Transcript Trauma Assessment and Management

seventh edition
International Trauma Life Support
for Emergency Care Providers
Trauma
Assessment and
Management
CHAPTER 2
Trauma Assessment and
Management
Courtesy of ITLS Ontario, Steve McNenly, Jennifer Lundren, and Sheryl Jackson
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Overview
• ITLS Patient Assessment
– Primary Survey
– Ongoing Exam
– Secondary Survey
• Initial Assessment related to
– Rapid Trauma Survey vs. Focused Exam
– Interruptions
• Critical conditions and the “Fix It” process
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Patient Assessment
• ITLS Primary Survey
– Scene Size-up
– Initial Assessment
– Rapid Trauma Survey
vs. Focused Exam
• ITLS Ongoing Exam
• ITLS Secondary Survey
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• ITLS Primary Survey
– Scene Size-up
– Initial Assessment
– Rapid Trauma Survey
vs. Focused Exam
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
• Delegate immediate interventions to
partners
• Do not stop your assessment unless
– Scene becomes unsafe
– Airway obstruction
– Cardiac arrest
Assessment
• Teamwork
Teamwork
“Fix It”
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Scene Size-up
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Scene Size-up
• Hazards
– Power lines, gas, animals, people
• PPE
• Number of patients
– Establish command
– Additional resources?
• MOI
– Anticipate type and severity of injuries
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Initial Assessment
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• Initial Assessment
– General impression
– Level of consciousness
– Manual stabilization of
cervical spine
– ABCs
• Prioritize patient
– Identify immediate life-threatening
conditions
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• Less than 2 minutes
– Initial Assessment and Rapid Trauma Survey
• Delegate any intervention
• Interrupt survey only for:
– Unsafe scene
– Airway obstruction
– Cardiac arrest
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• General impression
– Obvious major injuries or bleeding –
immediately control life-threatening bleeding
– Approximate age, sex, weight
– General appearance
– Position of patient body and surroundings
– Patient activity
• Triage multiple patients
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• Initial Level of Consciousness
– Cervical-spine stabilization
A
V
P
U
Alert
Responds to Verbal stimuli
Responds to Pain
Unresponsive
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• Airway: look, listen, feel
– Direct: simple positioning and suctioning
• If not adequate
© Pearson
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• Breathing: look, listen, feel
– Direct: high-flow oxygen
• If not adequate
© Pearson
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Respiratory Rates
Normal
Abnormal
Adult
10–20
<10 and >24
Child
15–30
<15 and >35
Infant
25–50
<25 and >60
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Primary Survey
• Major bleeding controlled?
– “Fix It”
• Circulation: peripheral pulse
– No peripheral, check carotid
– Too fast, too slow, quality
– Interrupt: cardiac arrest
• Skin
© Pearson
– Color, temperature, condition
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
MOI Decision
• Dangerous generalized or
unconscious
– Rapid Trauma Survey
• Dangerous focused
– Focused Exam
• No significant MOI
Initial Assessment normal
– Focused Exam
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
© Mikael Damkier
Rapid Trauma Survey
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Rapid Trauma Survey
• Assess
– Head and neck
– Chest
– Abdomen
– Pelvis
– Lower and upper
extremities
– Back
• Transfer to backboard
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Rapid Trauma Survey
If critical situation, transfer to
ambulance to complete exam.
© Pawel Nawrot
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Rapid Trauma Survey
• Obtain baseline vital signs
• If altered mental status
– Brief neurological exam
– Pupils, GCS, and signs of cerebral herniation
– Look for medic alert tags
– Consider other causes
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Glasgow Coma Scale
*Decorticate posturing to pain
**Decerebrate posturing to pain
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Priority Patient
• Dangerous MOI
• History
– Loss of consciousness
• High Risk Groups
• Abnormal Initial
Assessment
– Altered mental status
– Difficulty breathing
– Abnormal perfusion
© Pawel Nawrot
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
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
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Brief Targeted History
•
•
•
•
•
•
S
A
M
P
L
E
Symptoms
Allergies
Medications
Past medical history
Last oral intake
Events preceding incident
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
When in doubt—transport early!
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Critical Interventions
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•
•
•
•
Manage airway
Assist ventilation
Administer oxygen
Begin CPR
Control major external
bleeding
• Seal sucking chest
• Stabilize flail chest
• Decompress tension
pneumothorax
• Stabilize impaled
object
• Complete packaging
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Initiate Transport
• Procedures not on scene, not lifesaving
– Splinting, bandaging, IV line insertion
– Elective intubation
• Contact medical direction
– As early as possible
– Estimated time of arrival (ETA)
– Condition of patient
– Special needs on arrival
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
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 changes
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Ongoing Exam
• Subjective changes
• Mental status
(LOC and pupils)
• ABCs
• Neck, chest,
abdomen
• Previously identified injuries
• Interventions
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Secondary Survey
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Secondary Survey
• More comprehensive exam
– Evaluation for all injuries, not just
life-threatening
– Establishes baseline for treatment decisions
• Performed
– Critical patients—done during transport
– Short transport—may not have time
– Noncritical patients—done on scene
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
ITLS Secondary Survey
• Initial Assessment
– Repeat routinely
• Vital signs
– Repeat routinely
– Monitoring
• Detailed Exam
– Head-to-toe
DCAP-BLS-TIC
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Detailed Exam: DCAP-BLS-TIC
Deformities
Burns
Tenderness
Contusions
Lacerations Instability
Abrasions
Swelling
Crepitus
Penetrations
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Adjuncts for Patient Assessment
• Pulse oximetry
• Wave form capnography
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Adjuncts for Patient Assessment
• Serum lactate
– Marker for tissue hypoxia
– Finger-stick serum levels
– Further studies needed
• Portable ultrasound
– F.A.S.T.
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians
Summary
• ITLS Patient Assessment
– Key to trauma care
– Not difficult, but time-critical
– Rapid, orderly, thorough
• Remain calm
– Maximize speed through organization and
teamwork
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell • Alabama College of Emergency Physicians