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Primary/Secondary Survey of the Casualty Objectives Discuss the importance of the primary/secondary survey Outline how ATLS applies to the casualty.

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Presentation on theme: "Primary/Secondary Survey of the Casualty Objectives Discuss the importance of the primary/secondary survey Outline how ATLS applies to the casualty."— Presentation transcript:

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2 Primary/Secondary Survey of the Casualty

3 Objectives Discuss the importance of the primary/secondary survey Outline how ATLS applies to the casualty

4 Time of death

5 Primary/Secondary Survey Why is it important? –What and where are the wounds? What resuscitation is required? –Mode of EVAC?

6 What is the Approach? ATLS –Created by surgeons for the non-surgeon –Designed in the urban environment –Performed in the hospital setting –Requires a lot of high tech resources –This is our classical training platform Will this approach work in firefight?

7 How Do We Develop Our Approach? What are we going to see? –Injury patterns Civilian trauma? Firefight trauma?

8 How Do We Develop Our Approach? Civilian trauma –Trimodal death distribution First peak –Death results in the pre-hospital setting from massive head injury and massive vascular injury. Second peak –Death in the first few minute of arrival to the hospital and due to massive head, chest and abdominal injury Third peak –Post resuscitation/operative complications Firefight TraumaFirefight Trauma –We don’t know the death distribution It is believed that if the casualty can arrive alive and relatively stable to the ER…they will live.It is believed that if the casualty can arrive alive and relatively stable to the ER…they will live.

9 How Do We Develop Our Approach? ATLS –Based on urban injury patterns Primary Survey –A-Airway/c-spine control –B-Breathing –C-Circulation –D-Disability –E-Exposure Detailed secondary survey –Head-to-toe exam

10 How Do We Develop Our Approach? The Firefight Casualty –Slightly different injury pattern-in this order! Penetrating extremity trauma Tension pneumothorax Loss of airway –Instead of ABCs……think CBAs

11 The Firefight Casualty Primary Survey Assess for hemorrhage first –Intervene –Intervene for life threatening bleed only! Then, assess for tension pneumothorax Then, assess for an airway –Utilize –Utilize a Combitube or surgical airway –Rarely –Rarely a need for c-spine control

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16 The Firefight Casualty Primary Survey D-disability- decision to evacuate E-exposure –Explore ideas on how to expose your casualty while protecting them from the environment Hypothermia is BAD –Remember, they may need that kevlar!!!

17 Heat loss during transport

18 Hypothermia

19 The Firefight Casualty Secondary Survey Occurs after you have performed your primary survey and appropriate interventions Head-to-toe exam along ATLS guidelines. –Be very thorough-many injuries are subtle!

20 Commonly used acronyms DCAP-BTLS- deformities, contusions, abrasions, penetrations, burns, tears, lacerations, swelling. TIC- tenderness, instabilities, crepitus. TRD- tenderness, rigidity, distension PMS- pulse, motor, sensory

21 Head exam DCAP-BTLSPupils Raccoon/Battle signs Mid-face instability

22 Neck exam Step-off Tracheal deviation Jugular vein distention

23 Chest exam DCAP-BTLSTICAuscultationPercussion

24 Abdominal/Pelvic exam DCAP-BTLSTRD-P Pelvic instability Priapism Scrotal/labial hematoma/blood at the meatus

25 Extremity exam DCAP-BTLSTICPMS

26 Posterior Thorax Log roll casualty –Spine DCAP-BTLSTenderness/step-off –DRE Gross blood only

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31 Questions?


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