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So we've talked a little bit about a trauma that's arrived on the assignment of describe rule on the trauma team leader. So what about the rest of the team? Just to recap on the trauma scenario we were covering, it's a 60 year old mom. He's had a significant mechanism of injury full from scaffolding possible the fractures and a head injury. What happens then? Well, the trauma team leader organizes that team and to airway breathing in circulation teams on each of rules. The's airconditioning within the belt check manual really encourage you to read. Three. Do is to be sure that you're familiar. The airway team is very much comprised of a knee cyst on an airway nurse, usually so when they come dying, their rules are often very familiar to them. And but doing could a few extras. It's important that the and it's just assessed, assesses the patient for their neurological and level of consciousness. People's presence of seizures on whether or not they're they're moving their limbs, the lower limbs. And that's particularly important because you want to document someone's GCS before you put them off to sleep. And, of course, the reasons for airway compromised and trauma or often related Teo reduction and GCS. Hello, what may be separate from that? It may be that there's good in the airway or facial trauma or burns, for example, that will compromise the airway and the airway nurse will be familiar with setting up for in managing a trauma airway on. Of course, if the patient does need intubated, it's often a polls moment with the whole team has to really step back a lot of the airway to be millage to, um on. But then you can continue with the results station, and they're waiting will communicate with the trauma team leader about the need for intubation. And what drugs are you using? Um on walked in. Their con is for the airway. The breathing team will consist off a breathing nurses just usually a nurse from the emergency department on the breathing doctor, which is often one. Oh, the emergency department brokers just well. So the rule of the being nurse really is to make sure that the source is prepared and Moors Chest re infect sample truly is available and additional equipment and is available, and the access with removal of clothing when the patient arrives on the be nurse will apply at monitors. Xgeva shots put pressure on those observations and being verbalized back to the team. And the 20 leader on the breathing nurse would help with any procedures that are identified. Um, under assessable be such as chest re in, um, or doing a fast, and that they're also involved course, and the patient's ready for transfer to see t and with the equipment without involves the breathing. Doctor assesses. Be respectful. Very. It's, um, Aaron Tree. And then, if they have fast, can order signing two capabilities and then they should use thumb. Certainly very sensitive to detect you majorities. The breathing doctor would also have to communicate to trauma team, leader of the counter come through chest re in, and then they'd be assisted by the breathing tube to put that and as needed. And sometimes that there isn't a pneumothorax, then the B team may feel it have less to do. But one of their rules is to make sure that the old GI has been adequately requested and and also prescribed a minister drugs like algesia, antibiotics and tetanus. And so they had coordinate with the rest of team using the team approach that we suggested the circulation team will stand on the other side of the patient on by the nurse. There will be again involved in setting up the resource paper for the patient arrives and then a system with Tinning IV access and getting blood samples off. We discussed her that could be quite difficult when the patients is on noon, and they're also, um, ensuring that we have the initial supply of negative blood from the CT blood fridge, if that's what's required. And on, as I said, most patients will have received fax on the castle to Prehospital E, and the C team would make sure that that followup infusion of ground where it ours is prepared on Roman. The circulation doctor is, um, usually a surgeon, um, again when they arrive identifying themselves to team in the competencies and the first rule of the circulation doctor is again with the nurse to make sure that they can obtain venous access. That's an absolute priority, but it's very important to revert. Teo I oh access and we're being a success cannot begin with in the first two attempts perfectly and the Humulin r Mickley unstable patient and recess will have I, oh, guns. And also later three. And I also has, um, Andros is guns and would use them either particularly or humeral I Oh, it's probably prepared control because the time to superior in that in access is actually quite quite high from a humeral i. Oh, him. It's also important to assess the abdomen under see because could be a lot of blood lost into the abdomen and pelvis to ensure that the pellet binder is cited correctly and then also the any long bone injuries are are straightened to adjust any further blood loss from those on assessed circulation in the preference along with the senior. So so ensure that the tracks on the gas that has been given an infusion is running. I'm with the rest of the team. Coordinate their efforts to ensure that they're getting a patient to the CT scanner safely with in that 30 minutes. When do that we've discussed So all of those rules, um, are extremely important. But we have, um, recognized over time that the circulation nurse can become particularly overloaded in a situation where there's massive hemorrhage and Of course, that's one of the biggies in trauma that kills the patients who circulation nurse rules. Very important. If we're getting into a situation where there is major hemorrhage, want to make sure that the support for that rule, because the checking of blood and Loprox is particularly time consuming, cognitively overloading and then loading those into rapid transfusion system can take quite some time unresolved and overdue for the circulation there. So if the major and the most critical for trauma is activated, that then buys you an extra nurse essentially in the resource room. So the additional nurse will then come to check blood and blood products before that patient. And and that's really, really helpful. It's important to remember and major hemorrhage. And even if you're not on the C team and that you think about things like reversing out the coagulation, so find out what the drugs the patient is already on. If they're a week, then the cyst will be speaking to the patient of ahead and and should have taken a bowl. Trauma history, which will include allergies, medications, um, and a lot of the other information, if needed. So it's important to try and get out of the county. And remember that we should transfused Wanda one every shoes. So one red cells too plasma. And the major blood loss protocol is really helpful. Show you a copy of that night to use it as their for your for your assistance. And remember not to stay in 82 long at your imaging done so that you knew and where the blood is is being lost from and that in turn off the top, the major hemorrhage in trauma. Nice guidelines are very clear about what they recommend, and they certainly recommend not to use Crest Lloyd's and for fluid resource and and major hemorrhage and trauma. They also mention that we shouldn't overly rely on fast scaling. Make sure you're getting to the trauma CT rapidly on don't stay and recess too long with the bleeding patient Transfusion coordinator rule becomes particularly important that in those scenarios they will bring over a trolley, make sure that we've checked off all the blood that we've given in the correct order. Be involved in checking that blood on coordinating with the lab to ensure the porters are available and all the other things that need to happen whenever someone is beating heavily just to remain gee off a copy off the major blood loss protocol and trauma, It's really, really helpful. It helps you even at the start, to see who you need to activate it before what baseline investigations are needed to make sure that you're targeting quite get up with a with track sonic acid. Um, thinking about asked assistant hypothermia. I'm thinking about calcium. Make sure that you sure four units of O negative blood and to of trauma plasma Jordi available needy on. By the time you've used those trauma pack one should be on its way again. That's contains platelets, four f p and four of packed red cells. Getting the pictures up early about stage is helpful on the on the back of this performance. You take off everything that you've given on reminding the team really that you need to be thinking about why, why the patient is still bleeding on what to do with that patient. So and that process, you should think about what we've covered there. What is your rule? Are you gonna be on the 18, the B team or the C team, and it might be helpful to go over those in the training manual lie on, think about what and your rule would be on how to perform that rule and when a trauma arrives.