Major Trauma A standard approach Ballarat Health Services Emergency Medicine Training Hub

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

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

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

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

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

Primary Survey B Spring chest and examine for injury Auscultate for air and blood Air Blood

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

Primary Survey D GCS Obvious neurological injury Limb Spinal

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 doesn’t. I will then examine your back passage/anus to check for sensation and tone Turn to the head person – on your call.

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 doesn’t. I will then examine your back passage/anus to check for sensation and Turn to the head person – on your call.

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

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

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

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

Questions?

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