Transcript Initial Assessment and Management of Trauma

Initial Assessment and
Management of Trauma
Temple College
EMS Professions
Introduction
Trauma
–Leading killer from ages 1 to 44
–Up to one-third of deaths are
preventable
Introduction
Golden
Hour
–Time to reach operating room
–NOT time for transport
–NOT time in Emergency Department
Introduction
 EMS
does NOT have a Golden Hour
 EMS has a Platinum Ten Minutes
Introduction
 Patients
in Golden Hour must be:
– Recognized quickly
– Transported to APPROPRIATE facility
Introduction
 Survival
depends on assessment skills
 Good assessment results from
– An organized approach
– Clearly defined priorities
Size-Up
 Safety
 Scene
– How does scene look?
– How many patients?
– Where are they?
 Situation
– Additional resources?
– Critical vs non-critical patient?
Initial Assessment (Primary
Survey)
 Find
life threats
 If life threat present, CORRECT IT!
 If life threat can’t be corrected
– Support ABCs
– TRANSPORT!!
Primary Survey
With critical trauma you may
never get beyond primary survey
Airway with C-Spine Control
 You
don’t need a C-collar yet
 Return head to neutral position
 Stabilize without traction
Airway with C-Spine Control
 Noisy
breathing is obstructed
breathing
 But all obstructed breathing is not
noisy
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
Breathing
 Is
air moving?
 Is it moving adequately?
 Is oxygen getting to the blood?
Breathing
Look
Listen
Feel
Breathing
 Oxygenate
immediately if:
– Decreased level of consciousness
– ? Shock
– ? Severe hemorrhage
– Chest pain
– Chest trauma
– Dyspnea
– Respiratory distress
Breathing
If you think about giving
oxygen, GIVE IT!!
Breathing
 Consider
assisting ventilations if:
– Respirations <12
– Respirations >24
– Tidal volume decreased
– Respiratory effort increased
Breathing
If you can’t tell if ventilations
are adequate, they aren’t!!
If you are wondering whether
or not to bag the patient, you
should!!
Breathing
 If
respirations compromised:
– Expose chest
– Inspect front and back
– Palpate front and back
– Auscultate front and back
Circulation
 Is
heart beating?
 Is there serious external bleeding?
 Is the patient perfusing?
Circulation
 Does
patient have radial pulse?
– Absent radial = systolic BP < 80
 Does
patient have carotid pulse?
– Absent carotid = systolic BP < 60
Circulation
 No
carotid pulse?
– Extricate
– CPR
– Pneumatic Antishock Garment
– Run!!!!
 Survival
rate from cardiac arrest
secondary to blunt trauma is < 1%
Circulation
 Serious
external bleeding?
– Direct pressure (hand, bandage, PASG)
– Tourniquet as last resort
 All
bleeding stops eventually!
Circulation
 Is
patient in shock?
– Cool, pale, moist skin = shock, until
proven otherwise
– Capillary refill > 2 sec = shock until
proven otherwise
– Restlessness, anxiety, combativeness =
shock until proven otherwise
Circulation
 If
possible internal hemorrhage,
QUICKLY expose, palpate:
– Abdomen
– Pelvis
– Thighs
Disability (CNS Function)
 Level
of Consciousness = Best brain
perfusion indicator
 Use AVPU initially
 Check pupils
– The eyes are the window of the CNS
Disability (CNS Function)
Decreased LOC in trauma = Head
injury until proven otherwise
Expose and Examine
 You
can’t treat what you don’t find!
 If you don’t look, you won’t see!
 Remove ALL clothing from critical
patients ASAP
 Avoid delaying resuscitation while
disrobing patient
 Cover patient with blanket when
finished
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

Initial Assessment
A blood pressure or an exact
respiratory or pulse rate is NOT
necessary to tell that your patient is
critical !!!!!
Initial Assessment
If the patient looks sick,
he’s sick!!!
Initial Resuscitation
 Treat
as you go!
 Aggressively correct hypoxia and
inadequate ventilation.
 Control external blood loss.
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

Initial Resuscitation
Minimum Time On Scene
Maximum Treatment In
Route
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
Physical Exam
 Stepwise,
organized
 Every patient, same way, every time
 Superior to inferior; proximal to distal
 Look--Listen--Feel
History
 Chief
complaint
–What PATIENT says problem is
–Not necessarily what you see
History
A
= Allergies
 M = Medications
 P = Past medical history
 L = Last oral intake
 E = Events leading up to incident
Definitive Field Care
Performed ONLY on stable
patients
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
Reevaluation
 Ventilation
and perfusion status
 Repeat vital signs
 Continued stabilization of
identified problems
 Continued reassessment for
unidentified problems
PowerPoint Source
 Slides
for this presentation from
Temple College EMS:
http://www.templejc.edu/dept/ems/
pages/powerpoint.html