cards · checks stay on this phone
Trauma
157 values across 11 cards. Rows check off; per-kg doses compute on the weight.
— kg kg SET WEIGHT drives every per-kg dose below
age mo yr ESTIMATE KG no scale? APLS estimate — prefer a measured weight
Brain Injury Guidelines (BIG) 12 mBIG-1 clinical criteria — All of: GCS 13–15 or baseline · normal neuro exam · not intoxicated · not anticoagulated.
mBIG-1 CT criteria — CT: SDH or IPH ≤4 mm · SAH ≤3 sulci and <1 mm · no skull fracture, IVH or EDH.
mBIG-1 disposition — Observe 6 h, q2h neuro checks, discharge. No repeat CT, no neurosurgery.
mBIG-2 clinical criteria — All of: GCS 13–15 or baseline · normal neuro exam · not anticoagulated. May be intoxicated — BAC >80 mg/dL does not exclude an mBIG-2.
mBIG-2 CT criteria — CT: SDH or IPH >4–7.9 mm · SAH one hemisphere or 1–3 mm · non-displaced skull fracture.
mBIG-2 disposition — Transfer to the receiving trauma center.
mBIG-3 clinical criteria (any one qualifies) — Abnormal neuro exam (GCS <13, focal findings or abnormal pupils), intoxication (BAC >80 mg/dL), or any anticoagulant or antiplatelet agent.
mBIG-3 CT criteria — CT: SDH/IPH ≥8 mm · any IVH or EDH · SAH >3 mm bi-hemispheric · midline shift · displaced fracture.
mBIG-3 disposition — Transfer to the receiving trauma center, same as mBIG-2.
Escalation — neurologic decline: Any neurologic decline escalates, whatever the category.
Escalation — anticoagulated/antiplatelet/thrombocytopenic: Anticoagulated, on antiplatelets, or thrombocytopenic → escalate automatically.
Transfer center tap-to-call
SOURCES ▸ Joseph JM, et al. J Emerg Med. 2022;63(4):490–498 Level 1 Trauma Activation 30 TIME SINCE ACTIVATION 0:00 START ✕ CLEAR
Physiologic — SBP / HR
SBP <90 (age 10–64); <110 (age ≥65); HR > SBP
Physiologic — RR / SpO2
RR <10 or >29; SpO2 <90% RA
Anatomic — penetrating / skull / deficit
Anatomic — flail chest / pelvis / long bones
Anatomic — mangled limb / amputation / tourniquet
Escalate despite normal vitals
Head injury on anticoagulants
Hemorrhage first — xABCDE
MTP trigger — ABC score
ABC score ≥2
Primary survey — <C> catastrophic hemorrhage
Primary survey — A Airway
GCS ≤8 → definitive airway
Primary survey — B Breathing
Primary survey — C Circulation (blood, TXA)
TXA 1 g IV over 10 min, then 1 g over 8 h — only within 3 hours of injury
Primary survey — D Disability
Primary survey — E Exposure
Secondary survey — pelvis
Secondary survey — splint/tetanus/antibiotics
CT guidance blunt — unstable
CT guidance blunt — stable adult
CT guidance — CTA neck for BCVI
CT guidance — stable child
CT guidance penetrating — unstable
CT guidance penetrating — stable
SOURCES ▸ UW Medicine / Froedtert trauma activation criteria (local convention) CDC/ACS-COT National Guideline for Field Triage, 2021 Geriatric/anticoagulant overtriage: PubMed 31030991 ATLS Student Course Manual, 11th ed. (2024) Nunez TC, et al. J Trauma 2009;66(2):346-352 ATLS 11th ed. CRASH-2; ATLS 11th ed. · ruled 2026-08-25 (C13) Canadian C-Spine Rule (Stiell, JAMA 2001); NEXUS (Hoffman, NEJM 2000) PECARN (Kuppermann, Lancet 2009) Blunt Polytrauma 10 OPEN THE LIVE PATHWAY — BLUNT TRAUMA — TENSION · TUBE · MTP ▸ Hemorrhage first, blood early
Permissive hypotension / TBI target
SBP ~80–90; TBI SBP ≥110 (age 15–49, 70+) or ≥100 (age 50–69)
Balanced transfusion 1:1:1
TXA — full dosing
1 g IV over 10 min, then 1 g over 8 h · IV · within 3 hours of injury
Blunt aortic injury: target
SBP <120
SOURCES ▸ ATLS 11th Edition (2025) Bickell WH, NEJM 1994; Brain Trauma Foundation 4th ed. 2017 · ruled 2026-08-25 (C29) Sierink JC (REACT-2), Lancet 2016 Holcomb JB (PROPPR), JAMA 2015 CRASH-2 Collaborators, Lancet 2010/2011 · CRASH-2 dosing EAST PMG, Blunt Aortic Injury (Fox N, et al., 2015) EAST PMG, Blunt Cardiac Injury Screening (Clancy K, et al., 2012) Seatbelt-sign/hollow-viscus CT exclusion study, PMC9280606 Penetrating Trauma 18 OPEN THE LIVE PATHWAY — PENETRATING — TCA PATHWAY ▸ Department safety — lockdown: Consider lockdown. Say it out loud as a question. Tell the charge nurse.
Department safety — Weapons. Assume they still have one; staff cut and search the clothing.
Department safety — controlled entrance: One controlled entrance. Family to a defined area, with a named person managing it.
Evidence — clothing: Cut around holes, not through them. Do not clean wounds for description alone.
MARCH — massive hemorrhage before airway when the bleeding is catastrophic.
Permissive hypotension: SBP ~80–90, or a palpable radial pulse. Not if TBI.
Tension pneumothorax is a clinical diagnosis — immediate needle/finger decompression, don't wait for imaging.
Sucking chest wound → vented chest seal. Deteriorates after sealing? Burp or remove it.
Massive hemothorax: ≥1500 mL out at once, or >200 mL/h for 3 h → surgeon, transfer.
Tamponade: use the eFAST pericardial view, not Beck's triad.
Arrest with signs of life → TCA pathway; thoracotomy criteria.
Abdomen — unstable/peritonitis: Hemodynamic instability or peritonitis → transfer/laparotomy is the priority; don't delay it for imaging.
Abdomen — stable stab vs GSW: Stable stab: selective non-operative management. Stable GSW: call the surgeon.
Positive FAST + hypotension = act. A negative FAST rules nothing out here.
GSW documentation — Never write “entry” or “exit” wound. Describe location, size, shape, features.
Count every wound: front, back, axillae, perineum, scalp.
TXA 1 g IV over 10 min, then 1 g over 8 h — only within 3 hours of injury. Penetrating is already 1 ABC point (
Level 1 Trauma Activation ).
Low-titer O-positive whole blood if you stock it; otherwise 1:1:1 components.
SOURCES ▸ TCCC Guidelines, current edition Bickell WH, NEJM 1994 TCCC open-pneumothorax dressing change (2013) Mowery NT, et al. (EAST), J Trauma 2011;70(2):510-8 Western Trauma Association, Resuscitative Thoracotomy algorithm, 2024 Como JJ, et al. (EAST), J Trauma 2010;68(3):721-33 ACEP Now, "The Clinical Forensic Evaluation of Gunshot Wounds in the ED." CRASH-2 Collaborators, Lancet 2010/2011 · ruled 2026-08-25 (C13) Burn 12 ABA transfer — TBSA / depth / location: Partial thickness >10% TBSA · any full thickness · face, hands, feet, genitals, joints.
ABA transfer — chemical / electrical / inhalation: All chemical burns · all electrical, including lightning · all suspected inhalation injury.
ABA transfer — comorbidity / trauma / children: Burn plus a complicating comorbidity, or plus trauma. Children without peds burn capability.
Rule of nines (%TBSA): head 9, each arm 9, each leg 18, front 18, back 18, perineum 1. Under about 12–14 years use an age-adjusted chart — larger head, smaller legs.
Palm plus fingers ≈1% TBSA — for scattered or patchy burns.
Burn fluid resuscitation — rate
2 mL/kg/%TBSA lactated Ringer's · IV · adults ≥20% TBSA
Half in the first 8 h from the burn, not from arrival. Titrate to urine ~0.5 mL/kg/h.
Inhalation injury — intubate early: Soot, singed nasal hair, hoarseness, stridor, carbonaceous sputum → intubate early.
CO: co-oximetry, 100% NRB. Cyanide: hydroxocobalamin 5 g IV over 15 min.
Cooling and analgesia
≥20 min, within 3 h
Pre-transfer — do not: Before transfer: nothing topical, no debridement, leave adhered clothing and tar.
SOURCES ▸ American Burn Association, Guidelines for Burn Patient Referral, 2022 Cartotto R, et al. ABA Clinical Practice Guidelines on Burn Shock Resuscitation, J Burn Care Res 2024 Orlando Regional Medical Center, Burn Inhalation Injury Treatment EBM guideline, 2025 rev. Orlando Regional Medical Center, Burn Inhalation Injury Treatment EBM guideline, 2025 rev. · ruled 2026-08-25 (C14) Romanowski KS, et al. (ABA pain guideline), J Burn Care Res 2020 Lanham JS, et al. (wound care), Am Fam Physician 2020 StatPearls, Escharotomy (Wang & Hughes, updated 2026) Isolated Head Trauma 11 Mild TBI: GCS 13–15 · Moderate: GCS 9–12 · Severe: GCS 3–8.
Intubation trigger — GCS ≤8 is the trigger — but weigh trajectory, reflexes and transport time too.
Canadian CT Head Rule — CT if any: GCS <15 at 2 h · open, depressed or basilar skull fracture · ≥2 vomits · age ≥65 · retrograde amnesia ≥30 min · dangerous mechanism.
CCHR does not cover under-16s, anticoagulation, or post-traumatic seizure.
Secondary-injury prevention targets
SBP ≥110 (age 15–49, 70+) / ≥100 (age 50–69); SpO2 >94%; PaCO2 35–38
HOB >30°, neck midline · normothermia 36.0–37.9°C · glucose ~100–180 mg/dL.
Herniation recognition — Cushing's triad, unequal pupils, posturing, GCS drop, new focal deficit.
Herniation — osmotherapy
mannitol 0.5–1 g/kg IV over 5–15 min, or 3% saline · IV
Head trauma on any anticoagulant → reverse now, before the CT confirms it.
Seizure prophylaxis
phenytoin or levetiracetam for 7 days
SOURCES ▸ Stiell IG, et al. (Canadian CT Head Rule), Lancet 2001;357(9266):1391-6 Stiell IG, et al. (Canadian CT Head Rule), Lancet 2001 Brain Trauma Foundation, Guidelines for the Management of Severe TBI, 4th ed., 2017 ACS TQIP Best Practices Guidelines for TBI, 2024 rev. ENLS TBI and ICP/Herniation Protocols ENLS ICP/Herniation Protocol; Murphy L, CJEM 2020 Kowal D, Ross D, ACEP Now, Oct 2022 Frontera JA, et al., Neurocritical Care 2016;24(1):6-46 Mangled / Amputated Extremity 13 MESS = bone/soft tissue (1–4) + ischemia (1–3, doubled beyond 6 h) + shock (0–2) + age (0–2). ≥7: consider amputation.
MESS is an adjunct, not a cutoff. The replant surgeon's judgment governs.
Amputated part preservation — Saline gauze → watertight bag → bag on ice. NEVER the part against ice.
Ischemia time windows
~6 h muscle, ~12 h digit; if iced, double both
Call the replant center: mechanism, level, ischemia time, preservation.
Vascular — hard vs soft signs: Hard sign → operate, no imaging. Soft sign → work it up.
ABI <0.9 → CTA. ABI ≥0.9 with a normal exam → safe to observe.
Revascularization is urgent regardless of the clock.
Compartment syndrome — earliest sign: Pain out of proportion or on passive stretch is the earliest and most reliable sign.
Fasciotomy pressure thresholds — Compartment pressure >30 mmHg, or delta pressure ≤30 mmHg → fasciotomy.
Open fracture antibiotics (Gustilo classification)
cefazolin (I/II); add gram-negative coverage (III); add penicillin (farm injury)
Mangled or open fracture = tetanus-prone.
SOURCES ▸ TCCC Guidelines, current edition Johansen K, et al. (MESS), J Trauma 1990;30(5):568-72 Aldabagh et al. 2023; Abdo et al. 2023 StatPearls, Digit Amputation; ILCOR scoping review Oct 2024 StatPearls, Digit Amputation EAST PMG, Penetrating Lower Extremity Arterial Trauma (2002); Romagnoli AN 2021 EAST PMG, Penetrating Lower Extremity Arterial Trauma (2002) StatPearls, Acute Compartment Syndrome EAST PMG, Prophylactic Antibiotics in Open Fractures (2011) BCVI Screening 11 Signs — unexplained neuro deficit
Denver — C-spine fracture pattern
Denver — basilar skull / DAI
Denver — hanging / clothesline / seatbelt
Expanded Denver — fractures
Expanded Denver — thoracic adds
Universal screening option
Positive screen — antithrombotic
aspirin or heparin
SOURCES ▸ Biffl WL, et al., Ann Surg 1998 (Denver screening criteria) Burlew CC, et al. J Trauma Acute Care Surg 2012;72(2):330-7 Black JA, et al., J Trauma Acute Care Surg 2021 Kim DY, et al. EAST PMG, J Trauma Acute Care Surg 2020;88(6):875-887 Biffl WL, et al. J Trauma 1999;47(5):845-53 (Denver grading) Mass-Casualty Incident — First 15 Minutes 11 START triage
RR >30 or no radial pulse → RED
Mark each patient's triage category
Blood bank and transfer center
SOURCES ▸ START/SALT triage per CHEMM (chemm.hhs.gov); ACS COT disaster resources Electrical & Lightning Injury 9 Voltage classification
high voltage ≥1000 V
Exam — entry/exit, commissure, compartments
Rhabdo — urine target
urine 1–2 mL/kg/h if pigmented
Fixed pupils after lightning
SOURCES ▸ Wilderness Medical Society lightning injury guidelines (WEM 2014) Zafren et al., electrical injuries review Hazmat / Contaminated Patient 20 Air handling / administrator
Elemental metals — no irrigation
Nerve agent — atropine + pralidoxime
atropine 2–6 mg, double q5 min until secretions dry; pralidoxime 1–2 g over 15–30 min
Cyanide — hydroxocobalamin
hydroxocobalamin 5 g IV over 15 min · IV
Pulmonary agents — no antidote
Poison control tap-to-call
SOURCES ▸ HHS/ASPR CHEMM (chemm.hhs.gov) ATSDR Medical Management Guidelines HHS Radiation Emergency Medical Management (REMM) CLEAR CHECKS & TIMERS — THIS PAGE Checks, weight and timers stay on this phone — no names, no record numbers, nothing leaves the device. Verbatim from the v1 harvest (@ ee60d25). Contested values were ruled 2026-08-25 — the ruling wins over anything shown here that lost. Each card's sources sit closed at its foot.