›Balanced transfusion strategy if hemorrhagic shock suspected local protocol dependent
›Massive transfusion protocol activation criteria local protocol dependent
›TXA within 3 hours for severe hemorrhage or high risk of hemorrhage local protocol dependent
Analgesia and sedation
›Pain control options
›Acetaminophen PO or IV 1000 mg once then 1000 mg every 6 hours maximum 4000 mg per day
›Ibuprofen PO 400 mg every 6 hours as needed
›Ketorolac IV 15 mg once then 15 mg every 6 hours as needed maximum 60 mg per day
›Fentanyl IV 25 mcg increments every 5 minutes to effect
›Hydromorphone IV 0.2 mg increments every 5 to 10 minutes to effect
›Analgesia cautions
›Avoid NSAIDs in significant bleeding risk
›Avoid oversedation obscuring neuro exam
Imaging and testing sequence
›Diagnostic pathway
›CXR and pelvis radiograph in unstable patients
›eFAST in shock
›CT pan scan selection based on stability and exam local protocol dependent
Wound and fracture care
›Soft tissue and bone care
›Tetanus update per immunization status
›Open fracture antibiotics local protocol dependent
›Splinting and immobilization
›Compartment syndrome monitoring
Reassessment loop
›Iterative checks
›Repeat vitals every 15 to 30 minutes until stable
›Repeat neuro exam after analgesia and imaging
›Repeat abdominal exam at 2 to 4 hours when observation chosen
›Escalation if new hypotension hypoxia or mental status change
Consultation
›Specialty involvement
›Trauma surgery
›Neurosurgery for intracranial hemorrhage or unstable spine
›Orthopedics for fractures and dislocations
›Vascular surgery for suspected vascular injury
›OB for pregnancy trauma local protocol dependent
17Disposition/dispo27
ICU criteria
›Critical care indications
›Ongoing vasopressor or transfusion requirement
›Respiratory failure or impending airway compromise
›Severe TBI
›Unstable spine injury with neuro compromise
Inpatient admission criteria
›Admission indications
›Intracranial hemorrhage or concerning CT findings
›Unstable fractures
›Solid organ injury
›Persistent hypoxia
›Blunt cardiac injury with abnormal ECG or troponin
Observation pathway
›Observation candidates
›Mild TBI with persistent symptoms and normal imaging
›Abdominal pain with negative CT but ongoing tenderness
›Serial exams needed due to intoxication or distracting injuries
Transfer criteria
›Trauma center transfer triggers
›Need for surgery not available
›Polytrauma with high resource needs
›Severe TBI
›Unstable pelvic fracture
Discharge criteria
›Safe discharge requirements
›Hemodynamically stable
›Pain controlled with oral meds
›Ambulation safe or baseline mobility confirmed
›Normal neuro exam or stable mild concussion plan
›Reliable supervision and return access
›Clear follow up plan
18Discharge Instructions/di30
Copy discharge instructions
›Summary
›You were evaluated after a motor vehicle collision
›Your exam and tests today did not show a dangerous injury that needs admission
›Expected symptoms
›Muscle soreness and stiffness can worsen over the next 24 to 48 hours
›Bruising may increase over the next few days
›Pain control
›Acetaminophen as directed on the label
›Ibuprofen as directed on the label unless you were told to avoid it
›Avoid alcohol or sedatives if using opioid pain medicine
›Activity
›No driving if you feel dizzy sleepy or are taking sedating medicines
›Gradual return to normal activity as tolerated
›Avoid contact sports until concussion symptoms are gone if you had a head injury
›Wound care
›Keep wounds clean and dry for the first day unless told otherwise
›Return for redness pus fever or worsening pain at a wound site
›Follow up
›Primary care follow up within 2 to 3 days
›Return sooner if symptoms are not improving
›Return to ED now for
›Trouble breathing or chest pain
›Worsening headache repeated vomiting or confusion
›Weakness numbness trouble walking or new vision or speech problems
›Fainting
›Increasing abdominal pain or belly swelling
›Blood in urine or inability to urinate
›New severe back or neck pain
›Increasing limb swelling severe pain or color change
›Fever or chills
19References/r13
Evidence based sources
›Core trauma guidance
›ACS Committee on Trauma ATLS Student Course Manual latest edition local protocol dependent
›Eastern Association for the Surgery of Trauma practice management guidelines
›World Society of Emergency Surgery guidelines for trauma topics local protocol dependent
›Decision rules
›Canadian C Spine Rule derivation and validation
›NEXUS C Spine criteria derivation and validation
›Canadian CT Head Rule derivation and validation
›PECARN pediatric head trauma rule derivation and validation
›NEXUS Chest decision instrument studies
›Hemorrhage and TXA
›CRASH 2 trial tranexamic acid in trauma 2010
›CRASH 3 trial tranexamic acid in traumatic brain injury 2019
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.