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

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

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

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

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

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

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

9. 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

10. Primary Survey D GCS Obvious neurological injury Limb Spinal

11. 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.

12. 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 tone#@!**. Turn to the head person – on your call.

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

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

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

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

17. Questions?

18. Thankyou