Initial Assessment of a Trauma Patient - Pelvic Fracture Scenario

This video - produced by students at Oxford University Medical School in conjunction with the faculty - demonstrates how to perform the initial assessment of a patient with suspected traumatic injury.
This scenario is of a patient with a suspected pelvic fracture and internal haemorrhage.

Category:

Education

Tags:

• Medicine
• Trauma
• Oxford University
• IATP
• ATLS
• Acute Assessment
• Primary Survey
• ED
• A&E
• Pelvic Binder

[Happyascanbe1]

With such a clear hint of a likely catastrophic bleed from the start you want those IV lines in asap and not after 5-6 min like in this video. Basically, after the patient told you he can hear you, you had your A and B good enough to pop on O2 and and secure the IV access first. Cervical spine should also wait until C is dealt with, as the patient is not going to be on a speedboat while you inserting the IV lines, is he. Just tell him not to move the head and don't ask him any closed questions.

[OxfordMedicalSchool]

@Happyascanbe1 This is a teaching scenario, designed to demonstrate the structure of a trauma assessment. In practice it is clearly more flexible, but it is important to teach this format to ensure nothing is missed.

[lorrainewands]

slightly different from how I've been taught to conduct my assessment, at least is far as the order is concerned

[OxfordMedicalSchool]

@lorrainewands Fair point, but I guess the important thing is to prioritise A then B then C, and not worry too much about the intricacies of the order.

[adilmd]

@OxfordMedicalSchool he forgot to mention fast scan or dpl.

[OxfordMedicalSchool]

@adilmd A fair point. In this case I would add that there is evident abdominal and/or pelvic pathology. As the trauma team (and general surgeons) have been called, the implication is that this patient may go to theatre anyway, independent of the scan result. However, as you say, a FAST scan is always a good idea l in these scenarios.

[DrAlexoulis]

@Happyascanbe1 this not safe practice. A patient with an unstable C spine # and in haemmorhagic shock can be drowsy, or confused or even initially agitated. Airway comes with C spine immobilasation always!

Suggest to do ATLS for more information...

[Happyascanbe1]

I understand what you mean, but if you choose a teaching scenario with 80 systolic with pelvic pain in a trauma patient and then practice going meticulously for airways and c-spine--then you are in all fairness practicing exactly how to miss something. In other words, you should be careful what you practice on your guitar, as you'll end up playing that on a gig.

[dangormo]

You're all SO Oxford! Would be far quicker if you didn't concern yourselves so much with such particular articulation and manners

[dangormo]

Nurse is cute!

[scaramouche706]

@muskndusk the scenario shown here is for a high mechanism trauma resulting in a major injury.

i suspect from what you say that your injury, however painful for you, was assessed and diagnosed as soft tissue damage, therefore not requiring an x-ray.

great video.

[muskndusk]

In an NHS hospital very little of this would be done. Approx one month ago I went to A&E in a ambulance after falling downstairs and damaging my back. Long wait; then a brief examination and no X-ray. I'm still in a great deal of pain and relying on friends because I can't walk far. This video may show best practise, but it's not what actually happens.

[ekundayowt]

the bedside FAST scan does help a lot in trauma patients

[KrukovAleksey]

Хорошо работают студенты