Prehospital Trauma Life Support: Assessment and Management

Prehospital Trauma Life Support
Lesson
Assessment and Management
PROVIDER COURSE
Copyright 2003, Elsevier Science (USA). All rights reserved.
Objectives
Discuss the importance of scene assessment Identify components of the primary survey Differentiate between critical and noncritical patients Defend the need for early transport of critical patients Describe when to perform a secondary survey
3-2
Its mid-January and you have been dispatched to a multi-vehicle crash on the Interstate. Initial reports are that there are multiple patients and a fuel tanker is involved. When does your scene assessment begin?
3-3
What are the components of scene assessment?
3-4
Scene Safety
Ensure safety of rescuers and patients
Threatening situations may include:
Fire Electrical lines Hazardous materials Blood and body fluids Traffic Weapons Environmental conditions
Can you think of any other hazards?
3-5
Scene Situation
What really happened? What are the kinematics? How many patients involved? Ages? Additional resources needed? How will patients be transported?
3-6
Your patient is the 32-year-old female unrestrained driver who is found slumped over in the vehicle. She has no obvious external hemorrhage, is breathing rapidly, and is mumbling inappropriate words. What do these findings suggest? How should you assess this patient?
3-7
Standard Precautions
Gloves Eye protection Masks Gowns Inappropriate handling/disposal of contaminated sharps and other items
3-8
Patient Assessment
Primary survey
Treat as you go
Resuscitation Secondary survey Definitive care in the field
3-9
Primary Survey
Airway/cervical spine Breathing/ventilation Circulation Disability Expose/Environment
3-10
Airway
Manual stabilization of the cervical spine
How is the airway assessed? What interventions may be needed?
3-11
Breathing
How is breathing assessed? What interventions may be needed?
3-12
Circulation
Assess for and control external hemorrhage Assess perfusion: Pulse Skin
- rate - quality - regularity - location - color - temperature - moisture - capillary refilling time
3-13
Disability
Level of consciousness GCS score can range from 3 to 15
Eyes Verbal Motor
Pupils
Reporting total GCS score instead of reporting the individual components
3-14
Glasgow Coma Scale

Eyes
Open your eyes. Nailbed pressure or axillary tissue squeeze
Verbal
What happened to you? Add T to score if intubated
Motor
Hold up two fingers Nailbed pressure or axillary tissue squeeze
3-15
Glasgow Coma Scale

Eye Opening Spontaneous To Voice To Pain None Oriented Confused Inappropriate Words Incomprehensible Words None Obeys Command Localizes Pain Withdraw (pain) Flexion (pain) Extension (pain) None 4 3 2 1 5 4 3 2 1 6 5 4 3 2 1
Verbal Response
Motor Response
3-16
Expose/Environment
Expose patient as environment allows to assess for other life-threatening conditions; then preserve/maintain body heat
Life-threatening conditions missed because of failure to adequately expose the patient

Failing to preserve body heat and to consider environmental conditions
3-17
Simultaneous Assessment
Kinematics Expose/ Environment Airway
Disability
Breathing
Circulation
3-18
Decision Making
Trauma-related incident Scene assessment Primary Survey Life threatening or multisystem injuries
Yes
Initiate rapid transport Reassess Secondary survey
No
Secondary survey Reassess Manage injuries as appropriate Initiate transport
3-19
Critical Trauma Patient

You may never get past the primary survey if the patients status is critical
Failing to recognize a critical trauma patient during the primary survey Failing to complete a secondary survey after lifethreatening conditions are managed
3-20
Critical Trauma Patient

Inadequate or threatened airway Impaired ventilations Hemorrhage Shock Abnormal neurological status Most penetrating trauma Amputation or near-amputation Trauma combined with complicating factor
3-21
A 16-year-old loses control of his bicycle on gravel. Your patient is found on the side of the road holding his right wrist. Multiple abrasions are noted on his face and upper extremities. The scene is safe.
3-22
Primary Survey
A - Patent B - Normal; BS clear C - Minor bleeding from chin laceration; radial pulse normal; skin warm, pink, and dry D - GCS score 15 E - Deformity noted to right wrist How do you proceed?
3-23
Secondary Survey
Vital signs AMPLE history Head-to-toe exam
Performing a secondary survey on a critical patient prior to initiating resuscitation
Failing to complete a secondary survey on a noncritical patient
3-24
Head-to-Toe Exam
Systematic and complete: Observation
What do we look for?
Auscultation
What do we listen for?
Palpation
What do we feel for?
3-25
Definitive Care in the Field
Packaging
Spinal immobilization if indicated Splint musculoskeletal injuries Dress wounds
3-26
Transportation
Closest appropriate facility
In general, bypass closest facility to reach trauma center Receiving facilities should be determined by local protocol
Mode
Ground Aeromedical
3-27
Trauma Center Candidates

Triage to trauma centers determined by:
Physiologic criteria Anatomic criteria Mechanism of injury Preexisting conditions
Follow local protocol
3-28
Reassessment
How frequently should we reassess? What should we reassess?
Failing to recognize the development of lifethreatening conditions in a previously noncritical patient
3-29
Pain Management
Consider analgesia for:
Isolated extremity injury Spinal fracture
Narcotics
Titrate in small increments IV Beware of ventilatory depression and vasodilation (hypotension)
3-30
Pain Management
Administering analgesia to a critical trauma patient Withholding analgesia from a trauma patient with an isolated injury who complains of pain
3-31
Communication
Notify receiving facility as early as possible
Trauma team activation
What information should be communicated to the receiving facility?
3-32
Documentation
Well-written narrative
Pertinent findings Care provided Response to treatment
A legal document QA/QI

Failing to document the reasons for delay in transport of critical patients
3-33
Triage
Multiple patients with adequate resources
Treat most critical patients first
Multiple patients with inadequate resources

Treat those with the greatest likelihood of survival first
Be familiar with local disaster plan Use Incident Command System
3-34
Summary
Perform scene assessment Initiate treatment for life-threatening conditions when identified during primary survey Prompt transport of critically injured patients to closest appropriate facility Complete assessment and definitive care of noncritical patients Communicate and document key information
3-35
Prehospital Trauma Life Support

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3-36

Prehospital Trauma Life Support: Assessment and Management

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Prehospital Trauma Life Support: Assessment and Management

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Prehospital Trauma Life Support

Assessment and Management

What are the components of scene assessment?

Can you think of any other hazards?

Resuscitation Secondary survey Definitive care in the field

Glasgow Coma Scale

Glasgow Coma Scale

Life-threatening conditions missed because of failure to adequately expose the patient

Copyright 2003, Elsevier Science (USA). All rights reserved.

Critical Trauma Patient

Critical Trauma Patient

Definitive Care in the Field

Trauma Center Candidates

Follow local protocol

What information should be communicated to the receiving facility?

A legal document QA/QI

Multiple patients with inadequate resources

Be familiar with local disaster plan Use Incident Command System

Prehospital Trauma Life Support

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