 Single System: an injury involving a single isolated body system  Multiple System: an injury that involves two or more body systems

 Access  Prehospital  Initial Resuscitation  Acute Care  Rehabilitation

 Blunt  Penetrating  Blast  Intentional  Nonintentional

 Primary: occurs at the time of injury  Secondary: occurs as the result of secondary insults (hypoxia, hypotension, infection etc.)

 Younger than 5, older than 55  Medical / surgical hx.  Substance abuse  Severity of injury  Time of injury to definitive care  Quality of care

 Primary Survey / resuscitation  Secondary assessment  Psychological, social and environmental factors

 Mechanism=detailed cause or type of event  Kinematics = physics of trauma, how is energy dispersed  Part of primary survey…listen to prehospital caregivers

 Assessment and resuscitation occur simultaneously  Reassess frequently  Establish priorities and anticipate needs  Life over limb  Preparedness, organization, communication  Someone must be in control  Do no further harm  If condition progressively worsens…definitive care is needed.

 Oxygenation of vital tissues….it’s all about perfusion

 Subjective Data › Mechanism of Injury › Chief Complaint

 Signs / Symptoms › Decreased LOC › Agitation › Stridor › Cyanosis › Accessory Muscles › Hoarseness › No air movement  Treatment › Establish airway without manipulation of cervical spine › Jaw thrust › Suction › NP / OP airways › ETT

 Signs / Symptoms › Cyanosis, decreased breath sounds, increased resp. rate, decreased LOC, noisy resp., hypoxia, acidosis.  Diagnosis › Assess clinical presentation, ABG’s, oximetry trends, CO2 monitoring, CXR  Treatment › High flow O2, assist ventilation, treat tension pnuemo, open pnuemo, flail chest or hemothorax, PAIN MANAGEMENT

 Signs of hypovolemic shock › Altered LOC, tachycardia, hypotension, tachypnea, cool diaphoretic skin, low UOP, slow capillary refill time.  Diagnosis › CBC, PT, PTT, X rays, DPL, US, arteriograms  Treatment of hypovolemia › Direct pressure to external bleeding, high flow O2, 2 lg bore IV’s, fluids, blood › Rule out sources of obstructive shock

 Based on mechanism, not neuro deficit  SCI may occur with or without bony involvement  High index of suspicion › Pain, paralysis, paresthesia, ptosis, priapism, presenting position, pregnancy, MOI.  Diagnostics › Initial AP/ lateral to include C-7 and T-1 › Correlate with physical exam › CT

 AVPU  Trend Glasgow Coma Scale score  Trend pupillary size  Assess motor function of all four ext.  Diagnostics…rule out › Decreased perfusion or direct cerebral injury, Drugs / ETOH, Hypoxia, Hypotension

 Complete primary survey  Treat life threatening injury  Complete secondary survey  Rapid resuscitation  Avoid prolonged hyperventilation  Avoid hypotension SBP>90  Serial monitoring of VS / NS  Consider Narcan or Mannitol

 Judicious nakedness.  Keep patients WARM.  Monitor temperature carefully

 Should not be initialized until life threatening injuries are treated and primary assessment is complete  AMPLE History  Head to Toe physical exam, including posterior surfaces

 Foley (if no contraindications) › maintain UOP >30 ml / hr  Decompress stomach with NG › If no CSF leak, midface fx

 Pediatrics  Geriatrics

 Resuscitation priorities are identical to those on non-pregnant trauma patient.  Consult OB resources early in resuscitation.