1. ASSESSMENT 1 DR FARZAD PANAHI ASSOCIATE PROFESSOR OF GENERAL SURGERY HEAD OF TRAUMA AND DISASTER RESEARCH CENTER (BMSU) BAQUITOLLAH MEDICAL SCHOOL UNIVERSITY

2. ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT

3. OVERVIEWOVERVIEW SCENE SIZE-UPSCENE SIZE-UP BTLS PRIMARY SURVEYBTLS PRIMARY SURVEY TRANSPORT DECISION AND CRITICAL INTERVENTIONSTRANSPORT DECISION AND CRITICAL INTERVENTIONS DETAILED EXAMDETAILED EXAM ONGOING EXAMONGOING EXAM

4. SCENE SIZE-UP SCENE SAFETYSCENE SAFETY TOTAL NUMBER OF PATIENTSTOTAL NUMBER OF PATIENTS ESSENTIAL EQUIPMENTESSENTIAL EQUIPMENT ARE ADDITIONAL RESOURCES NEEDEDARE ADDITIONAL RESOURCES NEEDED MECHANISM OF INJURYMECHANISM OF INJURY

5. ESSENTIAL EQUPMENT PERSONAL PROTECTIVE EQUIPMENTPERSONAL PROTECTIVE EQUIPMENT BACKBOARD, STRAPS, AND HEAD IMMOBILIZERBACKBOARD, STRAPS, AND HEAD IMMOBILIZER C-COLLARC-COLLAR OXYGEN & AIRWAY EQUIPMENTOXYGEN & AIRWAY EQUIPMENT TRAUMA BOXTRAUMA BOX

6. BTLS PRIMARY SURVEY INITIAL ASSESSMENTINITIAL ASSESSMENT RAPID TRAUMA SURVEY OR FOCUSED EXAMRAPID TRAUMA SURVEY OR FOCUSED EXAM

8. INITIAL ASSESSMENT GENERAL IMPRESSION OF PATIENT ON APPROACHGENERAL IMPRESSION OF PATIENT ON APPROACH CONTROL C-SPINE AND ASSESS LEVEL OF CONSCIOUSNESSCONTROL C-SPINE AND ASSESS LEVEL OF CONSCIOUSNESS AIRWAYAIRWAY BREATHINGBREATHING CIRCULATIONCIRCULATION

9. DO NOT INTERRUPT THE INITIAL ASSESSMENT EXCEPT FOR Airway ObstructionAirway Obstruction Cardiac ArrestCardiac Arrest

10. LEVELS OF MENTAL STATUS A – ALERTA – ALERT V – RESPONDS TO VERBAL STIMULIV – RESPONDS TO VERBAL STIMULI P – RESPONDS TO PAINP – RESPONDS TO PAIN U – UNRESPONSIVEU – UNRESPONSIVE

11. PRIORITY PATIENTS Dangerous mechanism of injuryDangerous mechanism of injury History reveals:History reveals:  Loss of consciousness  Difficulty breathing Abnormal Initial AssessmentAbnormal Initial Assessment Poor general impressionPoor general impression

12. RAPID TRAUMA SURVEY OR FOCUSED EXAM? Dangerous generalized mechanism or altered mental status = Rapid Trauma SurveyDangerous generalized mechanism or altered mental status = Rapid Trauma Survey Dangerous focused mechanism suggesting isolated injury or no significant life threat = Focused ExamDangerous focused mechanism suggesting isolated injury or no significant life threat = Focused Exam

13. RAPID TRAUMA SURVEY Brief assessment of head, neck, chest, abdomen, pelvis, and extremities to identify immediate life threatsBrief assessment of head, neck, chest, abdomen, pelvis, and extremities to identify immediate life threats SAMPLE historySAMPLE history Baseline vital signsBaseline vital signs If altered LOC do brief neurological examIf altered LOC do brief neurological exam

14. SAMPLE HISTORY S – SYMPTOMSS – SYMPTOMS A – ALLERGIESA – ALLERGIES M –MEDICATIONSM –MEDICATIONS P – PAST MEDICAL HISTORYP – PAST MEDICAL HISTORY L – LAST MEALL – LAST MEAL E – EVENTS PRIOR TO INJURYE – EVENTS PRIOR TO INJURY

15. IF ALTERED LOC DO BRIEF NEURO EXAM TO RULE OUT INCREASED INTRACRANIAL PRESSUREDO BRIEF NEURO EXAM TO RULE OUT INCREASED INTRACRANIAL PRESSURE –LOC –PUPILS –GCS –SIGNS OF CUSHINGS REFLEX –MEDICAL IDENTIFICATION DEVICES?

16. FINISHING THE BTLS PRIMARY SURVEY Check the patient’s backCheck the patient’s back Transfer the patient to the backboardTransfer the patient to the backboard Load-and-Go situation = immediate transportLoad-and-Go situation = immediate transport

17. LOAD-AND-GO SITUATIONS Significant mechanism of injury or poor general impressionSignificant mechanism of injury or poor general impression Initial Assessment revealsInitial Assessment reveals –Altered mental status –Abnormal airway or respiration –Abnormal circulation (shock or uncontrolled bleeding)

18. LOAD-AND-GO SITUATIONS continued Signs discovered during Rapid Trauma Survey suggesting impending shockSigns discovered during Rapid Trauma Survey suggesting impending shock –Abnormal chest exam –Tender, distended abdomen –Unstable pelvis –Bilateral femur fractures

19. INTERVENTIONS THAT MAY BE DONE ON-SCENE Initial airway managementInitial airway management Oxygen/ventilatory assistanceOxygen/ventilatory assistance CPRCPR Control major bleedingControl major bleeding Seal sucking chest woundsSeal sucking chest wounds

20. INTERVENTIONS THAT MAY BE DONE ON-SCENE Stabilize flail chestStabilize flail chest Decompress tension pneumothoraxDecompress tension pneumothorax Stabilize impaled objectsStabilize impaled objects Immobilize spineImmobilize spine

21. DETAILED EXAM Detailed exam to find injuries other than life- threatsDetailed exam to find injuries other than life- threats Provides baseline for future decisionsProvides baseline for future decisions Performed en route on critical patientsPerformed en route on critical patients Record your findingsRecord your findings

22. DETAILED EXAM Record vital signsRecord vital signs Neurological examNeurological exam Consider monitorsConsider monitors Do head-to-toe examDo head-to-toe exam Further bandaging and splintingFurther bandaging and splinting Continually observeContinually observe

23. DETAILED NEUROLOGICAL EXAM LOCLOC PupilsPupils Motor functionMotor function SensationSensation If altered mental status, perform Glasgow Coma ScoreIf altered mental status, perform Glasgow Coma Score

24. ONGOING EXAM Ask patient about changes in symptomsAsk patient about changes in symptoms Reassess mental statusReassess mental status Reassess ABCsReassess ABCs Reassess abdomenReassess abdomen Reassess identified injuriesReassess identified injuries Reassess interventionsReassess interventions

25. COMMUNICATIONS WITH MEDICAL DIRECTION Contact early if patient is criticalContact early if patient is critical Be concise and to the pointBe concise and to the point Give your destination and ETAGive your destination and ETA Identify any special preparations that should be done before your arrivalIdentify any special preparations that should be done before your arrival

26. PITFALLSPITFALLS Approaching the patient before performing a Scene Size-UpApproaching the patient before performing a Scene Size-Up Trying to do too much on-sceneTrying to do too much on-scene –Attempting to “stabilize” the patient in the field

27. SUMMARYSUMMARY Scene Size-UpScene Size-Up BTLS Primary SurveyBTLS Primary Survey –Initial Assessment –Rapid Trauma Survey or Focused Exam Critical interventions and transport decisionCritical interventions and transport decision Detailed ExamDetailed Exam Ongoing ExamOngoing Exam

28. QUESTIONS?QUESTIONS?