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International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma Assessment and Management 2.

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Presentation on theme: "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma Assessment and Management 2."— Presentation transcript:

1 International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma Assessment and Management 2

2 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma Assessment and Management Courtesy of ITLS Ontario, Steve McNenly, Jennifer Lundren, and Sheryl Jackson

3 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview ITLS Patient Assessment –Primary Survey –Ongoing Exam –Secondary Survey Initial Assessment related to –Rapid Trauma Survey vs. Focused Exam –Interruptions Critical conditions and the “Fix It” process

4 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Patient Assessment ITLS Primary Survey –Scene Size-up –Initial Assessment –Rapid Trauma Survey vs. Focused Exam ITLS Ongoing Exam ITLS Secondary Survey

5 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey –Scene Size-up –Initial Assessment –Rapid Trauma Survey vs. Focused Exam

6 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Delegate immediate interventions to partners Do not stop your assessment unless –Scene becomes unsafe –Airway obstruction –Cardiac arrest Teamwork Assessment “Fix It”Teamwork

7 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Scene Size-up

8 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Scene Size-up Hazards –Power lines, gas, animals, people PPE Number of patients –Establish command –Additional resources? MOI –Anticipate type and severity of injuries

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

10 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey Initial Assessment –General impression –Level of consciousness –Manual stabilization of cervical spine –ABCs Prioritize patient –Identify immediate life-threatening conditions

11 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey Less than 2 minutes –Initial Assessment and Rapid Trauma Survey Delegate any intervention Interrupt survey only for: –Unsafe scene –Airway obstruction –Cardiac arrest

12 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey General impression –Obvious major injuries or bleeding – immediately control life-threatening bleeding –Approximate age, sex, weight –General appearance –Position of patient body and surroundings –Patient activity Triage multiple patients

13 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey Initial Level of Consciousness –Cervical-spine stabilization Alert Responds to Verbal stimuli Responds to Pain Unresponsive

14 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey Airway: look, listen, feel –Direct: simple positioning and suctioning If not adequate © Pearson

15 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey Breathing: look, listen, feel –Direct: high-flow oxygen If not adequate © Pearson

16 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Respiratory Rates NormalAbnormal Adult10–20 24 Child15–30 35 Infant25–50 60

17 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey Major bleeding controlled? –“Fix It” Circulation: peripheral pulse –No peripheral, check carotid –Too fast, too slow, quality –Interrupt: cardiac arrest Skin –Color, temperature, condition © Pearson

18 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians MOI Decision Dangerous generalized or unconscious –Rapid Trauma Survey Dangerous focused –Focused Exam No significant MOI Initial Assessment normal –Focused Exam © Mikael Damkier

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

20 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Rapid Trauma Survey Assess –Head and neck –Chest –Abdomen –Pelvis –Lower and upper extremities –Back Transfer to backboard

21 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Rapid Trauma Survey If critical situation, transfer to ambulance to complete exam. © Pawel Nawrot

22 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Rapid Trauma Survey Obtain baseline vital signs If altered mental status –Brief neurological exam –Pupils, GCS, and signs of cerebral herniation –Look for medic alert tags –Consider other causes

23 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Glasgow Coma Scale *Decorticate posturing to pain **Decerebrate posturing to pain

24 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Priority Patient Dangerous MOI History –Loss of consciousness High Risk Groups Abnormal Initial Assessment –Altered mental status –Difficulty breathing –Abnormal perfusion © Pawel Nawrot

25 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Brief Targeted History S Symptoms A Allergies MMedications P Past medical history L Last oral intake E Events preceding incident

26 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Load-and-Go Situations Initial Assessment –Altered mental status –Abnormal respiration –Abnormal circulation Shock potential –Abnormal chest exam –Tender, distended abdomen –Pelvic instability –Bilateral femur fractures Significant MOI and/or poor general health

27 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians When in doubt—transport early!

28 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Critical Interventions Manage airway Assist ventilation Administer oxygen Begin CPR Control major external bleeding Seal sucking chest Stabilize flail chest Decompress tension pneumothorax Stabilize impaled object Complete packaging

29 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Initiate Transport Procedures not on scene, not lifesaving –Splinting, bandaging, IV line insertion –Elective intubation Contact medical direction –As early as possible –Estimated time of arrival (ETA) –Condition of patient –Special needs on arrival

30 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Ongoing Exam Change in co ndition –Patient –Interventions Perform and record –Critical: every 5 minutes –Stable: every 15 minutes –Each time patient moved –With each intervention –If condition changes

31 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Ongoing Exam Subjective changes Mental status (LOC and pupils) ABCs Neck, chest, abdomen Previously identified injuries Interventions

32 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Secondary Survey

33 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Secondary Survey More comprehensive exam –Evaluation for all injuries, not just life-threatening –Establishes baseline for treatment decisions Performed –Critical patients—done during transport –Short transport—may not have time –Noncritical patients—done on scene

34 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Secondary Survey Initial Assessment –Repeat routinely Vital signs –Repeat routinely –Monitoring Detailed Exam –Head-to-toe DCAP-BLS-TIC

35 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Detailed Exam: DCAP-BLS-TIC D eformities C ontusions A brasions P enetrations B urns L acerations S welling T enderness I nstability C repitus

36 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Adjuncts for Patient Assessment Pulse oximetry Wave form capnography

37 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Adjuncts for Patient Assessment Serum lactate –Marker for tissue hypoxia –Finger-stick serum levels –Further studies needed Portable ultrasound –F.A.S.T.

38 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Summary ITLS Patient Assessment –Key to trauma care –Not difficult, but time-critical –Rapid, orderly, thorough Remain calm –Maximize speed through organization and teamwork


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