Title: Initial Assessment and Management of Trauma
1Initial Assessment and Management of Trauma
- Temple College
- EMS Professions
2Introduction
- Trauma
- Leading killer from ages 1 to 44
- Up to one-third of deaths are preventable
3Introduction
- Golden Hour
- Time to reach operating room
- NOT time for transport
- NOT time in Emergency Department
4Introduction
- EMS does NOT have a Golden Hour
- EMS has a Platinum Ten Minutes
5Introduction
- Patients in Golden Hour must be
- Recognized quickly
- Transported to APPROPRIATE facility
6Introduction
- Survival depends on assessment skills
- Good assessment results from
- An organized approach
- Clearly defined priorities
7Size-Up
- Safety
- Scene
- How does scene look?
- How many patients?
- Where are they?
- Situation
- Additional resources?
- Critical vs non-critical patient?
8Initial Assessment (Primary Survey)
- Find life threats
- If life threat present, CORRECT IT!
- If life threat cant be corrected
- Support ABCs
- TRANSPORT!!
9Primary Survey
- With critical trauma you may never get beyond
primary survey
10Airway with C-Spine Control
- You dont need a C-collar yet
- Return head to neutral position
- Stabilize without traction
11Airway with C-Spine Control
- Noisy breathing is obstructed breathing
- But all obstructed breathing is not noisy
12Airway with C-Spine Control
- Anticipate airway problems with
- Decreased level of consciousness
- Head trauma
- Facial trauma
- Neck trauma
- Upper chest trauma
- Open, Clear, Maintain
13Breathing
- Is air moving?
- Is it moving adequately?
- Is oxygen getting to the blood?
14Breathing
15Breathing
- Oxygenate immediately if
- Decreased level of consciousness
- ? Shock
- ? Severe hemorrhage
- Chest pain
- Chest trauma
- Dyspnea
- Respiratory distress
16Breathing
If you think about giving oxygen, GIVE IT!!
17Breathing
- Consider assisting ventilations if
- Respirations lt12
- Respirations gt24
- Tidal volume decreased
- Respiratory effort increased
18Breathing
If you cant tell if ventilations are adequate,
they arent!!
If you are wondering whether or not to bag the
patient, you should!!
19Breathing
- If respirations compromised
- Expose chest
- Inspect front and back
- Palpate front and back
- Auscultate front and back
20Circulation
- Is heart beating?
- Is there serious external bleeding?
- Is the patient perfusing?
21Circulation
- Does patient have radial pulse?
- Absent radial systolic BP lt 80
- Does patient have carotid pulse?
- Absent carotid systolic BP lt 60
22Circulation
- No carotid pulse?
- Extricate
- CPR
- Pneumatic Antishock Garment
- Run!!!!
- Survival rate from cardiac arrest secondary to
blunt trauma is lt 1
23Circulation
- Serious external bleeding?
- Direct pressure (hand, bandage, PASG)
- Tourniquet as last resort
- All bleeding stops eventually!
24Circulation
- 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
25Circulation
- If possible internal hemorrhage, QUICKLY expose,
palpate - Abdomen
- Pelvis
- Thighs
26Disability (CNS Function)
- Level of Consciousness Best brain perfusion
indicator - Use AVPU initially
- Check pupils
- The eyes are the window of the CNS
27Disability (CNS Function)
Decreased LOC in trauma Head injury until
proven otherwise
28Expose 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
29The 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
30Initial Assessment
- A blood pressure or an exact respiratory or pulse
rate is NOT necessary to tell that your patient
is critical !!!!!
31Initial Assessment
- If the patient looks sick, hes sick!!!
32Initial Resuscitation
- Treat as you go!
- Aggressively correct hypoxia and inadequate
ventilation. - Control external blood loss.
33Initial 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
34Initial Resuscitation
- Minimum Time On Scene
- Maximum Treatment In Route
35Detailed 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
36Physical Exam
- Stepwise, organized
- Every patient, same way, every time
- Superior to inferior proximal to distal
- Look--Listen--Feel
37History
- Chief complaint
- What PATIENT says problem is
- Not necessarily what you see
38History
- A Allergies
- M Medications
- P Past medical history
- L Last oral intake
- E Events leading up to incident
39Definitive Field Care
- Performed ONLY on stable patients
40Definitive 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
41Reevaluation
- Ventilation and perfusion status
- Repeat vital signs
- Continued stabilization of identified problems
- Continued reassessment for unidentified problems
42PowerPoint Source
- Slides for this presentation from Temple College
EMS http//www.templejc.edu/dept/ems/pages/power
point.html