DR FARZAD PANAHI

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DR FARZAD PANAHI

• ASSOCIATE PROFESSOR OF GENERAL SURGERY
• HEAD OF TRAUMA AND DISASTER RESEARCH CENTER
• (BMSU)
• BAQUITOLLAH MEDICAL SCHOOL UNIVERSITY

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ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT
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OVERVIEW

• SCENE SIZE-UP
• BTLS PRIMARY SURVEY
• TRANSPORT DECISION AND CRITICAL INTERVENTIONS
• DETAILED EXAM
• ONGOING EXAM

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SCENE SIZE-UP

• SCENE SAFETY
• TOTAL NUMBER OF PATIENTS
• ESSENTIAL EQUIPMENT
• ARE ADDITIONAL RESOURCES NEEDED
• MECHANISM OF INJURY

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ESSENTIAL EQUPMENT

• PERSONAL PROTECTIVE EQUIPMENT
• BACKBOARD, STRAPS, AND HEAD IMMOBILIZER
• C-COLLAR
• OXYGEN AIRWAY EQUIPMENT
• TRAUMA BOX

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BTLS PRIMARY SURVEY

• INITIAL ASSESSMENT
• RAPID TRAUMA SURVEY OR FOCUSED EXAM

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INITIAL ASSESSMENT

• GENERAL IMPRESSION OF PATIENT ON APPROACH
• CONTROL C-SPINE AND ASSESS LEVEL OF CONSCIOUSNESS
  
• AIRWAY
• BREATHING
• CIRCULATION

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DO NOT INTERRUPT THE INITIAL ASSESSMENT EXCEPT FOR

• Airway Obstruction
• Cardiac Arrest

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LEVELS OF MENTAL STATUS

• A ALERT
• V RESPONDS TO VERBAL STIMULI
• P RESPONDS TO PAIN
• U UNRESPONSIVE

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PRIORITY PATIENTS

• Dangerous mechanism of injury
• History reveals
• Loss of consciousness
• Difficulty breathing
• Abnormal Initial Assessment
• Poor general impression

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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 Focused
  Exam

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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

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SAMPLE HISTORY

• S SYMPTOMS
• A ALLERGIES
• M MEDICATIONS
• P PAST MEDICAL HISTORY
• L LAST MEAL
• E EVENTS PRIOR TO INJURY

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IF ALTERED LOC

• DO BRIEF NEURO EXAM TO RULE OUT INCREASED
  INTRACRANIAL PRESSURE
• LOC
• PUPILS
• GCS
• SIGNS OF CUSHINGS REFLEX
• MEDICAL IDENTIFICATION DEVICES?

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FINISHING THE BTLS PRIMARY SURVEY

• Check the patients back
• Transfer the patient to the backboard
• Load-and-Go situation immediate transport

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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)

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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

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INTERVENTIONS THAT MAY BE DONE ON-SCENE

• Initial airway management
• Oxygen/ventilatory assistance
• CPR
• Control major bleeding
• Seal sucking chest wounds

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INTERVENTIONS THAT MAY BE DONE ON-SCENE

• Stabilize flail chest
• Decompress tension pneumothorax
• Stabilize impaled objects
• Immobilize spine

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DETAILED EXAM

• Detailed exam to find injuries other than
  life-threats
• Provides baseline for future decisions
• Performed en route on critical patients
• Record your findings

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DETAILED EXAM

• Record vital signs
• Neurological exam
• Consider monitors
• Do head-to-toe exam
• Further bandaging and splinting
• Continually observe

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DETAILED NEUROLOGICAL EXAM

• LOC
• Pupils
• Motor function
• Sensation
• If altered mental status, perform Glasgow Coma
  Score

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ONGOING EXAM

• Ask patient about changes in symptoms
• Reassess mental status
• Reassess ABCs
• Reassess abdomen
• Reassess identified injuries
• Reassess interventions

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COMMUNICATIONS WITH MEDICAL DIRECTION

• 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

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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

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SUMMARY

• Scene Size-Up
• BTLS Primary Survey
• Initial Assessment
• Rapid Trauma Survey or Focused Exam
• Critical interventions and transport decision
• Detailed Exam
• Ongoing Exam

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QUESTIONS?