Transcript No Slide Title

DR FARZAD PANAHI
ASSESSMENT
ASSOCIATE PROFESSOR OF
GENERAL SURGERY
HEAD OF TRAUMA AND DISASTER
RESEARCH CENTER
(BMSU)
BAQUITOLLAH MEDICAL SCHOOL UNIVERSITY
1
ASSESSMENT AND
MANAGEMENT OF
THE TRAUMA
PATIENT
OVERVIEW
• SCENE SIZE-UP
• BTLS PRIMARY SURVEY
• TRANSPORT DECISION
AND CRITICAL
INTERVENTIONS
• DETAILED EXAM
• ONGOING EXAM
SCENE SIZE-UP
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•
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SCENE SAFETY
TOTAL NUMBER OF PATIENTS
ESSENTIAL EQUIPMENT
ARE ADDITIONAL RESOURCES
NEEDED
• MECHANISM OF INJURY
ESSENTIAL
EQUPMENT
• PERSONAL PROTECTIVE
EQUIPMENT
• BACKBOARD, STRAPS,
AND HEAD IMMOBILIZER
• C-COLLAR
• OXYGEN & AIRWAY
EQUIPMENT
• TRAUMA BOX
BTLS PRIMARY
SURVEY
• INITIAL
ASSESSMENT
• RAPID TRAUMA
SURVEY OR
FOCUSED EXAM
INITIAL
ASSESSMENT
• GENERAL IMPRESSION
OF PATIENT ON
APPROACH
• CONTROL C-SPINE AND
ASSESS LEVEL OF
CONSCIOUSNESS
• AIRWAY
• BREATHING
DO NOT INTERRUPT THE
INITIAL ASSESSMENT
EXCEPT FOR
• Airway
Obstruction
• Cardiac Arrest
LEVELS OF
MENTAL STATUS
• A – ALERT
• V – RESPONDS TO
VERBAL
STIMULI
• P – RESPONDS TO PAIN
• U – UNRESPONSIVE
PRIORITY PATIENTS
• Dangerous mechanism
of injury
• History reveals:
 Loss of consciousness
 Difficulty breathing
• Abnormal Initial
Assessment
• Poor general
RAPID TRAUMA SURVEY
OR FOCUSED EXAM?
• Dangerous generalized
mechanism or altered
mental status = Rapid
Trauma Survey
• Dangerous focused
mechanism suggesting
isolated injury or no
significant life threat =
RAPID TRAUMA
SURVEY
• Brief assessment of head, neck,
chest, abdomen, pelvis, and
extremities to identify immediate life
threats
• SAMPLE history
• Baseline vital signs
• If altered LOC do brief neurological
exam
SAMPLE HISTORY
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•
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S – SYMPTOMS
A – ALLERGIES
M – MEDICATIONS
P – PAST MEDICAL
HISTORY
• L – LAST MEAL
• E – EVENTS PRIOR TO
INJURY
IF ALTERED LOC
• DO BRIEF NEURO EXAM TO
RULE OUT INCREASED
INTRACRANIAL PRESSURE
– LOC
– PUPILS
– GCS
– SIGNS OF CUSHINGS REFLEX
– MEDICAL IDENTIFICATION
FINISHING THE
BTLS PRIMARY
SURVEY
• Check the patient’s back
• Transfer the patient to the
backboard
• Load-and-Go situation =
immediate transport
LOAD-AND-GO
SITUATIONS
• Significant mechanism of injury or
poor general impression
• Initial Assessment reveals
– Altered mental status
– Abnormal airway or respiration
– Abnormal circulation (shock or
uncontrolled bleeding)
LOAD-AND-GO
SITUATIONS
continued
• Signs discovered during Rapid
Trauma Survey suggesting
impending shock
– Abnormal chest exam
– Tender, distended abdomen
– Unstable pelvis
– Bilateral femur fractures
INTERVENTIONS THAT MAY
BE DONE ON-SCENE
• Initial airway
management
• Oxygen/ventilatory
assistance
• CPR
• Control major bleeding
• Seal sucking chest
INTERVENTIONS THAT MAY
BE DONE ON-SCENE
• Stabilize flail chest
• Decompress tension
pneumothorax
• Stabilize impaled
objects
• Immobilize spine
DETAILED EXAM
• Detailed exam to find
injuries other than lifethreats
• Provides baseline for
future decisions
• Performed en route on
critical patients
• Record your findings
DETAILED EXAM
• Record vital signs
• Neurological exam
• Consider monitors
• Do head-to-toe exam
• Further bandaging and
splinting
• Continually observe
DETAILED
NEUROLOGICAL EXAM
• LOC
• Pupils
• Motor function
• Sensation
• If altered mental
status, perform
Glasgow Coma Score
ONGOING EXAM
• Ask patient about
changes in symptoms
• Reassess mental status
• Reassess ABCs
• Reassess abdomen
• Reassess identified
injuries
• Reassess interventions
COMMUNICATIONS WITH
MEDICAL DIRECTION
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Contact early if patient is critical
Be concise and to the point
Give your destination and ETA
Identify any special preparations
that should be done before your
arrival
PITFALLS
• Approaching the
patient before
performing a Scene
Size-Up
• Trying to do too much
on-scene
– Attempting to “stabilize”
the patient in the field
SUMMARY
• Scene Size-Up
• BTLS Primary Survey
– Initial Assessment
– Rapid Trauma Survey or
Focused Exam
• Critical interventions and
transport decision
• Detailed Exam
QUESTIONS?