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Initial priorities
Initial priorities
Trauma activation criteria
High-energy mechanism
SBP < 90 mmHg
Altered mental status
Suspected open fracture
Suspected vascular injury
Airway and breathing threats
Hypoxia
Aspiration risk
Circulation threats
Hemorrhagic shock risk from femoral fracture
Estimated blood loss up to 1.5 L in closed femoral shaft fracture
Higher risk with open fracture
Higher risk with polytrauma
Analgesia and immobilization first-pass bundle
Early regional anesthesia option
Early splint or traction strategy
Hemorrhage and shock
Hemorrhage and shock
Hemodynamic targets
SBP ≥ 90 mmHg
MAP ≥ 65 mmHg
Mental status improvement target
Urine output ≥ 0.5 mL/kg/hour
Hemorrhage source control
Femur immobilization to reduce ongoing bleeding
Thomas splint option
Traction splint option with contraindication screen
Concomitant hemorrhage search
Pelvis
Abdomen
Chest
Resuscitation strategy
Large-bore IV access
Massive transfusion protocol trigger
Persistent hypotension despite initial fluids
Ongoing bleeding concern
Shock index > 1
Balanced blood product strategy
RBC
Plasma
Platelets
Antifibrinolytic option
If major trauma with hemorrhagic shock and within 3 hours, initiate TXA protocol
TXA 1 g IV over 10 minutes
Limb threat screening
Limb threat screening
Neurovascular compromise triggers
Absent distal pulses
Immediate reduction of gross deformity if tensioned
Immediate vascular surgery consult
CT angiography lower extremity when stable
Expanding hematoma
Immediate vascular surgery consult
Hard signs of vascular injury
Pulsatile bleeding
Bruit or thrill
Distal ischemia
Compartment syndrome triggers
Pain out of proportion
Pain with passive stretch
Paresthesia
Tense compartments
If high concern, emergent orthopedics
Open fracture triggers
Antibiotics within 1 hour
Tetanus prophylaxis pathway
Orthoplastic or trauma center transfer if required
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.