Major Trauma A standard approach

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Major Trauma A standard approach

• Ballarat Health Services
• Emergency Medicine Training Hub

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Trauma workshop

• Objectives
• C-Spine assessment and collar application
• Primary Survey
• Log Roll

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C-Spine Assessment

• History
• Observe patient
• Head Holding
• Posturing
• Failure to tolerate collar
• Palpate
• Midline
• Paracervical structures
• Neurological Examination
• Move/collar as indicated

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C-Spine Assessment

• History
• Observe patient
• Head Holding
• Posturing
• Failure to tolerate collar
• Palpate
• Midline
• Paracervical structures
• Neurological Examination
• Move/collar as indicated

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Sizing a collar
Use fingers, horizontally placed to assess
distance from apex of trapezius to line of
mandible.
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Primary Survey

• A
• Talk to the patient!
• Look, listen, feel, monitor
• Intervene as required
• Oro/naso-pharyngeal
• BMV
• RSI and ETT

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Primary Survey

• B
• Spring chest and examine for injury
• Auscultate for air and blood

Air
Blood
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Primary Survey

• C
• Examine
• Heart Rate
• Blood pressure
• CRT
• JVP
• Heart Sounds
• Abdomen
• Long bone injury
• Chest, Abdomen, Pelvis, Limbs and one more the
  floor

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Primary Survey

• D
• GCS
• Obvious neurological injury
• Limb
• Spinal

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Log Roll

• 5 people (4 in children)
• Four to roll, one to examine

• Keep your hands across your chest.
• You will not fall but will feel like you might.
• I will press down your spine on each bone
  (demonstrate on an unbroken clavicle) like this.
• Say yes if it hurts, no if it doesnt.
• I will then examine your back passage/anus to
  check for sensation and tone_at_!.
• Turn to the head person on your call.

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To say to the patient

• Keep your hands across your chest.
• You will not fall but will feel like you might.
• I will press down your spine on each bone
  (demonstrate on an unbroken clavicle) like this.
• Say yes if it hurts, no if it doesnt.
• I will then examine your back passage/anus to
  check for sensation and tone_at_!.
• Turn to the head person on your call.

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Log Roll
Is everybody ready? We will roll on three. . . 1,
2, 3
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Log Roll

• Palpate down the spine, each vertebra
• Do not forget to
• PR (if indicated)
• examine the back of the head, c-spine, torso

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Log Roll
Is everybody ready? We will roll back on on
three. . . 1, 2, 3
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Summary

• C-Spine assessment with Canadian C-spine rules
• Primary Survey intervene and start again at A
• Log roll team and procedure

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Questions?
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Thankyou