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Scenario Template Multi Trauma – HypotensionError! Bookmark not defined. Learning objectives Target audience Setting Overview Mannikin/Moulage Actors/Confederates Equipment Supplies Prebrief Handover Events Phase 1 Deverill 08/10/2014 Identify causes of hypotension in the multi trauma patient Avoidance of drugs likely to cause further hypotension Appropriate fluid resus in the hypotensive trauma patients Emergency Department SHOs, Registrars, RNs Emergency Department, Sunday afternoon Middle aged male, MBA, bike vs tree Sim man 3G, multiple abrasions, bike helmet Nurse confederate for SHOs, no confederate for registrars / RNs Intubation trolley Ventilator USS ECG machine Defibrillator Normal saline Blood Fentanyl Morphine Midazolam Suxamethonium Rocuronium Ketamine 45yo male, MBA, bike vs tree, approx 100kph, multiple injuries, hypotensive Male patient, riding along highway, lost control and hit tree at approx 100kph, significant pain – given 20mg morphine Brief LOC at scene Patient is hypotensive on arrival despite fluids given by QAS Progressively more hypotensive during resus, becomes more difficult to control pain, requires intubation Hypotensive on induction Positive FAST scan Phase 2 Phase 3 Phase 4 GCS ECG HR BP RR SpO2 WOB Pain Temp 13 Sinus tachy 136 86/48 26 99% on 15L Increase 10/10 37.1 I feel [...] Investigations Expected Actions Pitfalls Discussion points Author/Date GCS 11 Sinus tachy 138 74/40 32 99% on 15L Increase 10/10 36.4 ECG HR BP RR SpO2 WOB Pain Temp I feel [...] GCS ECG HR BP RR SpO2 […] […] […] […] […] […] GCS ECG HR BP RR SpO2 […] […] […] […] […] […] WOB Pain Temp […] […] […] WOB Pain Temp […] […] […] I feel [...] I feel [...] BSL iSTAT ECG USS – positive FAST CXR Fluid resuscitation in the trauma patient Activation of MTP Avoidance of further hypotension Use drugs likely to cause further hypotension Fluid resus in hypotensive trauma patients Appropriate drug use Dr Danielle Spratt 12/06/2014