1. Basic Trauma Life Support and Trauma Resuscitation
CSI 202 Skills Lab 8
Basic Trauma Life Support and Trauma Resuscitation
Daryl P. Lofaso, M.Ed, RRT

2. Trauma
Trauma – 4th leading cause of death in the first four decades of life (ages )
130,000 deaths annually in the US
Disabilities dwarfs mortality by 3 to 1
$871 billion Economic Loss and Social harm

3. Trimodal Death Distribution
First Peak
death occurs in seconds to minutes of injury (lacerations: brain, brain stem, high cord , heart, aorta, &b large blood vessels)
Second Peak
death occurs within minutes to several hours of injury (subdural/epidural hematomas, pneumothorax, spleen, liver, pelvic fx & blood loss)
Third Peak
death occurs several day to weeks after initial injury (sepsis and multiple organ system failure)

4. Mechanism of Injury Motor Vehicle Collision (MVC) Falls Penetrating
T-bone, Roll-over
Falls
> 12 ft.
Lethal Dose (LD50) > 48 ft.
Penetrating
Gunshot wound (GSW) & Stab
Altercation
Fist, stick, pipe

5. Classification of Head Injury
Blunt
High velocity (MVC)
Low velocity (fall, assault)
Penetrating
Gunshot wound (GSW)
Other penetrating injuries (stab)

6. Severity of Head Injury
Mild
GCS Score:
Moderate
GCS Score:
Severe
GCS Score: 3 - 8

7. T-Bone Collision

8. T-Bone Collision Injuries
Impact to Driver:
Closed Head injury (CHI)
C-spine
Pelvic fx & Extremity fx (Long Bone)
Spleen
Blunt chest trauma
Pulmonary contusion
Rib fx
Cardiac contusion

9. T-Bone Collision Injuries
Impact to Passenger:
Closed Head injury (CHI)
C-spine
Pelvic fx & Extremity fx (Long Bone)
Solid organ injury
Liver, spleen
Blunt chest trauma
Pulmonary contusion
Rib fx
Cardiac contusion
Pneumo/Hemothorax

10. Most likely injury types:
Pedestrian vs. Car
Most likely injury types:
Adults – tibia / fibula or knee fx
Teenagers – femur
Small kids (ages 5-7) head on the bumper

11. Pathophysiology of Shock
Shock is an acute state in which tissue perfusion is inadequate to maintain the supply of oxygen and nutrient necessary for normal cell function. (Alexander et al 1994), which results in widespread hypoxia.
Inability to maintain homeostasis.

12. Shock: Inadequate Tissue Perfusion
↓ Circulating blood volume
Failure of the heart to pump effectively
Massive increase in peripheral vasodilation

13. Classification of Shock
Hypovolaemic: ↓ Blood volume
Cardiogenic: Left vent. failure
Anaphylatic: severe allergic reaction (vasodilation)
Septic: over-whelming bacterial toxins (vasodilation); (Most common: Gram -)
Neurogenic: loss of sympathetic nerve activity (vasodilation); Drug or Trauma injury

14. Stages of Shock
Initial Stage: cells are deprived of oxygen; no energy (ATP); cells become damaged
Compensatory Stage: anaerobic metabolism and hyperventilation
Progressive Stage: compensatory mechanisms fail
Refractory Stage: vital organs have failed and shock can no longer be reversed

15. Fluid Replacement Crystalloids Fluid
Peds. – Normal Saline (NS) (20cc/kg)
Adults – NS / Lactated Ringers (LR) (2L)
If unresponsive to fluid bolus, repeat & consider blood.
“O” neg. (1st available – 1 min.)
Type specific (2nd available – min.)
Fully type and matched (3rd available – min.)

16. PE Exam Signs of Trauma Raccoon Eyes Battle Sign Flail chest
Indicate Retroperitoneal Injury
Periumbilical Ecchymosis
Cullen’s sign
Flank Ecchymosis
Gray – Turner’s sign
Seat Belt Sign
↑ Probability of Intra-Abdominal Injury

17. Injuries Hip Fx. - leg shortened & externally rotated
Posterior Hip Dislocation – injury leg internally rotated & flexed
Anterior Shoulder Dislocation – arm positioning – adduction and flexion at elbow