
    • Chest
    • Abdomen
    • Extremity (includes pelvis)
    • External injury

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