Scenario Template
Multi Trauma - HypoxiaError! Bookmark not defined.
Learning objectives
Target audience
Setting
Overview
Mannikin/Moulage
Actors/Confederates
Equipment
Supplies
Prebrief
 Identify multiple life threatening injuries in the multi trauma
patient
 Avoidance of secondary brain injury in the hypoxic head
injured patient - avoid hypotension, provide adequate
oxygen, maintain normal temp / biochemistry / CO2
levels, elevate head of bed, antiemetics and sedation to
avoid raised ICP
 Use of appropriate medications during RSI
 Emergency Department SHOs, Registrars and RNs
 ED, Saturday afternoon
 Pedestrian v car, hypoxia, multiple injuries
 Sim man 3G
 Chest wall contusions
 Haematoma / wound to head
 Facial injuries
 Nurse confederate for SHOs, no confederate for registrars
/ RNs
 Intubation trolley
 Ventilator
 Difficult airway trolley
 Defibrillator
 ECG machine
 USS
 Normal saline
 3% saline
 Blood
 Fentanyl
 Morphine
 Midazolam
 Suxamethonium
 Rocuronium
 Propofol
 Ketamine
 Prothrombinex
 84yo male, hit by 4x4, multiple injuries, GCS 8, sats 82%
on oxygen, tachycardic
 PMH AF on warfarin
Handover
 Elderly male, hit by car while crossing the road, GCS 10
at scene, gradually decreased en route, tachycardic and
hypoxic on oxygen, sats 82% on 15L O2, agitated – given
Events
5mg IV midazolam by QAS, facial injuries – unable to use
airway adjuncts
 Patient becomes more hypoxic despite oxygen (phase 2)
Deverill 08/10/2014
 Pneumothorax discovered on exam, requires
decompression, sats improve slightly (phase 3)
 Facial injuries prevent PEEP / BiPAP use for
preoxygenation
 Intubation unsuccessful – requires emergency
cricothyroidotomy
(phase 4, post intubation)
Phase 2
Phase 3
Phase 4
Phase 1
GCS
ECG
HR
BP
RR
SpO2
WOB
Pain
Temp
8
Fast AF
125
106/74
32
82% on
15L O2
Increase
Unable to
describe
35.8
I feel [...]
Investigations
Expected Actions
Pitfalls
Discussion points
Author/Date
GCS
ECG
HR
BP
RR
SpO2
6
Fast AF
136
96/63
35
78% on
15L O2
Increase
35.2
WOB
Pain
Temp
I feel [...]





GCS
ECG
HR
BP
RR
SpO2
WOB
Pain
Temp
I feel [...]
6
Fast AF
132
95/62
32
85% on
15L O2
Increase
35.2
GCS
ECG
HR
BP
RR
SpO2
WOB
Pain
Temp
3
Fast AF
126
97/67
As per
vent
settings
91%
34.9
I feel [...]
BSL
iSTAT
ECG
CXR – left PTx
Provide appropriate resuscitation measures to prevent
further hypoxia in a head inured patient
 Identify pneumothorax and decompress the chest prior to
intubation
 Identify the difficult airway in a patient with facial injuries
 Appropriate management of the warfarinised trauma
patient
 Failure to prevent secondary brain injury using
appropriate resuscitation techniques
 Use inappropriate drugs for RSI
 Failure to recognize the difficult airway
 Current evidence regarding resus of a head injured
patient
 Current warfarin reversal guidelines
Dr Danielle Spratt
12/06/2014