Initial Assessment and Management of Trauma 4/27/2017 Initial Assessment and Management of Trauma Temple College EMS Professions Temple College EMS Professions

Introduction Trauma Leading killer from ages 1 to 44 Up to one-third of deaths are preventable

Introduction Golden Hour Time to reach operating room NOT time for transport NOT time in Emergency Department

Introduction EMS does NOT have a Golden Hour EMS has a Platinum Ten Minutes

Introduction Patients in Golden Hour must be: Recognized quickly Transported to APPROPRIATE facility

Introduction Survival depends on assessment skills Good assessment results from An organized approach Clearly defined priorities

Size-Up Safety Scene Situation How does scene look? How many patients? Where are they? Situation Additional resources? Critical vs non-critical patient?

Initial Assessment (Primary Survey) Find life threats If life threat present, CORRECT IT! If life threat can’t be corrected Support ABCs TRANSPORT!!

With critical trauma you may never get beyond primary survey

Airway with C-Spine Control You don’t need a C-collar yet Return head to neutral position Stabilize without traction

Airway with C-Spine Control Noisy breathing is obstructed breathing But all obstructed breathing is not noisy

Airway with C-Spine Control Anticipate airway problems with Decreased level of consciousness Head trauma Facial trauma Neck trauma Upper chest trauma Open, Clear, Maintain

Breathing Is air moving? Is it moving adequately? Is oxygen getting to the blood?

Breathing Look Listen Feel

Breathing Oxygenate immediately if: Decreased level of consciousness ? Shock ? Severe hemorrhage Chest pain Chest trauma Dyspnea Respiratory distress

If you think about giving oxygen, GIVE IT!! Breathing If you think about giving oxygen, GIVE IT!!

Breathing Consider assisting ventilations if: Respirations <12 Tidal volume decreased Respiratory effort increased

Breathing If you can’t tell if ventilations are adequate, they aren’t!! If you are wondering whether or not to bag the patient, you should!!

Breathing If respirations compromised: Expose chest Inspect front and back Palpate front and back Auscultate front and back

Circulation Is heart beating? Is there serious external bleeding? Is the patient perfusing?

Circulation Does patient have radial pulse? Absent radial = systolic BP < 80 Does patient have carotid pulse? Absent carotid = systolic BP < 60

Circulation No carotid pulse? Extricate CPR Pneumatic Antishock Garment Run!!!! Survival rate from cardiac arrest secondary to blunt trauma is < 1%

Circulation Serious external bleeding? All bleeding stops eventually! Direct pressure (hand, bandage, PASG) Tourniquet as last resort All bleeding stops eventually!

Circulation Is patient in shock? Cool, pale, moist skin = shock, until proven otherwise Capillary refill > 2 sec = shock until proven otherwise Restlessness, anxiety, combativeness = shock until proven otherwise

Circulation If possible internal hemorrhage, QUICKLY expose, palpate: Abdomen Pelvis Thighs

Disability (CNS Function) Level of Consciousness = Best brain perfusion indicator Use AVPU initially Check pupils The eyes are the window of the CNS

Disability (CNS Function) Decreased LOC in trauma = Head injury until proven otherwise

Expose and Examine You can’t treat what you don’t find! If you don’t look, you won’t see! Remove ALL clothing from critical patients ASAP Avoid delaying resuscitation while disrobing patient Cover patient with blanket when finished

The “Load and Go” Situations Head injury with decreased LOC Airway obstruction unrelieved by mechanical methods Conditions resulting in inadequate breathing Shock Conditions that rapidly lead to shock Tender, distended abdomen Pelvic instability Bilateral femur fractures Traumatic cardiopulmonary arrest

Initial Assessment A blood pressure or an exact respiratory or pulse rate is NOT necessary to tell that your patient is critical !!!!!

If the patient looks sick, he’s sick!!! Initial Assessment If the patient looks sick, he’s sick!!!

Initial Resuscitation Treat as you go! Aggressively correct hypoxia and inadequate ventilation. Control external blood loss.

Initial Resuscitation Immobilize C-spine (rigid collar) Keep airway open Oxygenate Rapidly extricate to long board Begin assisted ventilation with BVM Expose Apply and inflate PASG Transport Reassess and report in route Consider requesting ALS intercept

Initial Resuscitation Minimum Time On Scene Maximum Treatment In Route

Detailed Exam (Secondary Survey) History and Physical Exam You WILL get here with MOST trauma patients Perform ONLY after initial assessment is completed and life threats corrected Do NOT hold critical patients in field for detailed exam

Physical Exam Stepwise, organized Every patient, same way, every time Superior to inferior; proximal to distal Look--Listen--Feel

History Chief complaint What PATIENT says problem is Not necessarily what you see

History A = Allergies M = Medications P = Past medical history L = Last oral intake E = Events leading up to incident

Performed ONLY on stable patients Definitive Field Care Performed ONLY on stable patients

Definitive Field Care Stable patients can receive attention for individual injuries before transport Bandaging Splinting Reassess carefully for hidden problems If patient becomes unstable at any time, TRANSPORT

Reevaluation Ventilation and perfusion status Repeat vital signs Continued stabilization of identified problems Continued reassessment for unidentified problems

PowerPoint Source Slides for this presentation from Temple College EMS: http://www.templejc.edu/dept/ems/pages/powerpoint.html