ACS Sepsis Stroke Trauma GI bleed DKA Anaphylaxis Pregnancy trauma Child sepsis Status epilepticus APO HyperK

Polytrauma in pregnancy

Start this sheet when: Pregnant with a trauma-team call, or any abdominal blow, fall or road accident from 20 weeks (fundus at or above the umbilicus), even if she looks well. Save the mother first.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time of injury (clock time)

Time since door

TXA window (3 h): enter time of injuryAnti-D window (72 h): enter time of injury

Team

Write who holds each role and stamp when they arrive. In a small ED one person may hold two roles; write the name in both.

Team leader · senior ED doctor

Directs from the foot end; makes the calls

Airway · anaesthetist

Airway, C-spine hold, RSI, ventilation

Procedures · surgeon / 2nd doctor

Chest, eFAST, drains, binder, bleeding control

Circulation nurse · staff nurse 1

IV/IO x2, bloods, blood products, TXA, drugs

Monitor & scribe · staff nurse 2

Vitals every 5 min; times on this sheet

Runner · MPW / attendant

Blood bank, samples, CT, porter, family

Obstetrician · obstetrics

Uterus, CTG, abruption, perimortem kit

Neonatal · paediatrician

Newborn resus if 24 wk+ and delivery likely

Targets met --Breaches 0

1.Trauma leader at bedside, obstetrician called
≤ 5 min from door · Local target: both teams on one call
Enter door time
2.Left uterine displacement / 15-30° tilt(20 weeks+)
≤ 5 min from door · ATLS 11e: at once from 20 weeks
N/AEnter door time
3.Primary survey and eFAST completed
≤ 15 min from door · Local target (ATLS sequence)
Enter door time
4.First blood product running (MTP)(Shocked)
≤ 15 min from door · Local target: O-negative in shock
N/AEnter door time
5.Tranexamic acid 1 g given(Bleeding)
≤ 3 h from time of injury · CRASH-2: within 3 h of injury
N/AEnter door time
6.Continuous CTG started(24 weeks+)
≤ 30 min from door · Local target; run at least 4 h (ATLS 11e)
N/AEnter door time
7.Maternal cardiac arrest(Arrest)
Record · Record only: starts the delivery clock
N/AEnter door time
8.Perimortem delivery started(Arrest, 20 weeks+)
≤ 4 min from maternal arrest · RCOG GTG 56: start by 4 min, baby out by 5
N/AEnter door time
9.Kleihauer sent and anti-D given(Rh-negative)
≤ 72 h from time of injury · BCSH 2014: within 72 h of the event
N/AEnter door time
10.MLC registered, police intimated
Record · Never delay care for police (Parmanand Katara)
Enter door time
11.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
12.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Normal vitals can hide 30% blood loss: blood early, vasopressors last
☐Never withhold a CT the mother needs; chest drain 1-2 spaces higher
☐Abruption can be silent: CTG for 4 h even after minor trauma
☐Tender or hard uterus, bleeding, contractions: obstetrician now
☐Arrest: CPR with the uterus pushed left; knife ready by minute 4
☐Ask about violence at home in private; document and refer

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.