Trauma – shocked intubated motorcycle crash with haemopneumothorax.
a. Preparation priorities
Activate the trauma call and allocate clear team roles.
Notify the nurse in charge to prepare the trauma bay, staff, and department flow.
Notify blood bank and activate massive transfusion readiness.
Notify radiology/CT/interventional radiology, operating theatre, ICU, and surgical teams as appropriate.
Prepare eFAST, chest drain/underwater seal, pelvic binder, rapid infuser/fluid warmer, and thoracotomy equipment if indicated.
Prepare sedation/paralysis, limited crystalloid, blood products, vasopressors/resuscitation drugs, and family/social work support.
b. Lethal triad prevention
Component
Preventive action
Hypothermia
Remove wet clothing, cover and actively warm the patient, use forced-air warming and warmed blood/fluids.
Acidosis
Control bleeding, use damage-control resuscitation with minimal crystalloid, oxygenate/ventilate appropriately, and use bicarbonate only as a temporising measure in severe acidosis.
Coagulopathy
Use haemostatic resuscitation with balanced blood products, tranexamic acid, cryoprecipitate/calcium as needed, minimise crystalloid dilution, and treat hypothermia and acidosis.
c. Theatre indications
More than 1000 mL of blood immediately after tube thoracostomy.
Ongoing chest tube output of about 150-200 mL/hr for 2-4 hours.
Repeated transfusion required to maintain haemodynamic stability.
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