1. TRAUMA Resuscitation A quick review

2. 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

3. ABCDE

4. 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

5. 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.

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

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

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

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