SAQ 117 – Trauma – blunt multitrauma transfer preparation

Question 5. blunt multitrauma transfer preparation.

a. CT abnormalities

• Moderate pericardial effusion.
• Large left pleural effusion, likely haemopneumothorax.
• Left collapsed lung.
• Small right pleural effusion.
• Right airspace opacification from collapse, contusion, or aspiration.
• Aortic valve replacement.
• Left anterior thorax haematoma or small right-sided haematoma.

b. Hypotensive resuscitation

• No high-level evidence supports routine use in blunt multitrauma; the best-defined role is in penetrating trauma.
• Hypotension may worsen ischaemia in traumatised vascular beds.
• Avoid over-resuscitation as it may precipitate tamponade or increase bleeding.
• Contraindicated if head injury or spinal injury is present.
• The role is unclear in non-penetrating trauma.

c. Preparation for transfer

• Stabilise pelvis with pelvic binder.
• Insert left intercostal catheter; consider right side if rib fractures or pneumothorax.
• Pericardiocentesis if signs of tamponade; take equipment and be prepared to use it.
• Take blood for ongoing resuscitation.
• Provide analgesia.
• Consider warfarin reversal, noting AVR suggests warfarin may be likely.
• Communicate with family and receiving hospital.
• Ensure monitoring, documentation, imaging, portable ultrasound if needed, airway equipment, and two secure functioning IV lines.