Management of Trauma
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
Survivaldepends on assessment skills
Good assessment results from
– An organized approach
– Clearly defined priorities
Size-Up
Safety
Scene
– 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!!
Primary Survey
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
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?
– 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)
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
Definitive Field Care