Major Trauma

Major Trauma

14 year old pedestrian hit by a van in hit & run incident at at least 40mph. Loss of consciousness at scene. Scooped & ran as felt too unstable for transfer to Major Trauma Centre (MTC).


  • RR 30, SpO2 91% in air

  • HR 110, BP 100/40, CRT 3 secs

  • A[V]PU, GCS 10 (E3 M5 V2), PERL 3mm bilat


  • Moaning, incorrectly applied c-spine immobilisation.

  • Bruising & wound to scalp, bruising over abdomen & pelvis, open fracture right lower leg.


"A significant proportion of severely injured children were not conveyed to hospital by ambulance”. Almost 30% of paediatric major trauma does not present to a MTC (TARN, 2012). Children with very significant injuries can present at any hospital so it is essential that all units are able to provide initial trauma care.


  1. Familiarise yourself with equipment before you need to use it on a patient

  2. When your hospital cannot provide definitive management for a time critical injury consider carefully how much investigation & management should be initiated before transferring to that definitive care


  • Recognition of patient with multi-system injuries that needed transfer to trauma centre.

  • Managed task focussed specialty doctor well, did not get distracted from treatment priorities.

  • Identified time critical head injury and started neuroprotective measures.

Edit & Peer Review by Jamie Sillett
Diabetic Ketoacidosis

Diabetic Ketoacidosis

Meningococcal Sepsis

Meningococcal Sepsis