UNCONTROLLED WHEN PRINTED
Quick Chart
Introduction
  • Catastrophic bleeding must be managed as a priority. Assess for blood loss in five places:
    • External
    • Chest
    • Abdomen
    • Pelvis
    • Long bones
Clinical Presentation
  • Consider hypovolaemic shock, early signs include:
    • Pallor
    • Cool peripheries / > 2 seconds CRT
    • Anxiety, abnormal behaviour, decreased mental status
    • Increased respiratory rate
    • Tachycardia
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Catastrophic haemorrhage can be defined as extreme bleeding likely to cause death in minutes.
  • Decompensating patients might present with Bradycardia.
  • Adult permissive hypotension is a systolic blood pressure of 70mmHg.
  • In the TBI, adult patient attempts should be made to maintain systolic blood pressure at 90mmHg.
  • In general, hypotension in adults can be defined as a systolic blood pressure of less than 90mmHg or greater than 30% decrease from that person’s baseline and in children less than: (70 mmHg + [2 x age]) from 1 – 10yo.
Management
Primary Care
Intermediate Care (EMT / Level 2)
  • Administer pain relief
  • Consider applying cardiac monitor if trained and authorised
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • Consider cardiac monitoring
  • Establish vascular access
  • The following patients may benefit from fluid therapy as per CPG:
    • Adult patients with blunt trauma and / or isolated head injury with hypotension and signs of impaired organ perfusion
    • Adult patients with a head injury and penetrating trauma with hypotension and signs of impaired organ perfusion
    • Hypotensive paediatric patients
  • Consider pain relief
  • Metropolitan crews should consider Major Trauma Bypass as per guideline
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
Additional Information
  • Adult patients with penetrating trauma, ectopic pregnancy or aortic aneurysm with hypotension and signs of impaired organ perfusion may benefit from permissive hypotension (systolic blood pressure of 70mmHg)
  • Neck wounds:
    • If major veins of the neck are severed, do not sit the patient up as air may be sucked in and develop into a venous air embolism. If air embolism occurs (sudden deterioration, collapse, neurological changes), lie the patient down and administer high concentration oxygen. Apply local pressure with broad pad and hand.

References
References
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