TCRN cheat sheet

Primary survey sequence: catastrophic hemorrhage control, then airway with cervical spine protection, breathing/ventilation, circulation with hemorrhage control, disability (GCS and pupils), and exposure with environmental control.

Hemorrhagic shock class III (30-40% blood loss): heart rate greater than 120, decreased systolic pressure, narrowed pulse pressure, urine output 20-30 mL/hr, and altered mental status.

Permissive hypotension targets systolic 80-90 mmHg until hemorrhage control in penetrating trauma without brain injury; with traumatic brain injury keep systolic at least 110 mmHg and MAP at least 80 mmHg.

GCS total = eye (1-4) + verbal (1-5) + motor (1-6), range 3-15; a score of 8 or less indicates the need for a definitive airway.

Revised Trauma Score = 0.9368 (coded GCS) + 0.7326 (coded systolic BP) + 0.2908 (coded respiratory rate), range 0-7.84; RTS of 4 or less predicts high mortality.

Abdominal compartment syndrome = sustained intra-abdominal pressure above 20 mmHg with new organ dysfunction; intra-abdominal hypertension begins above 12 mmHg.

Acute spinal cord injury: maintain MAP 85-90 mmHg for 5-7 days; neurogenic shock presents as hypotension with bradycardia and is treated with vasopressors rather than large fluid boluses alone.

Adult rule of nines: head 9%, each upper extremity 9%, anterior trunk 18%, posterior trunk 18%, each lower extremity 18%, perineum 1%.

Rehabilitation phase: progressive mobilization within 24-48 hours of ICU admission reduces ICU-acquired weakness and ventilator days; screen hemodynamic and neurologic stability first.

Level I: 24/7 in-house general surgeon, full specialty coverage, research and residency education. Level II: 24/7 surgeon availability but may lack in-house specialties. Level III: resuscitation, surgery, stabilization, and transfer agreements. Level IV: stabilize and transfer.

CDC field triage red (highest-risk) criteria include GCS 13 or less, systolic BP below 90 mmHg, respiratory rate below 10 or above 29, and penetrating injury proximal to elbow or knee.

Injury prevention frameworks: the Three E's (education, enforcement, engineering/environment) and the Haddon Matrix (host, agent, environment crossed with pre-event, event, post-event).

EMTALA requires a medical screening examination and stabilizing treatment for anyone presenting to an emergency department, regardless of insurance status or ability to pay.

Performance improvement loop: event identification, multidisciplinary review including preventable death review, action plan, then documented re-measurement and loop closure.

Trauma registry data are submitted to the National Trauma Data Bank and used for TQIP benchmarking, research, and injury prevention planning.

Forensic chain of custody: clothing, bullets, and other evidence go into separate paper containers, are labeled with patient identifiers, and are handed directly to law enforcement with documentation.

Structured communication: SBAR (Situation, Background, Assessment, Recommendation) for handoffs; crew resource management for team leadership, role clarity, and closed-loop communication.

Mandatory reporting: suspected child, elder, or intimate partner violence and specified injuries such as gunshot wounds must be reported according to state law.