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Pre hospital major trauma protocol:
Prehospital major trauma protocol’s main aim is reduction of death which refers to preventing
and improving patient outcomes. In order to achieve this, the needs of injured patient’s needs are
matched to a suitable level of care which is done in a timely and safe manner. In the pre-hospital
setting, the decisions of the interventions are done while considering available resources such as;
distance and time factors to the hospital, anatomic, high level mechanism and physiologic risk
criteria. Identification of major trauma in the prehospital setting is done if there is at least one
criteria out of the three present. These criteria include:
Existence of vital signs which are abnormal
Existence of an actual or assumed anatomic injury
At-risk patients having high risk injury mechanism.
Airway management considerations:
Traumatic brain injury:
Provision of Rapid Sequence Induction is required unless injured patient is experiencing
cardiac arrest. This includes patients having absent airway reflexes.
Use of Midazolam is preferable when controlling combativeness which precedes RSI in a
head injury. Administration of Judicious opioid pain reliever should be done. Additional
preparations for RSI shall be done rarely when combativeness prevents pre-oxygenation.
A relatively small Ketamine bolus (20-40mg) may be provided for enabling of preoxygenation.
Patient who is unconscious and unable to be ventilated and oxygenated by BVM and the
nasopharyngeal airway, intubation or laryngeal mask airway.
Massive facial traum...
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