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
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)
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
- Extremity (includes pelvis)
- External injury