- Stage of illness — e.g. resuscitation, acute stabilisation
- Primary, secondary or tertiary survey (examine from head to toe)
- Complications of stay e.g. VAP
- Need for ongoing surgical management?
- Rehabilitation phase
- usually blunt trauma to MVC or falls
- long stay patient
- spinal bed
- resuscitation fluid being administered
- noradrenaline (sepsis, CPP management for TBI, spinal injury)
- hypertonic saline
- sedation and neuromuscular blocking agents (ask!)
- level of support
- level of oxygenation (FiO2, PEEP)
- disease specific questions (ARDS: plateau pressure, pulmonary contusions)
- tachycardia (SIRS)
- ETCO2 (in TBI as a surrogate for PaCO2)
- arterial trace (pressure, swing, pulsus paradoxus, hypotension)
- cervical collar (not cleared or unstable injury)
- Edgerton bed for spinal injury
- ICCs (swing, bubbling, blood)
- intra-abdominal drains
- urine (output, myoglobinuria)
- external fixators
- plaster of paris
- cooling blankets (refractory ICP management or hyperthermia)
QUESTION SPECIFIC EXAMINATION
- expose patient as much as possible
- primary survey: if stable then proceed with secondary survey
- secondary survey: head -> neck -> arms -> chest -> abdomen -> legs examination -> back and ask re: PR/PV
-> quick examination
-> spinal injury (levels, bulbocavernosus reflex)
- type of penetrating implement?
- mechanism, speed?
- restrained, damage to vehicle, death at scene?
- GCS at scene (before and after resuscitation)?
- spinal integrity/ clearnace?
- tracheal secretions (blood stained)?
- N/G aspirates?
- tetanus status?
- compound orthopaedic injuries and wounds washed out?
- further surgery planned?
- radiology: CXR, spine, pelvic, CT, long bones
- liaising with other appropriate teams
- “My assessment follows a primary and secondary survey. Injuries from head to toe including relevant injuries are…”
- “I would like to review imaging…”
- “My plan for the next 24 hours is…”
- “I would like to liaise with the other treating teams…”
- pelvic fractures and haemorrhage
- TBI management, indications for ICP monitoring and decompressive craniectomy
- seizure prophylaxis post-TBI
- management of refractory ICPs
- steroids in spinal injury
- abdominal compartment syndrome
- trauma scoring systems
- damage control resuscitation
- factor 7
- assessment and clearance of the cervical spine