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Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital.

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Presentation on theme: "Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital."— Presentation transcript:

1 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital Care Providers Sixth Edition for Prehospital Care Providers Sixth Edition Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Chapter 1 Scene Size-up Chapter 1 Scene Size-up

2 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Courtesy of Bonnie Meneely, EMT-P Scene Size-up

3 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Overview Relationship of time to patient survival Actions on scene Steps of Scene Size-up Two basic mechanisms of motion injury Mechanisms and settings Two most common forms of penetrating injury Mechanisms and extent Assessment criteria for falls Anticipated injuries 2Scene Size-up -

4 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Overview Blast injury factors related to assessment Collisions in motor-vehicle crashCollisions in motor-vehicle crash Potential injuries related to vehicle damage motor-vehicle crash Common motor-vehicle crash forms Lateral-impact compared to head-on collision Potential head-on collision injuries Proper and improper use of safety devices Potential rear-end collision injuries Higher mortality rate for ejection 3Scene Size-up -

5 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Trauma Scene Size-up -4 For severely injured patients, survival is time-dependent!

6 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Golden Hour From moment of injury To definitive treatment EMS platinum 10 minutes Assessment and management Every action must have lifesaving purpose Organized, detail-oriented, selective, rapid Trauma Survival 5Scene Size-up -

7 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Trauma Care Teamwork is important! You must know: What you can handle and what you cant What you should handle and what you shouldnt When to stay and when to leave Fastest route there and fastest route away What to do, what not to do, and when to wait 6Scene Size-up -

8 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Scene Size-up A critical part of trauma assessment Anticipate what you will find at scene Anticipate equipment and resource needs Form a plan of approach Be prepared to modify that plan Failure to size-up can jeopardize lives. 7Scene Size-up -

9 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Scene Size-up First step in ITLS Primary Survey 8Scene Size-up -

10 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Scene Size-up 1.Standard precautions 2.Scene safety 3.Initial triage (total number of patients) 4.Need for more help or equipment 5.Mechanism of injury 9Scene Size-up -

11 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Standard Precautions Scene Size-up -10 Personal protective equipment is always needed at trauma scenes.

12 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Scene Safety Ambulance positioning Safe place to park Facing away from scene Windshield survey Threats to you Threats to/from patient Threats to/from bystanders 11Scene Size-up - Courtesy of Bonnie Meneely, EMT-P

13 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Initial Triage Total number of patients Call for backup Medical command Initiate MCI protocols Any more patients? 12Scene Size-up - Courtesy of Bonnie Meneely, EMT-P

14 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Need for More Essential equipment Carry to scene for time efficiency Change gloves between patients Additional resources Call early Relay what to expect, where to respond 13Scene Size-up -

15 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Mechanism of Injury Energy follows physics laws. Injuries present in predictable patterns High-energy at risk for severe injury. Consider injured until proven otherwise Factors to consider: Direction and speed of impact, patient kinetics and physical size, signs of energy release 14Scene Size-up -

16 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Basic Motion Mechanisms Blunt injuries Rapid forward deceleration Rapid vertical deceleration Blunt instrument energy transfer Penetrating injuries Projectiles Knives Falls upon objects 15Scene Size-up -

17 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Motor-Vehicle Collisions 16Scene Size-up - Each collision is three collisions: Machine Collision 1 Body Collision 2 Organ Collision 3

18 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Other Collisions Secondary collisions Objects are missiles at original speed Additional impacts Vehicle collides with another object Other vehicles collide with original vehicle 17Scene Size-up -

19 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Clues to Injury Deformity of vehicle What forces were involved in collision? Deformity of interior structures What did patient hit? Deformity or injury patterns on patient What anatomic areas were hit? 18Scene Size-up -

20 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Common Collisions Common types Head-on Lateral-impact (T-bone) Rear-impact Rollover Rotational 19Scene Size-up -

21 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Head-on Collision 20Scene Size-up - Windshield injuries Brain, soft-tissue injury, cervical spine Steering wheel injuries Traumatic tattooing of skin Dashboard injuries Face, brain, cervical spine, pelvis, hip, knee Courtesy of Bonnie Meneely, EMT-P

22 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Lateral-Impact Collision 21Scene Size-up - Similar to head-on with lateral energy Not easily predicted Consider organ damage Check impact side Head, neck, upper arm, shoulder, thorax, abdomen, pelvis, legs Courtesy of Bonnie Meneely, EMT-P

23 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Rear-Impact Collision 22Scene Size-up - Posterior displacement Rapid forward deceleration also possible Headrest position Hyperextension injuries Damage back and front Deceleration injuries Courtesy of Bonnie Meneely, EMT-P

24 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Rollover Collision 23Scene Size-up - Multiple impacts Multiple directions Multiple injuries Axial-loading injuries Spine injury Ejection Chance of death increases 25 times Courtesy of Bonnie Meneely, EMT-P

25 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Rotational Collision Scene Size-up - Head-on, lateral-impact combination Converts forward motion to spinning motion Windshield, dashboard, steering wheel, side Same possible injuries of both mechanisms 24

26 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Occupant Restraint Lap belt Clasp-knife effect Abdomen Lumbar spine Three-point restraint Cervical spine Clavicular fracture Air bags First impact only Always lift and look 25Scene Size-up -

27 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Tractor Accidents One-third of farm fatalities Side overturns 85% Likely to throw clear Rear overturns 15% Likely to entrap or crush Common injuries Crush injuries Thermal and chemical burns 26Scene Size-up - Courtesy of Roy Alson, MD

28 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Small-Vehicle Crashes Small vehicles Motorcycles All-terrain vehicles Personal watercraft Snowmobiles Factors Protective gear Additional impacts 27Scene Size-up -

29 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Pedestrian Injuries Mechanism Primary collision Additional impacts Common injuries Severe internal injuries and fractures Adult: bilateral leg, knee Child: pelvis, torso 28Scene Size-up - Courtesy of Bonnie Meneely, EMT-P

30 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Falls Vertical deceleration Distance of fall Anatomy impacted Surface struck 29Scene Size-up -

31 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Penetrating Injuries 30Scene Size-up - Knife-wound severity Anatomic area penetrated Fourth intercostal space may be chest and abdomen Length of blade Angle of penetration Stabilize impaled object Minimize external movement

32 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Penetrating Injuries 31Scene Size-up - Firearms Type of weapon Low-velocity High-velocity Caliber Missile size Bullet construction Tumbling/yaw Distance traveled Courtesy of Roy Alson, MD

33 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Penetrating Wounds Entry wound Smaller May be darkened, burned Exit wound One, none, or many Larger May be ragged 32Scene Size-up -

34 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Penetrating Wounds Internal wound Tissue contact damage High-velocity transfer of energy Shock waves Temporary cavity Pulsation of temporary cavity Damage proportional to tissue density Highly dense tissue sustains more damage 33Scene Size-up -

35 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Blast Injuries Primary Initial air blast Secondary Material propelled Tertiary Impact on object Quaternary Dispersed hazardous 34Scene Size-up - Courtesy of Roy Alson, MD

36 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Caution Do not approach until Scene Size-up is complete! Do not approach until Scene Size-up is complete! 35Scene Size-up -

37 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Summary Time is critical; teamwork is essential. Scene size-up can be lifesaving. Mechanism of injury: An aid to predict injury Part of overall management of trauma patient Record scene and mechanism findings. 36Scene Size-up -

38 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Discussion 37Scene Size-up - Photo © Jeff Forster

39 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Click for Next Chapter


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