1. Initial Assessment and Management of Trauma
4/27/2017
Initial Assessment and Management of Trauma
Temple College
EMS Professions
Temple College EMS Professions

2. Introduction Trauma Leading killer from ages 1 to 44
Up to one-third of deaths are preventable

3. Introduction Golden Hour Time to reach operating room
NOT time for transport
NOT time in Emergency Department

4. Introduction EMS does NOT have a Golden Hour
EMS has a Platinum Ten Minutes

5. Introduction Patients in Golden Hour must be: Recognized quickly
Transported to APPROPRIATE facility

6. Introduction Survival depends on assessment skills
Good assessment results from
An organized approach
Clearly defined priorities

7. Size-Up Safety Scene Situation How does scene look? How many patients?
Where are they?
Situation
Additional resources?
Critical vs non-critical patient?

8. Initial Assessment (Primary Survey)
Find life threats
If life threat present, CORRECT IT!
If life threat can’t be corrected
Support ABCs
TRANSPORT!!

9. With critical trauma you may never get beyond primary survey

10. Airway with C-Spine Control
You don’t need a C-collar yet
Return head to neutral position
Stabilize without traction

11. Airway with C-Spine Control
Noisy breathing is obstructed breathing
But all obstructed breathing is not noisy

12. Airway with C-Spine Control
Anticipate airway problems with
Decreased level of consciousness
Head trauma
Facial trauma
Neck trauma
Upper chest trauma
Open, Clear, Maintain

13. Breathing Is air moving? Is it moving adequately?
Is oxygen getting to the blood?

14. Breathing
Look
Listen
Feel

15. Breathing Oxygenate immediately if: Decreased level of consciousness
? Shock
? Severe hemorrhage
Chest pain
Chest trauma
Dyspnea
Respiratory distress

16. If you think about giving oxygen, GIVE IT!!
Breathing
If you think about giving oxygen, GIVE IT!!

17. Breathing Consider assisting ventilations if: Respirations <12
Tidal volume decreased
Respiratory effort increased

18. Breathing
If you can’t tell if ventilations are adequate, they aren’t!!
If you are wondering whether or not to bag the patient, you should!!

19. Breathing If respirations compromised: Expose chest
Inspect front and back
Palpate front and back
Auscultate front and back

20. Circulation Is heart beating? Is there serious external bleeding?
Is the patient perfusing?

21. Circulation Does patient have radial pulse?
Absent radial = systolic BP < 80
Does patient have carotid pulse?
Absent carotid = systolic BP < 60

22. Circulation No carotid pulse?
Extricate
CPR
Pneumatic Antishock Garment
Run!!!!
Survival rate from cardiac arrest secondary to blunt trauma is < 1%

23. Circulation Serious external bleeding? All bleeding stops eventually!
Direct pressure (hand, bandage, PASG)
Tourniquet as last resort
All bleeding stops eventually!

24. Circulation Is patient in shock?
Cool, pale, moist skin = shock, until proven otherwise
Capillary refill > 2 sec = shock until proven otherwise
Restlessness, anxiety, combativeness = shock until proven otherwise

25. Circulation If possible internal hemorrhage, QUICKLY expose, palpate:
Abdomen
Pelvis
Thighs

26. Disability (CNS Function)
Level of Consciousness = Best brain perfusion indicator
Use AVPU initially
Check pupils
The eyes are the window of the CNS

27. Disability (CNS Function)
Decreased LOC in trauma = Head injury until proven otherwise

28. Expose and Examine You can’t treat what you don’t find!
If you don’t look, you won’t see!
Remove ALL clothing from critical patients ASAP
Avoid delaying resuscitation while disrobing patient
Cover patient with blanket when finished

29. The “Load and Go” Situations
Head injury with decreased LOC
Airway obstruction unrelieved by mechanical methods
Conditions resulting in inadequate breathing
Shock
Conditions that rapidly lead to shock
Tender, distended abdomen
Pelvic instability
Bilateral femur fractures
Traumatic cardiopulmonary arrest

30. Initial Assessment
A blood pressure or an exact respiratory or pulse rate is NOT necessary to tell that your patient is critical !!!!!

31. If the patient looks sick, he’s sick!!!
Initial Assessment
If the patient looks sick, he’s sick!!!

32. Initial Resuscitation
Treat as you go!
Aggressively correct hypoxia and inadequate ventilation.
Control external blood loss.

33. Initial Resuscitation
Immobilize C-spine (rigid collar)
Keep airway open
Oxygenate
Rapidly extricate to long board
Begin assisted ventilation with BVM
Expose
Apply and inflate PASG
Transport
Reassess and report in route
Consider requesting ALS intercept

34. Initial Resuscitation
Minimum Time On Scene
Maximum Treatment In Route

35. Detailed Exam (Secondary Survey)
History and Physical Exam
You WILL get here with MOST trauma patients
Perform ONLY after initial assessment is completed and life threats corrected
Do NOT hold critical patients in field for detailed exam

36. Physical Exam Stepwise, organized Every patient, same way, every time
Superior to inferior; proximal to distal
Look--Listen--Feel

37. History Chief complaint What PATIENT says problem is
Not necessarily what you see

38. History A = Allergies M = Medications P = Past medical history
L = Last oral intake
E = Events leading up to incident

39. Performed ONLY on stable patients
Definitive Field Care
Performed ONLY on stable patients

40. Definitive Field Care
Stable patients can receive attention for individual injuries before transport
Bandaging
Splinting
Reassess carefully for hidden problems
If patient becomes unstable at any time, TRANSPORT

41. Reevaluation Ventilation and perfusion status Repeat vital signs
Continued stabilization of identified problems
Continued reassessment for unidentified problems

42. PowerPoint Source
Slides for this presentation from Temple College EMS: