TRAUMA Resuscitation A quick review

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Presentation transcript:

TRAUMA Resuscitation A quick review

First steps Designate team members Call in lab, x-ray. Consider ‘Code Blue’ ? Get as much equipment ready as possible – RSI equipment, Ventilator, IV bags with pressure, move out bed 2, move Lifepak, etc

ABCDE

A B C D E Airway with C-Spine Control Breathing Circulation. Look, Listen & Feel for breath sounds. Suction if necessary Chin lift, jaw thrust, oral airway Problem? Consider Intubation Breathing Listen to chest, look for JVD, Trachea midline? Problem? Consider need for chest tube/pericardiocentesis? Circulation. BP, skin color, capillary refill Look for obvious bleeding, apply pressure Start 2 IV’s (Ringers), blood for CBC, lytes, Blood type/x-match Disability. AVPU: (Alert, Verbal Response, Pain Response, Unconscious) Glasgow Coma Scale Expose and Environment Remove ALL clothing, cover with warm blanket Log Roll (protecting spine) and inspect back. Temperature

Secondary Survey – “Head to Toe” Trauma Resuscitation Secondary Survey – “Head to Toe” Light in ears, eyes, mouth Palpate scalp, facial bones, +/- C-spine and collar bones. If OK, insert NG tube. Listen to heart. Listen to chest, look at neck for JVD and tracheal deviation. Palpate abdomen. Palpate pelvic bones (down, out and distract legs). Rectal exam (if not done on log roll) - any blood at meatus? If normal, insert Foley – do urine preg test on females. Palpate arms for pain, have patient move feet, bend knees, assess foot planar/dorsi flexion, assess sensation and reflexes, plantar responses.

Trauma Resuscitation eFAST Substernal for PCE Abdomen for free fluid – check lungs for hemothorax Pelvis for free fluid Pleura for pneumothorax

Radiology “Trauma Series” CXR Pelvis C-Spine Trauma Resuscitation Radiology “Trauma Series” CXR Pelvis C-Spine

Trauma Resuscitation “AMPLE History” Allergies Medications, Drugs/Alcohol Ingestion Past Medical/Surgical history Last meal, LMP/Pregnant Events: History of accident and mechanism.

Trauma Resuscitation Positioning the patient: Trauma or shock patients should ideally be resuscitated with the head up 30-45 degrees to prevent aspiration. If spinal precautions prevent this, then you can put the whole stretcher in reverse Trendelenburg.