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Initial Assessment and Management of Trauma

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Leading killer from ages 1 to 44. Up to one-third of deaths are ... Thighs. Disability (CNS Function) Level of Consciousness = Best brain perfusion indicator ... – PowerPoint PPT presentation

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Title: Initial Assessment and Management of Trauma


1
Initial Assessment and Management of Trauma
  • Temple College
  • EMS Professions

2
Introduction
  • Trauma
  • Leading killer from ages 1 to 44
  • Up to one-third of deaths are preventable

3
Introduction
  • Golden Hour
  • Time to reach operating room
  • NOT time for transport
  • NOT time in Emergency Department

4
Introduction
  • EMS does NOT have a Golden Hour
  • EMS has a Platinum Ten Minutes

5
Introduction
  • Patients in Golden Hour must be
  • Recognized quickly
  • Transported to APPROPRIATE facility

6
Introduction
  • Survival depends on assessment skills
  • Good assessment results from
  • An organized approach
  • Clearly defined priorities

7
Size-Up
  • Safety
  • Scene
  • How does scene look?
  • How many patients?
  • Where are they?
  • Situation
  • Additional resources?
  • Critical vs non-critical patient?

8
Initial Assessment (Primary Survey)
  • Find life threats
  • If life threat present, CORRECT IT!
  • If life threat cant be corrected
  • Support ABCs
  • TRANSPORT!!

9
Primary Survey
  • With critical trauma you may never get beyond
    primary survey

10
Airway with C-Spine Control
  • You dont need a C-collar yet
  • Return head to neutral position
  • Stabilize without traction

11
Airway with C-Spine Control
  • Noisy breathing is obstructed breathing
  • But all obstructed breathing is not noisy

12
Airway with C-Spine Control
  • Anticipate airway problems with
  • Decreased level of consciousness
  • Head trauma
  • Facial trauma
  • Neck trauma
  • Upper chest trauma
  • Open, Clear, Maintain

13
Breathing
  • Is air moving?
  • Is it moving adequately?
  • Is oxygen getting to the blood?

14
Breathing
  • Look
  • Listen
  • Feel

15
Breathing
  • Oxygenate immediately if
  • Decreased level of consciousness
  • ? Shock
  • ? Severe hemorrhage
  • Chest pain
  • Chest trauma
  • Dyspnea
  • Respiratory distress

16
Breathing
If you think about giving oxygen, GIVE IT!!
17
Breathing
  • Consider assisting ventilations if
  • Respirations lt12
  • Respirations gt24
  • Tidal volume decreased
  • Respiratory effort increased

18
Breathing
If you cant tell if ventilations are adequate,
they arent!!
If you are wondering whether or not to bag the
patient, you should!!
19
Breathing
  • If respirations compromised
  • Expose chest
  • Inspect front and back
  • Palpate front and back
  • Auscultate front and back

20
Circulation
  • Is heart beating?
  • Is there serious external bleeding?
  • Is the patient perfusing?

21
Circulation
  • Does patient have radial pulse?
  • Absent radial systolic BP lt 80
  • Does patient have carotid pulse?
  • Absent carotid systolic BP lt 60

22
Circulation
  • No carotid pulse?
  • Extricate
  • CPR
  • Pneumatic Antishock Garment
  • Run!!!!
  • Survival rate from cardiac arrest secondary to
    blunt trauma is lt 1

23
Circulation
  • Serious external bleeding?
  • Direct pressure (hand, bandage, PASG)
  • Tourniquet as last resort
  • All bleeding stops eventually!

24
Circulation
  • Is patient in shock?
  • Cool, pale, moist skin shock, until proven
    otherwise
  • Capillary refill gt 2 sec shock until proven
    otherwise
  • Restlessness, anxiety, combativeness shock
    until proven otherwise

25
Circulation
  • If possible internal hemorrhage, QUICKLY expose,
    palpate
  • Abdomen
  • Pelvis
  • Thighs

26
Disability (CNS Function)
  • Level of Consciousness Best brain perfusion
    indicator
  • Use AVPU initially
  • Check pupils
  • The eyes are the window of the CNS

27
Disability (CNS Function)
Decreased LOC in trauma Head injury until
proven otherwise
28
Expose and Examine
  • You cant treat what you dont find!
  • If you dont look, you wont see!
  • Remove ALL clothing from critical patients ASAP
  • Avoid delaying resuscitation while disrobing
    patient
  • Cover patient with blanket when finished

29
The Load and Go Situations
  • Head injury with decreased LOC
  • Airway obstruction unrelieved by mechanical
    methods
  • Conditions resulting in inadequate breathing
  • Shock
  • Conditions that rapidly lead to shock
  • Tender, distended abdomen
  • Pelvic instability
  • Bilateral femur fractures
  • Traumatic cardiopulmonary arrest

30
Initial Assessment
  • A blood pressure or an exact respiratory or pulse
    rate is NOT necessary to tell that your patient
    is critical !!!!!

31
Initial Assessment
  • If the patient looks sick, hes sick!!!

32
Initial Resuscitation
  • Treat as you go!
  • Aggressively correct hypoxia and inadequate
    ventilation.
  • Control external blood loss.

33
Initial Resuscitation
  • Immobilize C-spine (rigid collar)
  • Keep airway open
  • Oxygenate
  • Rapidly extricate to long board
  • Begin assisted ventilation with BVM
  • Expose
  • Apply and inflate PASG
  • Transport
  • Reassess and report in route
  • Consider requesting ALS intercept

34
Initial Resuscitation
  • Minimum Time On Scene
  • Maximum Treatment In Route

35
Detailed Exam (Secondary Survey)
  • History and Physical Exam
  • You WILL get here with MOST trauma patients
  • Perform ONLY after initial assessment is
    completed and life threats corrected
  • Do NOT hold critical patients in field for
    detailed exam

36
Physical Exam
  • Stepwise, organized
  • Every patient, same way, every time
  • Superior to inferior proximal to distal
  • Look--Listen--Feel

37
History
  • Chief complaint
  • What PATIENT says problem is
  • Not necessarily what you see

38
History
  • A Allergies
  • M Medications
  • P Past medical history
  • L Last oral intake
  • E Events leading up to incident

39
Definitive Field Care
  • Performed ONLY on stable patients

40
Definitive Field Care
  • Stable patients can receive attention for
    individual injuries before transport
  • Bandaging
  • Splinting
  • Reassess carefully for hidden problems
  • If patient becomes unstable at any time, TRANSPORT

41
Reevaluation
  • Ventilation and perfusion status
  • Repeat vital signs
  • Continued stabilization of identified problems
  • Continued reassessment for unidentified problems
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