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International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Scene Size-up 1.

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Presentation on theme: "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Scene Size-up 1."— Presentation transcript:

1 International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Scene Size-up 1

2 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Scene Size-up © Jack Degley Photography

3 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Steps of Scene Size-up Two basic mechanisms of motion injury Three collisions associated with MVCs Common forms of MVCs Potential injuries associated with restraint systems

4 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Assessment criteria and anticipated injuries from falls Two most common forms of penetrating injury Blast injury factors related to assessment

5 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma Care Teamwork is important! You must know: –What you can handle and what you can't –What you should handle and what you shouldn't –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

6 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians 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

7 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Scene Size-up First step in ITLS Primary Survey

8 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians 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

9 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Standard Precautions Exposure to blood or OPIM very likely at a trauma scene Appropriate PPE must be worn –Covered in more detail in Chapter 22

10 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians 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 Courtesy of Bonnie Meneely, EMT-P

11 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Initial Triage Total number of patients –Call for backup –Medical command –Initiate MCI protocols –Any more patients? Courtesy of Bonnie Meneely, EMT-P

12 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Need for More Essential equipment –Carry to scene for time efficiency –Change gloves between patients Additional resources –Call early –Relay where to respond and any dangers

13 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Mechanism of Injury Energy follows physics laws. –Injuries present in predictable patterns High-energy at risk of severe injury. –Consider injured until proven otherwise Type of MOI –Generalized –Focused

14 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Basic Motion Mechanisms Blunt injuries –Rapid forward deceleration –Rapid vertical deceleration –Blunt instrument energy transfer Penetrating injuries –Projectiles –Knives –Falls upon objects

15 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Motor-Vehicle Collisions Each collision is three collisions: Machine Collision 1 Body Collision 2 Organ Collision 3

16 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Other Collisions Secondary collisions –Objects are missiles –Additional impacts –Vehicle collides with another object –Other vehicles collide with original vehicle

17 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians 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?

18 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Common Collisions Common types –Frontal-impact –Lateral-impact –Rear-impact –Rollover –Rotational (© Jack Dagley Photography)

19 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Frontal-Impact Collision 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 Maria Dryfhout, Shutterstock )

20 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Lateral-Impact Collision Similar to frontal-impact with lateral energy –Not easily predicted –Consider organ damage Check impact side –Head, neck, upper arm, shoulder, thorax, abdomen, pelvis, legs (Photo courtesy of Anthony Cellitti, NREMT-P)

21 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Rear-Impact Collision Posterior displacement –Rapid forward deceleration also possible Headrest position –Hyperextension injuries Damage back and front –Deceleration injuries (Courtesy of Bonnie Meneely, EMT-P)

22 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Rollover Collision Multiple impacts –Multiple directions –Multiple injuries Axial-loading injuries –Spine injury Ejection –Chance of death increases 25 times Courtesy of Bonnie Meneely, EMT-P (Courtesy of Bonnie Meneely, EMT-P)

23 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Rotational Collision Head-on, lateral-impact combination –Converts forward motion to spinning motion Windshield, dashboard, steering wheel, side –Same possible injuries of both mechanisms © Dedyukhin Dmitry / Shutterstock.com

24 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians 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” –Lumbar spine (Courtesy of Olivier Le Queinec, Shutterstock.com)

25 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Tractor Accidents 50% of farm fatalities –Side overturns 85%  Likely to throw clear –Rear overturns 15%  Likely to entrap or crush Common injuries –Crush injuries –Thermal or chemical burns Courtesy of Roy Alson, MD

26 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Small-Vehicle Crashes Small vehicles –Motorcycles –All-terrain vehicles –Personal watercraft –Snowmobiles Factors –Protective gear –Additional impacts © Orientaly / Shutterstock.com

27 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Pedestrian Injuries Mechanism –Primary collision –Additional impacts Common injuries –Internal injuries and fractures  Adult: bilateral leg, knee  Children: pelvis, torso Courtesy of Bonnie Meneely, EMT-P

28 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Falls Vertical deceleration –Distance of fall –Anatomy impact –Surface struck © Pearson

29 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Penetrating Injuries 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

30 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Penetrating Injuries Firearms –Type of weapon  Low-velocity  High-velocity –Caliber  Missile size  Bullet construction  Tumbling/yaw –Distance traveled Courtesy of Roy Alson, MD

31 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Penetrating Wounds Entry wound –Smaller –May be darkened, burned Exit wound –One, none, or many –Larger –May be ragged (©Edward T. Dickinson, MD)

32 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Wound Ballistics Factors –Missile velocity –Missile size –Missile deformity –Missile design –Tumbling and yaw (Courtesy of Roy Alson, MD)

33 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Wound Ballistics 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

34 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Blast Injuries Primary –Initial air blast Secondary –Material propelled Tertiary –Impact on object Quaternary –Dispersed hazardous material

35 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Caution Do not approach until Scene Size-up is complete!

36 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians 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


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