Criteria for assessment in the Resuscitation Room

Mechanism of injury:

• Gunshot wounds involving any part of the body except the lower leg distal to the popliteal fossa or forearm distal to the antecubital fossa (unless there is concern for neurovascular compromise or compartment syndrome - see below).

• Stab wounds involving the neck, chest, abdomen, back, or head.*

• Falls from greater than twice the patient's height.

• Burns >20% in adults, >10% in children or if there are signs of airway involvement or inhalational injury.

• Motor vehicle accidents, if high velocity,** or there has been rollover, ejection, or death of another occupant.

• Pedestrian vs vehicle accidents, if high velocity.**

• Attempted hanging.

*if there is concern for penetrating brain injury / the wound breaches cranial vault.

**determined on a case-by-case basis depending on clinical condition and resource availability. Utilise the LODOX, eFAST, blood gas analysis, and clinical assessment to guide decision making regarding streaming within TEU.

Primary and secondary survey:

A - Patients arriving intubated, those assessed to have a threatened airway, or who have an anticipated need for airway observation or intervention given the projected clinical course.

B - SpO2 <92% should be discussed with the registrar for consideration of assessment in Resus.*

C - SBP <90mmHg or any active haemorrhage not easily controlled with direct pressure or a haemostatic suture.

D - GCS <13 or seizure or focal neurological deficit or significant agitation requiring containment.

E - Concern for compartment syndrome or acute limb ischaemia.

*further investigation of the cause of hypoxia is warranted in Resus if the cause is not known, and escalation is required if the patient has any associated significant work of breathing, tachypnoea, or the hypoxia persists despite supplemental oxygen.

Pattern of injury:

• Fractures of the femur, sternum, multiple ribs, or any unstable spinal column injury.

• Pneumo/haemothorax.

• Pneumo/haemoperitoneum.

• Significant intracranial haemorrhage.

• Severe respiratory or metabolic acidosis.*

*determined on a case-by-case basis, depending on trend, clinical condition, and resource availability.