OR13.2 | Polytrauma Resuscitation Team Skills — Summary & Reflection

KEY TAKEAWAYS

Polytrauma resuscitation follows the ATLS ABCDE primary survey framework: Airway (with C-spine control) → Breathing → Circulation (haemorrhage control + IV access) → Disability (GCS, pupils) → Exposure. The sequence is fixed and must not be violated.

IV access in the C step uses two large-bore (14–16G) peripheral cannulae in the antecubital fossa; first cannula provides blood for crossmatch, FBC, coagulation, lactate. Flow ∝ r⁴/L (Hagen-Poiseuille) — short wide-bore peripheral lines are faster than long central lines. Central femoral vein access is the preferred central route in trauma.

Bladder catheterisation enables hourly urine output monitoring (target ≥0.5 mL/kg/h). Three contraindication signs must be checked before insertion: blood at urethral meatus (absolute contraindication), perineal/scrotal bruising, high-riding prostate on DRE. If any are present, use suprapubic catheterisation.

Endotracheal intubation in trauma uses Rapid Sequence Intubation (RSI — 7 P's). Ketamine 1–2 mg/kg is the preferred induction agent in haemodynamic instability; suxamethonium 1–1.5 mg/kg provides rapid-onset neuromuscular blockade. Correct tube placement is confirmed by bilateral chest rise + equal breath sounds + continuous ETCO₂ waveform.

Splintage is performed after the primary survey is complete — Thomas splint for femoral shaft fractures, extremity back-slabs for limb fractures. As a Phase III student, your team roles include IV access, the catheter contraindication check, C-spine stabilisation during intubation, and documentation.

REFLECT

Think about a simulated or real trauma scenario you have observed or participated in. Which of the five ABCDE steps was most rushed or skipped? Was the catheter contraindication check performed before catheterisation? Did the team leader clearly assign roles, or did multiple people attempt the same task simultaneously? Reflect on how team communication affected the quality and speed of resuscitation. Write 3–5 sentences describing one specific thing you would do differently as a team member, and why.