Trauma — ER NOTE

1กลไกการบาดเจ็บและเหตุการณ์ (Mechanism & Event)

กลไกการบาดเจ็บ (Mechanism)

เวลาที่บาดเจ็บ (Time of injury)

เข็มขัดนิรภัย/หมวกกันน็อก (Seatbelt / Helmet)

Yes No

การช่วยออกจากพาหนะ (Extrication)

ลักษณะสถานที่เกิดเหตุ (Scene description)

2Primary Survey (ATLS 11 — xABCDE)

x — Exsanguinating hemorrhage control

None Controlled with TXA if needed Ongoing → MTP

A — Airway

Patent Obstructed Intubated

B — Breathing

Spontaneous Tachypnea / shallow Thoracic injury Ventilated

C — Circulation

Stable Tachycardia Hypotension / shock Arrest

D — Disability

Awake GCS 13–14 GCS 9–12 GCS ≤8

E — Exposure / Environment

Warm Hypothermia Significant soft tissue injury

RR

SpO₂

HR

BP

3Secondary Survey

Head / Neck / C-spine

Normal Scalp laceration C-spine tenderness / collar Focal neurological deficit

Chest / Abdomen / Pelvis

Normal exam Chest wall injury / crepitus Abdominal tenderness / guarding Pelvic instability

Extremities / Neuro

Normal Deformity / fracture Open fracture Peripheral neurovascular deficit

Other findings / injuries

4Resuscitation & Imaging

IV access

O₂

Fluids / blood

FAST / Imaging / Labs

Damage control resuscitation

TXA 1 g IV over 10 min (within 3 hr) Massive transfusion protocol (1:1:1 PRBC:FFP:Platelet) Permissive hypotension Active rewarming Damage control surgery indicated

5Tetanus Prophylaxis (CDC 2024)

Wound type

Clean minor Dirty / major / devitalized

Immunization history

≥3 doses, last ≤10 yr ≥3 doses, last >10 yr (clean) ≥3 doses, last >5 yr (dirty) <3 doses / unknown

Tetanus prophylaxis: — select wound type + history —

6Disposition

Decision

Consults