SAQ 158 – Trauma – activation systems and post-intubation ventilation

Question 1. activation systems and post-intubation ventilation.

a. Single-tier features

• Full trauma team activation.
• Activation based on physiological, anatomical, or mechanism-of-injury criteria.

b. Major limitation

• Overactivation, particularly when mechanism alone triggers a full callout, causing inefficient resource use and increased workload.

c. Two-tier features

• Graded response: full team activation for abnormal physiology or specified physical findings.
• A subset of the trauma team is activated for lower-risk criteria, commonly mechanism alone.

d. Major effects

• Fewer unnecessary low-yield full-team callouts and better resource use.
• Risk of failing to fully activate when required, potentially delaying diagnosis or treatment of life-threatening injury.

e. Chest x-ray abnormalities

• Multiple right lateral rib fractures, including fractures in two places producing a flail segment.
• Right lateral heterogeneous pulmonary opacities consistent with pulmonary contusion.
• Possible right lateral clavicle fracture and/or widened upper mediastinum.

f. Post-intubation ventilation optimisation

• Insert an appropriately sized right intercostal catheter if pneumothorax or haemothorax is present; assess need on the left.
• Insert a nasogastric tube to decompress the stomach.
• Provide adequate analgesia and sedation.
• Use neuromuscular blockade if ongoing difficulty ventilating.
• Use lung-protective ventilation and titrate settings to physiological response.
• Elevate the head of the bed to approximately 30 degrees if not contraindicated.