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Assessment and Initial Management of the Trauma Patient

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Chapter 2. Assessment and Initial Management of the Trauma Patient ... Snoring, Gurgling, Stridor, Silence. Breathing. Present? Rate, Depth, Effort ... – PowerPoint PPT presentation

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Title: Assessment and Initial Management of the Trauma Patient


1
Chapter 2 Assessment and Initial Management of
the Trauma Patient
2
Assessment and Initial Management of the Trauma
Patient
Courtesy of ITLS Ontario
3
Overview
  • Steps of ITLS Patient Assessment
  • ITLS Primary Survey
  • ITLS Secondary Survey
  • ITLS Ongoing Exam
  • Initial Assessment related to Rapid Trauma
    Survey or Focused Exam
  • Initial Assessment interruptions
  • Critical conditions and critical interventions

4
ITLS Patient Assessment
  • ITLS Primary Survey
  • Scene Size-up
  • Initial Assessment
  • Rapid Trauma Survey or Focused Exam
  • ITLS Secondary Survey
  • ITLS Ongoing Exam

5
ITLS Primary Survey
  • ITLS Primary Survey
  • Scene Size-up
  • Initial Assessment
  • Rapid Trauma Survey or Focused Exam

6
Scene Size-up
7
Scene Size-up
8
Initial Assessment
9
ITLS Primary Survey
  • Initial Assessment
  • General impression
  • Initial level of consciousness
  • Manual stabilization of cervical spine
  • ABCs
  • Prioritizes patient
  • Determines existence of immediately
    life-threatening conditions

10
ITLS Primary Survey
  • Less than 2 minutes
  • Initial Assessment and Rapid Trauma Survey
  • Delegate any intervention. Interrupt survey only
    for

Scene danger Airway obstruction Cardiac arrest
11
ITLS Primary Survey
  • General impression
  • Approximate age, sex, weight
  • General appearance
  • Position of patient body and surroundings
  • Patient activity
  • Obvious major injuries or bleeding
  • Triage patients rapidly, if necessary.

12
ITLS Primary Survey
  • Initial Level of Consciousness
  • Cervical-spine stabilization
  • Alert
  • Responds to Verbal stimuli
  • Responds to Pain
  • Unresponsive

13
ITLS Primary Survey
  • Airway look, listen, feel
  • Direct simple positioning and suctioning
  • If not adequate, not quickly correctable
  • Interrupt advanced airway techniques

14
ITLS Primary Survey
  • Breathing look, listen, feel
  • Direct high-flow oxygen
  • If not adequate
  • Direct assisted ventilation

15
Breathing Rates
16
ITLS Primary Survey
  • Circulation peripheral pulse
  • No peripheral, check carotid
  • Too fast, too slow, quality
  • Interrupt cardiac arrest
  • Skin
  • Color, temperature, condition
  • Major bleeding scan
  • Direct bleeding control

17
MOI Decision
  • Dangerous generalized or unconscious
  • Rapid Trauma Survey
  • Dangerous focused
  • Focused Exam
  • Not significantInitial Assessment normal
  • Focused Exam

18
Priority Patient
  • Dangerous MOI
  • History
  • Loss of consciousness
  • Difficulty breathing
  • Severe pain in head, neck, torso
  • High-risk group
  • Altered mental status
  • Difficulty breathing
  • Abnormal perfusion
  • Abnormal Initial Assessment

19
Rapid Trauma Survey
20
Rapid Trauma Survey
  • Inspect Head and Neck
  • Major Facial Injuries, Bruising, Swelling,
    Penetrations, Subcutaneous Emphysema
  • Neck Vein Distention? Tracheal Deviation?

21
Rapid Trauma Survey
  • Inspect Chest
  • Asymmetry, Contusion, Penetrations, Paradoxical
    Motion, Instability, Crepitation
  • Breath Sounds
  • Present? Equal?
  • (If unequal Percussion)
  • Heart Tones

22
Rapid Trauma Survey
  • Abdomen
  • Bruising, Penetration/Evisceration, Tenderness,
    Rigidity, Distention
  • Pelvis
  • Tenderness, Instability, Crepitation

23
Rapid Trauma Survey
  • Lower/Upper Extremities
  • Swelling, Deformity, Instability, Motor, Sensory
  • Place Patient on Backboard
  • Posterior
  • Penetrations, Deformity, Presacral Edema

24
Rapid Trauma Survey
  • If critical situation,transfer to ambulance to
    complete exam.

25
Rapid Trauma Survey
  • Baseline Vital Signs
  • Measured Pulse, Respirations, Blood Pressure
  • Pupils
  • Size? Reactive? Equal?
  • (If Altered Mental Status)
  • Glasgow Coma Scale Score
  • Eyes, Voice, Motor, Orientation, Emotional State

26
Glasgow Coma Scale
Decorticate posturing to pain Decerebrate
posturing to pain
27
Brief Targeted History
  • S Symptoms
  • A Allergies
  • M Medications
  • P Past medical history
  • L Last oral intake
  • E Events preceding incident

28
Load-and-Go Situations
  • Initial Assessment
  • Altered mental status
  • Abnormal respiration
  • Abnormal circulation
  • Shock potential
  • Abnormal chest exam
  • Tender, distended abdomen
  • Pelvic instability
  • Bilateral femur fractures

Significant MOI and/or poor general health
29
  • When in doubttransport early!

30
Critical Interventions
  • On-scene procedures
  • Manage airway
  • Assist ventilation
  • Administer oxygen
  • Begin CPR
  • Control major external bleeding
  • Seal sucking chest
  • Stabilize flail chest
  • Decompress tension pneumothorax
  • Stabilize impaled
  • Complete packaging

31
Initiate Transport
  • Procedures not on scene, not life-saving
  • Splinting, bandaging, IV line insertion
  • Endotracheal intubation, often
  • Contact medical direction
  • As early as possible
  • Estimated time of arrival (ETA)
  • Condition of patient
  • Special needs on arrival

32
ITLS Secondary Survey
33
ITLS Secondary Survey
  • More comprehensive exam
  • Evaluation for all injuries, not just
    life-threatening
  • Establishes baseline for treatment decisions
  • Performed
  • Critical patientsdone during transport
  • Short transportmay not have time
  • Non-critical patientsdone on scene

34
ITLS Secondary Survey
  • Initial Assessment
  • Repeat routinely
  • Vital signs
  • Repeat routinely
  • Monitoring
  • Detailed Exam
  • Head-to-toe
  • DCAP-BTLS

35
ITLS Secondary Survey
  • Initial Assessment
  • LOC
  • AVPU
  • Airway
  • Control Cervical Spine
  • Snoring, Gurgling, Stridor, Silence
  • Breathing
  • Present? Rate, Depth, Effort
  • Carotid/Radial Pulses
  • Present? Rate, Rhythm, Quality
  • Skin Color, Temperature, Moisture Capillary
    Refill
  • Uncontrolled External Hemorrhage?

36
Detailed Exam DCAP-BTLS
  • Deformities
  • Contusions
  • Abrasions
  • Penetrations
  • Burns
  • Tenderness
  • Lacerations
  • Swelling

37
ITLS Secondary Survey
  • DETAILED EXAM
  • Patient History
  • Complete SAMPLE History
  • Vital Signs
  • Measured Pulse, Respirations, Blood Pressure
  • SpO2, ECG, Blood Sugar, EtCO2
  • Glasgow Coma Scale Score
  • Eyes, Voice, Movement Emotional State
  • Head
  • Pupils, Battles Sign, Raccoon Eyes, Drainage
  • DCAP-BTLS

38
ITLS Secondary Survey
  • Neck
  • DCAP-BTLS Neck Vein Distention? Tracheal
    Deviation?
  • Chest
  • Asymmetry Paradoxical Motion DCAP-BTLSTenderne
    ss, Instability, Crepitation TIC
  • Breath Sounds
  • Present? Equal?
  • (If unequal Percussion)
  • Heart Tones

39
ITLS Secondary Survey
  • Abdomen
  • DCAP-BTLS Rigidity, Distention
  • Pelvis
  • DCAP-BTLS
  • Lower/Upper Extremities
  • DCAP-BTLS TIC PMS
  • Posterior
  • Examine only if not done in ITLS Primary Survey
    DCAP-BTLS

40
ITLS Ongoing Exam
  • Change in condition
  • Patient
  • Interventions
  • Perform and record
  • Critical every 5 minutes
  • Stable every 15 minutes
  • Each time patient moved
  • With each intervention
  • If condition worsens

41
ITLS Ongoing Exam
  • Subjective Changes
  • How do you feel?
  • Reassess Mental Status
  • LOC, Pupils, GCS
  • Reassess ABCs
  • Patency, Vital Signs, Color, Skin Condition,
    Temperature, JVD, Tracheal Deviation, Breath
    Sounds, Heart Tones
  • Reassess Abdomen
  • Development of Tenderness, Distention, Rigidity
  • Check Each Identified Injury
  • Change in Status, PMS
  • Check Interventions
  • Patency, Position, Flow Rate, Security

42
Summary
  • ITLS Patient Assessment
  • Key to trauma care
  • Not difficult, but time-critical
  • Rapid, orderly, thorough
  • Remain calm
  • Optimum speed by organization and teamwork

43
Discussion
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