Critical Trauma Patient

PHYSIOLOGIC FACTORS

Adult - (fourteen (14) years of age and older):

1. Glasgow Coma Scale less than or equal to 13
2. Systolic Bp less than 90 mmHg
3. Respiratory rate less than 10 or greater than 29

Pediatrics - (under fourteen (14) years of age):

1. Glasgow Coma Scale less than or equal to 13
2. Systolic Bp:
   • Less than 80 mmHg (7 to 14 years of age)
   • Less than 70 mmHg (under 7 years of age)
3. Respiratory rate less than 10 or greater than 29

ANATOMIC FACTORS

1. All penetrating injuries to head, neck, torso, and extremities proximal to elbow and knee
2. Flail chest
3. Two or more proximal long-bone fractures
4. Pelvic fractures
5. Open or depressed skull fracture.
6. Traumatic paralysis
7. Amputation proximal to wrist and ankle
8. Combination trauma with burns: Second or third degree burns with greater than 15% BSA, any facial or airway

MECHANISM OF INJURY

1. Patient ejected from a motor vehicle.
2. Patient ejected from a motorcycle (e.g. jet ski, snowmobile, etc.) traveling > 20 mph
3. Death in same passenger compartment
4. High speed auto crash with major deformity
5. Extrication time > 20 minutes
6. Falls > 20 feet
7. Rollover without a seatbelt
8. Auto-pedestrian/auto-bicycle injury with > 5 mph impact
9. Pedestrian thrown or run over

AGE AND CO-MORBID FACTORS

1. Age less than 5 years and difficult to evaluate or age greater than 55 years
2. Cardiac or respiratory disease
3. Insulin – dependant diabetes, cirrhosis or morbid obesity
4. Pregnancy
5. Immunosuppressed patients
6. Patient with bleeding disorder or on anticoagulants