South Wales Major Trauma Triage Tool

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South Wales Major Trauma Triage Tool Applies to South Wales, West Wales and South Powys (v2.5SM/GL) Apply this triage tool to all patients suspected to have suffered major trauma Yes to ANY of the below criteria - contact the trauma desk on 0300####### talk group 442 Any patient with airway compromise or catastrophic haemorrhage – Pre-alert to nearest Emergency Department 1.Measure vital signs. 2. Assess Anatomy of Injury 3. Assess Mechanism of 4. Special considerations. Injury. Penetrating injuries if shocked or (Use JRCALC abnormal values for requiring haemorrhage control Falls. Older Adults. children) Adult > 20 feet (6 metres) If over 65 complete the Silver Significant chest wall trauma. Child >10 feet (or 2 x height of Trauma Triage Tool (see Respiratory rate. (e.g. Deformity, flail Chest). child). reverse). <10 or >29 breaths per minute. Two or more proximal long bone Children Systolic Blood. High mechanism RTC. fractures (i.e femur, tibia and humeral Higher potential for injury. Sustained Systolic Blood Pressure Significant cabin intrusion. shaft-not neck of femur/humerus) Ejection (partial or complete) from <90 mmHg or absent radial Any clinical concern pulses. Crushed/ De-gloved/ mangled/ motor vehicle. Death in same passenger pulseless limbs. Anticoagulation and Bleeding Glasgow Coma Score. compartment. Disorders Motor score 4 (flexing to pain) or Amputation above wrist or ankle. Available information consistent with high risk of injury. Patients on anticoagulation less. medication (e.g. Warfarin, Suspected Major Pelvic fractures. Motor Vehicle vs Pedestrian or Apixaban Rivaroxaban) are at a (If active bleeding is suspected from a cyclist > 20mph. higher risk and need discussion pelvic fracture following blunt high-energy Motorcycle crash > 20 mph. with trauma desk trauma) Head injuries are particularly at Non motor vehicle incident Open or depressed skull fractures. risk. Major Burns Base of Skull fractures. Large animal incident (collision/fall/trampled) Pregnancy > 20 weeks NO Spinal trauma suggested by new, NO NO abnormal neurology. No to all above criteria – Convey to nearest Trauma Unit (Local guidelines in Hywel Dda UHB) Patients ≥65 must have a Silver Trauma Triage Tool assessment A TTime of M I SSigns and TTreatment Age and sex Mechanism Injuries Incident Symptoms Given Silver Trauma Triage Tool Major Trauma Centre University Hospital for Wales Cardiff CF 14 4XW Criteria: 1. Patients suspected of suffering major trauma Trauma Units 2. Patients who have had the major trauma tool applied and are negative Glangwili Hospital Carmarthen SA31 2 AF 3. Patients over 65 years of age Morriston Hospital Swansea-SA6 6NL Neville Hall Hospital-NP7 7EG Princess of Wales Bridgend- CF311RQ Prince Charles Hospital Merthyr-CF479DT Yes to any of the below then contact the Trauma Desk Clinician on 0330xxxxxx Royal Gwent Hospital Newport-NP20 2UB (The Grange Hospital NP44 2XJ will become the Physiology Anatomy Mechanism Trauma Unit for Aneurin Bevan health board once completed) Sustained SBP <110mmHg Injury to 2 or more body areas Fall down 3 or more steps in the presence of injury (excluding injuries distal Tranexamic acid should be administered as soon as Pedestrian vs car/cycle (excluding minor injuries) wrist/ankles) possible following trauma, ideally within the first Caution:Older adults with hour. Anticoagulant medication in Suspected fracture to shaft of frailty: low level falls (ground the presence of injury femur The indications for Tranexamic: level) might result in severe For all patients aged ≥1 with Time Critical injury Open fracture to wrist or ankle injury, especially alongside degenerative conditions where significant internal/external haemorrhage is suspected. Traumatic cardiac arrest .

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Mass/Multiple Casualty Triage

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Guidelines for Trauma Team Activation (TTA)

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MASS CASUALTY TRAUMA TRIAGE PARADIGMS and PITFALLS July 2019

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Fat Embolism Syndrome – a Qualitative Review of Its Incidence, Presentation, Pathogenesis and Management

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UHS Adult Major Trauma Guidelines 2014

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Redefining the Trauma Triage Matrix

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Guidelines for the Management of Severe Traumatic Brain Injury 4Th Edition

Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition Nancy Carney, PhD Oregon Health & Science University, Portland, OR Annette M. Totten, PhD Oregon Health & Science University, Portland, OR Cindy O'Reilly, BS Oregon Health & Science University, Portland, OR Jamie S. Ullman, MD Hofstra North Shore-LIJ School of Medicine, Hempstead, NY Gregory W. J. Hawryluk, MD, PhD University of Utah, Salt Lake City, UT Michael J. Bell, MD University of Pittsburgh, Pittsburgh, PA Susan L. Bratton, MD University of Utah, Salt Lake City, UT Randall Chesnut, MD University of Washington, Seattle, WA Odette A. Harris, MD, MPH Stanford University, Stanford, CA Niranjan Kissoon, MD University of British Columbia, Vancouver, BC Andres M. Rubiano, MD El Bosque University, Bogota, Colombia; MEDITECH Foundation, Neiva, Colombia Lori Shutter, MD University of Pittsburgh, Pittsburgh, PA Robert C. Tasker, MBBS, MD Harvard Medical School & Boston Children’s Hospital, Boston, MA Monica S. Vavilala, MD University of Washington, Seattle, WA Jack Wilberger, MD Drexel University, Pittsburgh, PA David W. Wright, MD Emory University, Atlanta, GA Jamshid Ghajar, MD, PhD Stanford University, Stanford, CA Reviewed for evidence-based integrity and endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. September 2016 TABLE OF CONTENTS PREFACE ...................................................................................................................................... 5 ACKNOWLEDGEMENTS .............................................................................................................................................
Mass Casualty Incident (MCI) Response Module 1

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Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors Over Time—A Systematic Review

Journal of Clinical Medicine Review Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review Maximilian Lempert 1,* , Sascha Halvachizadeh 1 , Prasad Ellanti 2, Roman Pfeifer 1, Jakob Hax 1, Kai O. Jensen 1 and Hans-Christoph Pape 1 1 Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091 Zürich, Switzerland; [email protected] (S.H.); [email protected] (R.P.); [email protected] (J.H.); [email protected] (K.O.J.); [email protected] (H.-C.P.) 2 Department of Trauma and Orthopedics, St. James’s Hospital, Dublin-8, Ireland; [email protected] * Correspondence: [email protected]; Tel.: +41-44-255-27-55 Abstract: Background: Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that speciﬁc injury patterns predispose to its development. Materials and Methods: Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019. Study Selection: Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included. Data Extraction: Two authors independently extracted data using a predesigned form. Statistics: Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960–12 December 1979, Group 2: 1 January 1980–1 December 1999, and Group 3: 1 January 2000–31 December 2019, chi-square test, χ2 test for group comparisons of categorical Citation: Lempert, M.; p n Halvachizadeh, S.; Ellanti, P.; Pfeifer, variables, -value < 0.05.