Emergency Patient Assessment, Shock States, and Advanced Life Support

Comprehensive vocabulary flashcards covering patient deterioration recognition, trauma surveys, trauma team roles, biomechanics, special populations, shock pathophysiology, and adult advanced life support principles.

The Golden Hour

A critical emergency management window wherein prompt medical intervention significantly improves survival and reduces severe secondary complications or death following major trauma, stroke, or sepsis.

Tachypnoea (as a clinical predictor)

The single most accurate vital sign predictor of serious patient illness and clinical deterioration, while paradoxically being the least accurately recorded vital sign by nurses.

Victorian Trauma Triage Guidelines

Emergency transfer protocols mandating that major trauma patients be transported directly to a Major Trauma Service (MTS) if travel time is $<30\,\text{minutes}$, or to the next highest-level service within $30\,\text{minutes}$, with Adult Retrieval Victoria (ARV) consulted within $60\,\text{minutes}$ of arrival.

Thrombolysis (Ischaemic Stroke)

The primary emergency medical reperfusion therapy for acute ischaemic stroke using alteplase or Tenecteplase, demonstrated to be most clinically effective when administered within $3-4.5\,\text{hours}$ of symptom onset.

Sepsis Golden Hour Bundle

A 6-step clinical action bundle established by Safer Care Victoria (2020) to 'think sepsis, act fast' within the first hour: oxygen administration, 2 sets of blood cultures, venous blood lactate, fluid resuscitation, appropriate antibiotics (within $30\,\text{minutes}$ for oncology patients), and ongoing vital observations.

Trauma Team Leader

A senior medical practitioner (GP, Surgeon, Anaesthetist, or Emergency Doctor) responsible for overall resuscitation supervision, member allocation, investigation prioritization, directing invasive procedures, and coordinating definitive transfer.

Trauma Scribe

A designated emergency resuscitation team member (Registered Nurse or Paramedic) responsible for real-time documentation of vital signs, procedure timestamps, medication timing, adherence to team leader directives, and bay access control.

Primary Survey (C-ABCDE)

A rapid, sequential or simultaneous clinical assessment prioritizing immediate life-saving interventions in responsive trauma patients: Catastrophic haemorrhage, Airway with in-line c-spine immobilisation, Breathing, Circulation, Disability, and Exposure.

Secondary Survey (FGH)

A systematic, detailed clinical assessment performed after primary stabilization comprising Full vital signs and fluids, Glucose and comfort measures, and a thorough Head-to-toe examination including a log roll and patient medical history.

SCALPeR

A clinical mnemonic identifying the six anatomical compartments capable of concealing major, life-threatening blood loss: Street (scalp/external), Chest, Abdomen, Long bones (femurs accumulating $1-3\,\text{L}$), Pelvis (accumulating $3-5\,\text{L}$), and Retroperitoneum.

ATMIST

A structured paramedic handover mnemonic utilized upon emergency department arrival detailing: Age, Time of incident, Mechanism of injury, Injuries identified, Signs (vital observations), and Treatment administered.

AMPLE

A focused emergency patient history mnemonic covering: Allergies, Medications, Past medical history (PMHx), Last meal, and Events surrounding the injury.

Kinetic Energy ($KE$) in Trauma

The kinetic force transferred to tissues calculated by $KE = \frac{1}{2}mv^2$, demonstrating that doubling the velocity quadruples ($4\times$) the energy transferred and potential tissue damage, whereas doubling mass only doubles the energy.

Blast Injury Classifications

A 4-tier categorisation of explosive trauma: Primary (blast shockwave impacting air-tissue interfaces like alveoli and tympanic membranes), Secondary (flying shrapnel/projectiles), Tertiary (physical displacement of the body), and Quaternary (burns, smoke inhalation, or toxic exposure).

Paediatric Assessment Triangle (PAT)

A rapid, non-invasive visual and auditory observational assessment tool used to evaluate a child's clinical stability within seconds across three distinct parameters: Appearance, Work of Breathing, and Circulation to skin.

TICLS Mnemonic

A clinical assessment mnemonic used to evaluate the Appearance component of the Paediatric Assessment Triangle: Tone, Interactions, Consolability, Look/gaze, and Speech/cry.

Supine Hypotension Syndrome

A maternal cardiovascular complication occurring in late pregnancy where the gravid uterus compresses the inferior vena cava while supine, reducing venous return and cardiac output by up to $30\%$, managed by left lateral tilt.

Threatened Miscarriage

Pregnancy-related vaginal bleeding occurring with a closed cervical os and documented fetal cardiac activity.

Inevitable Miscarriage

Pregnancy-related vaginal bleeding accompanied by cervical os dilation, where products of conception may be visualized or palpated at or above the cervical canal.

Incomplete Miscarriage

Pregnancy-related vaginal bleeding associated with a dilated cervical os in which partial products of conception have been expelled while residual gestational tissue remains retained within the uterus.

Anaerobic Metabolism

An emergency cellular metabolic pathway triggered by inadequate oxygen delivery ($DO_2$) resulting in reduced ATP synthesis, pyruvate conversion to lactate, accumulation of hydrogen ($H^+$) ions, and subsequent metabolic acidosis.

Distributive Shock

A state of shock characterized by widespread loss of vascular smooth muscle tone in arterioles and venules, causing profound decreases in systemic vascular resistance (SVR) and relative hypovolaemia without initial total fluid loss.

Neurogenic Shock

A form of distributive shock caused by cervical or high thoracic ($\ge T6$) spinal cord injury disrupting sympathetic pathways, characterized by hypotension, bradycardia, hypothermia or poikilothermia, and warm, dry skin.

Hypovolaemic Shock Class 3

A severe haemorrhagic stage involving $1500-2000\,\text{mL}$ ($30-40\%$) blood loss, presenting with tachycardia ($120-140\,\text{bpm}$), hypotension, narrowed pulse pressure, tachypnoea ($30-40\,\text{breaths/min}$), marked oliguria ($5-15\,\text{mL/hour}$), and severe anxiety or confusion.

Trauma Triad of Death

A mutually reinforcing lethal physiological triad comprising Coagulopathy, Hypothermia ($<36.5^\circ\text{C}$), and Acidosis ($\text{pH} < 7.2$), which progresses to the 'Diamond of Death' when hypocalcaemia is additionally present.

Cardiogenic Shock

Severe tissue hypoperfusion caused by mechanical pump failure of the heart (frequently following loss of $\ge 40\%$ of left ventricular myocardium), leading to reduced ejection fraction, decreased cardiac output, and elevated pulmonary venous pressures.

Obstructive Shock

Shock resulting from a direct physical impediment to cardiac filling or great vessel outflow, caused either by pulmonary vascular obstruction (massive PE, severe PHTN) or external mechanical compression (tension pneumothorax, pericardial tamponade).

Beck's Triad

The classic clinical diagnostic triad of cardiac tamponade consisting of hypotension, distended jugular veins (elevated JVP), and muffled or distant heart sounds.

Adult ALS Algorithm (Shockable Rhythm)

The advanced cardiac life support protocol for VF/pVT comprising prompt defibrillation, continuous CPR cycles of 30:2 or uninterrupted compressions for $2\,\text{minutes}$, adrenaline $1\,\text{mg}$ IV after the 2nd shock (every second cycle thereafter), and amiodarone $300\,\text{mg}$ IV after the 3rd shock.

4 H's and 4 T's

The primary reversible causes of cardiac arrest managed during ALS: Hypoxaemia, Hypovolaemia, Hyper/hypokalaemia and metabolic disorders, Hypo/hyperthermia; Tension pneumothorax, Tamponade, Toxins, and Thrombosis (pulmonary or coronary).