Last updated on 26 Jan 2023 at 10:56 AM (ED10)

Penetrating chest trauma
A 23 year Indian medical student is brought by ambulance to the resuscitation room of the Emergency Department after a high-speed road traffic crash. He has major injuries including a fence post lodged in his chest. There is evidence of splenic trauma.

 

Applied Science for Medicine
Anatomy of the abdomen and thorax
Pathology of pneumothorax
Pathophysiology of a tension pneumothorax
Mechanisms controlling haemostasis: platelets and coagulation factors
Pharmacology of opioids, metoclopramide, ondansetron, domperidone and scopolamine

Clinical and Communication Skills
History from a trauma patient and/or witness including managing patient and family/whānau distress
Perform a primary survey in a trauma patient
Perform a secondary survey
Perform an assessment of the airway, breathing and circulation, cervical spine integrity, recognise signs of life
Perform an assessment of the level of consciousness using the Glasgow Coma Scale (GCS) and Alert, Voice, Pain, Unresponsive (AVPU) Scale
Classify hypovolaemic shock according to severity based on clinical signs
Indications for trauma series X-rays, further imaging, Focused Assessment with Sonography for Trauma (FAST) scanning
Interpret full blood count, arterial blood gas, chest X-ray, abdominal X-ray, limb plain film X-ray and pelvic X-ray
Management of severe hypotension, pneumothorax, cardiac tamponade
Complications and prognosis of penetrating chest trauma
Role of the haematologist/transfusion medicine specialist in the treatment of massive haemorrhage
Obtaining consent when the patient is unconscious
Assessment of pelvic/abdominal injury
Indications for splenectomy; long term management post splenectomy including vaccinations, travel and antibiotic advice

Personal and Professional Skills
Ethics of life and death decision-making
Being able to manage own identification with the patient
Being aware of your own skills and calling for senior assistance as required
Self-care: coping with distressing presentations and maintaining your ability to carry out your tasks (see resources below)
Hospital transfer: when and how
Role of the police and coroner in trauma patients
Role of the Accident Compensation Corporation

Hauora Māori
Rates of severe injuries by ethnicity
Ethnic disparities in the long-term management of traumatic injury in New Zealand
Differential ACC claims and rehabilitation for Māori vs non-Māori
Differential impact of injuries on employment/income for Māori (i.e. more likely to be employed in 'manual' jobs)
Consideration of access to cultural/spiritual support for patient and whānau

Population Health
Provision of rescue helicopter services across New Zealand
Epidemiology of road traffic crashes including alcohol and drugs; strategies for prevention

 

Conditions to be considered relating to this scenario

Common

simple pneumothorax, haemothorax, haemopneumothorax, rib fracture, sternal fracture, pulmonary contusion, skin laceration and contusion

Less common but 'important not to miss'

flail chest, tension pneumothorax, cardiac tamponade, splenic rupture, pulmonary laceration, great vessel injury, direct cardiac trauma, intracranial haemorrhage, diffuse axonal injury, spinal cord trauma

Uncommon

surgical emphysema