Initial Assessment and Management of the Trauma Patient
|
|
|
- Madeleine Watkins
- 5 years ago
- Views:
Transcription
1 Initial Assessment and Management of the Trauma Patient 1
2 Epidemiology Road Traffic Accidents are major cause of long term morbidity and mortality in developing nations WHO predicts that by 2020, Road Traffic Accidents will be second leading cause of loss of life for world s population High Morbidity = Loss of income to society Challenges in Developing Countries Technological Advances in Trauma Care Lack of Infrastructure for Trauma Management EMS 2
3 Source: Global Burden of Disease, WHO, 2004 Injury: Scale of the Global Problem 5.8 million deaths/year 10% of worlds deaths 32% more deaths than HIV, TB and Malaria combined 3
4 Injury: Scale of the Global Problem 4
5 Epidemiology Trimodal Distribution of Trauma Deaths 50% Golden Hour = 80% of trauma deaths in first hour after injury Rapid trauma care has greatest level of impact in these patients 30% 20% Immediately Hours Days/Weeks 5
6 History of Trauma System Development Standardized Trauma Assessment Nebraska Cornfield, 1976 Orthopedic Surgeon Lead to development of ATLS Trauma Systems Development First developed my military in wartime i.e. MASH Units Expanded in US to Level 1, 2, 3 Trauma Centers Urban Systems Statewide networks of systems Level 1 Highest level of care, Leaders in research, clinical care and education Level 2 Provides definitive care in wide range of complex traumatic patients Level 3 Provides initial stabilization and treatment. May care for uncomplicated trauma patients Level 4 Provides initial stabilization and transfers all trauma patients for definitive care 6
7 Mechanisms of Injury Blunt Trauma Compression Forces Cells in tissues are compressed and crushed E.g. Spleen Shear Forces Acceleration/Deceleration Injury E.g. Aorta Shearing force = Spectrum from Full thickness tear (Exsanguination) to Partial tear (Pseudoaneurysm) Overpressure Body cavity compressed at a rate faster than the tissue around it, resulting in rupture of the closed space E.g. Plastic bag E.g. in trauma = diaphragmatic rupture, bladder injury 7
8 Mechanisms of Injury Frontal Impact Collisions Lateral Impact Collisions (T bone) Rear Impact Collisions Rollover Mechanism Open Vehicle or Motorcycle/Moped Pedestrian Vs. Car Penetrating Injury (Guns vs. Knives) Nico.se (flickr) Vincent J Brown (flickr) Juicyrai (flickr) Knockhill (flickr) Nxtiak (flickr) 8
9 Basics of Trauma Assessment Preparation Team Assembly Equipment Check Triage Sort patients by level of acuity (SATS) Primary Survey Designed to identify injuries that are immediately life threatening and to treat them as they are identified Resuscitation Rapid procedures and treatment to treat injuries found in primary survey before completing the secondary survey Secondary Survey Full History and Physical Exam to evaluate for other traumatic injuries Monitoring and Evaluation, Secondary adjuncts Transfer to Definitive Care ICU, Ward, Operating Theatre, Another facility 9
10 Preparation for Patient Arrival Organize Trauma Response Team 10
11 Primary Survey Airway and Protection of Spinal Cord Breathing and Ventilation Circulation Disability Exposure and Control of the Environment 11
12 Key Principles Primary Survey When you find a problem during the primary survey, FIX IT. If the patient gets worse, restart from the beginning of the primary survey Some critical patients in the Emergency Department may not progress beyond the primary survey 12
13 Airway and Protection of Spinal Cord Why first in the algorithm? Loss of airway can result in death in < 3 minutes Prolonged hypoxia = Inadequate perfusion, End-organ damage Airway Assessment Vital Signs = RR, O2 sat Mental Status = Agitation, Somnolent, Coma Airway Patency = Secretions, Stridor, Obstruction Traumatic Injury above the clavicles Ventilation Status = Accessory muscle use, Retractions, Wheezing Clinical Pearls Patients who are speaking normally generally do not have a need for immediate airway management Hoarse or weak voice may indicate a subtle tracheal or laryngeal injury Noisy respirations frequently indicates an obstructed respiratory pattern 13
14 Airway Interventions Maintenance of Airway Patency Suction of Secretions Chin Lift/Jaw thrust Nasopharyngeal Airway Definitive Airway Airway Support Oxygen NRBM (100%) Bag Valve Mask Definitive Airway Definitive Airway Endotracheal Intubation In-line cervical stabilization Surgical Crichothyroidotomy 14
15 Protection of Spinal Cord General Principle: Protect the entire spinal cord until injury has been excluded by radiography or clinical physical exam in patients with potential spinal cord injury. Spinal Protection Rigid Cervical Spinal Collar = Cervical Spine Long rigid spinal board or immobilization on flat surface such as stretcher = T/L Spine Etiology of Spinal Cord Injury (U.S.) Road Traffic Accidents (47%) High energy falls (23%) Clinical Pearls Treatment (Immobilization) before diagnosis Return head to neutral position Do not apply traction Diagnosis of spinal cord injury should not precede resuscitation Motor vehicle crashes and falls are most commonly associated with spinal cord injuries Main focus = Prevention of further injury 15
16 C-spine Immobilization Return head to neutral position Maintain in-line stabilization Correct size collar application Blocks/tape Sandbags 16
17 Breathing and Ventilation General Principle: Adequate gas exchange is required to maximize patient oxygenation and carbon dioxide elimination Breathing/Ventilation Assessment: Exposure of chest General Inspection Tracheal Deviation Accessory Muscle Use Retractions Absence of spontaneous breathing Paradoxical chest wall movement Auscultation to assess for gas exchange Equal Bilaterally Diminished or Absent breath sounds Palpation Deviated Trachea Broken ribs Injuries to chest wall 17
18 Breathing and Ventilation Identify Life Threatening Injuries Tension Pneumothorax Air trapping in the pleural space between the lung and chest wall Sufficient pressure builds up and pressure to compress the lungs and shift the mediastinum Physical exam Absent breath sounds Air hunger Distended neck veins Tracheal shift Treatment Needle Decompression 2 nd Intercostal space, Midclavicular line Tube Thoracostomy 5 th Intercostal space, Anterior axillary line 18
19 / Breathing and Ventilation Hemothorax Blood collecting in the pleural space and is common after penetrating and blunt chest trauma Source of bleeding = Lung, Chest wall (intercostal arteries), heart, great vessels (Aorta), Diaphragm Physical Exam Absent or diminished breath sounds Dullness to percussion over chest Hemodynamic instability Treatment = Large Caliber Tube Thoracostomy 10-20% of cases will require Thoracostomy for control of bleeding 19
20 Breathing and Ventilation Flail Chest Direct injury to the chest resulting in an unstable segment of the chest wall that moves separately from remainder of thoracic cage Typically results from two or more fractures on 2 or more ribs Typically accompanied by a pulmonary contusion Physical exam = paradoxical movement of chest segment Treatment = improve abnormalities in gas exchange Early intubation for patients with respiratory distress Avoidance of overaggressive fluid resuscitation 20
21 Breathing and Ventilation Author unknown, 902/ Open Pneumothorax Sucking Chest Wound Large defect of chest wall Leads to rapid equilibration of atmospheric and intrathoracic pressure Impairs oxygenation and ventilation Initial Treatment Three sided occlusive dressing Provides a flutter valve effect Chest tube placement remote to site of wound Avoid complete dressing, will create a tension pneumothorax 21
22 Needle Thoracostomy Needle Thoracostomy Midclavicular line 14 gauge angiocath Over the 2 nd rib Rush of air is heard 22
23 Tube Thoracostomy Insertion site 5 th intercostal space, Anterior axillary line Sterile prep, anesthesia with lidocaine 2-3 cm incision along rib margin with #10 blade Dissect through subcutaneous tissues to rib margin Puncture the pleura over the rib Advance chest tube with clamp and direct posteriorly and apically Observe for fogging of chest tube, blood output Suture the tube in place Complications of Chest Tube Placement Injury to intercostal nerve, artery, vein Injury to lung Injury to mediastinum Infection Allergic reaction to lidocaine Inappropriate placement of chest tube 23
24 Circulation Shock Impaired tissue perfusion Tissue oxygenation is inadequate to meet metabolic demand Prolonged shock state leads to multi-organ system failure and cell death Clinical Signs of Shock Altered mental status Tachycardia (HR > 100) = Most common sign Arterial Hypotension (SBP < 120) Femoral Pulse SBP > 80 Radial Pulse SBP > 90 Carotid Pulse SBP > 60 Inadequate Tissue Perfusion Pale skin color Cool clammy skin Delayed cap refill (> 3 seconds) Altered LOC Decreased Urine Output (UOP < 0.5 ml/kg/hr) 24
25 Circulation Types of Shock in Trauma Hemorrhagic Assume hemorrhagic shock in all trauma patients until proven otherwise Results from Internal or External Bleeding Obstructive Cardiac Tamponade Tension Pneumothorax Neurogenic Spinal Cord injury Sources of Bleeding Chest Abdomen Pelvis Bilateral Femur Fractures 25
26 Circulation Emergency Nursing Treatment Two Large IV Lines Cardiac Monitor Blood Pressure Monitoring General Treatment Principles Stop the bleeding Apply direct pressure Temporarily close scalp lacerations Close open-book pelvic fractures Abdominal pelvic binder/bed sheet Restore circulating volume Crystalloid Resuscitation (2L) Administer Blood Products Immobilize fractures Responders vs. Nonresponders Transient response to volume resuscitation = sign of ongoing blood loss Non-responders = consider other source for shock state or operating room for control of massive hemorrhage 26
27 Circulation Pericardium Blood Epicardium Pericardial Tamponade Pericardium or sac around heart fills with blood due to penetrating or blunt injury to chest Beck s Triad Distended jugular veins Hypotension Muffled heart sounds Treatment Rapid evacuation of pericardial space Performed through a pericardiocentesis (temporizing measure) Open thoracotomy 27
28 Disability Baseline Neurologic Exam Pupillary Exam Dilated pupil suggests transtentorial herniation on ipsilateral side AVPU Scale Alert Responds to verbal stimulation Responds to pain Unresponsive Gross Neurological Exam Extremity Movement Equal and symmetric Normal gross sensation Glasgow Coma Scale: 3-15 Rectal Exam Normal Rectal Tone Note: If intubation prior to neuro assessment, consider quick neuro assessment to determine degree of injury 28
29 Glasgow Coma Scale Eye Disability Spontaneously opens 4 To verbal command 3 To pain 2 No response 1 Best Motor Response Obeys verbal commands 6 Localizes to pain 5 Withdraws from pain 4 Flexion to pain (Decorticate Posturing) 3 Extension to pain (Decerebrate Posturing) 2 No response 1 Verbal Response Oriented/Conversant 5 Disoriented/Confused 4 Inappropriate words 3 Incomprehensible words 2 No response 1 GCS 8 Intubate 29
30 Disability Key Principles Precise diagnosis is not necessary at this point in evaluation Prevention of further injury and identification of neurologic injury is the goal Decreased level of consciousness = Head injury until proven otherwise Maintenance of adequate cerebral perfusion is key to prevention of further brain injury Adequate oxygenation Avoid hypotension Involve neurosurgeon early for clear intracranial lesions 30
31 Exposure Remove all clothing Examine for other signs of injury Injuries cannot be diagnosed until seen by provider Logroll the patient to examine patient s back Maintain cervical spinal immobilization Palpate along thoracic and lumbar spine Minimum of 3 people, often more providers required Avoid hypothermia Apply warm blankets after removing clothes Hypothermia = Coagulopathy Increases risk of hemorrhage 31
32 Exposure 32
33 Exposure 33
34 Trauma Logroll One person = Cervical spine Two people = Roll main body One person = Inspect back and palpate spine 34
35 Secondary Survey Secondary Survey is completed after primary survey is completed and patient has been adequately resuscitated. No patient with abnormal vital signs should proceed through a secondary survey Secondary Survey includes a brief history and complete physical exam 35
36 SAMPLE History Signs and symptoms Allergies Medications History Past Medical History, Pregnancy Last Meal Events surrounding injury, Environment History may need to be gathered from family members or ambulance service 36
37 Head Neck Chest Abdomen Pelvis Genitourinary Extremities Neurologic Physical Exam 37
38 Difficult airway Physical Exam 38
39 Seatbelt sign Physical Exam 39
40 Physical Exam Battle Sign Raccoon's Eyes Cullen s Sign Grey-Turner s Sign 40
41 Trauma in Special Populations Pregnancy Supine Hypotensive Syndrome After 20 weeks, enlarged uterus with fetus and amniotic fluid compresses inferior vena cava Decreases venous return and decrease cardiac output Keep pregnant patients in left lateral decubitus position to avoid excessive hypotension Optimal maternal and fetal outcome is determined by adequate resuscitation of mother Fetal Monitoring 41
42 Trauma in Special Populations Pediatric Trauma Resuscitation Differences in head to body ratio and relative size and location of anatomic features make children more susceptible to head injury, abdominal injury Underdeveloped anatomy leads to chest pliability and less protection of thoracic cage Cardiac Arrest Typically result from respiratory arrest degrading into cardiac arrest 42
43 Conclusion Assessment of the trauma patient is a standard algorithm designed to ensure life threatening injuries do not get missed Primary Survey + Resuscitation Airway Breathing Circulation Disability Exposure Secondary Survey Definitive Care 43
44 Questions? 44
European Resuscitation Council
European Resuscitation Council Incidence of Trauma in Childhood Leading cause of death and disability in children older than one year all over the world Structured approach Primary survey and resuscitation
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to
Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl Seger, 2009-2010. License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution
ITLS Pediatric Provider Course Basic Pre-Test
ITLS Pediatric Provider Course Basic Pre-Test 1. You arrive at the scene of a motor vehicle collision and are directed to evaluate a child who was in one of the vehicles. The patient appears to be a child
3. D Objective: Chapter 4, Objective 4 Page: 79 Rationale: A carbon dioxide level below 35 mmhg indicates hyperventilation.
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials
Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials 1 1. A high-risk bodily fluid for spreading infection is blood. 2. Items that can reduce the spread of infection include masks, gloves, and
ITLS Pediatric Provider Course Advanced Pre-Test
ITLS Pediatric Provider Course Advanced Pre-Test 1. You arrive at the scene of a motor vehicle crash and are directed to evaluate a child who was in one of the vehicles. The patient appears to be a child
ITLS Advanced Pre-Test Annotated Key 8 th Edition
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
Medical NREMT-PTE. NREMT Paramedic Trauma Exam.
Medical NREMT-PTE NREMT Paramedic Trauma Exam https://killexams.com/pass4sure/exam-detail/nremt-pte Question: 41 Which of the following most accurately describes the finding of jugular venous distension
CHEST TRAUMA. Dr Naeem Zia FCPS,FACS,FRCS
CHEST TRAUMA Dr Naeem Zia FCPS,FACS,FRCS Learning objectives Anatomy of chest wall and thoracic viscera Physiology of respiration and nerve pathways for pain Enumerate different thoracic conditions requiring
INTERNATIONAL TRAUMA LIFE SUPPORT
INTERNATIONAL TRAUMA LIFE SUPPORT NC ITLS Rev. 2/18 STUDENT GUIDE TO INTERNATIONAL TRAUMA LIFE SUPPORT What to wear ITLS is a practical course that stresses hands-on teaching. You should wear comfortable
Emergency Room Resuscitation of the Unstable Trauma Patient
Emergency Room Resuscitation of the Unstable Trauma Patient Goals of trauma resuscitation Maintain: Systemic oxygenation Systemic perfusion Neurologic function Approach to unstable trauma patient Primary
1. In a rear-impact motor vehicle crash, which area of the spine is most susceptible to injury? A. Cervical B. Thoracic C. Lumbar D.
1. In a rear-impact motor vehicle crash, which area of the spine is most susceptible to injury? A. Cervical B. Thoracic C. Lumbar D. Sacral-coccygeal 2. A 36-year-old male sustains blunt force thoracic
The Primary Survey. C. Clay Cothren, MD FACS. Attending Surgeon, Denver Health Medical Center Assistant Professor of Surgery, University of Colorado
The Primary Survey C. Clay Cothren, MD FACS Attending Surgeon, Denver Health Medical Center Assistant Professor of Surgery, University of Colorado Outlining the ABCs Why do we need such an approach? The
APPROACH TO TRAUMA. Dr E.Memary Anesthesiologist Assistant Professor of SBMU
APPROACH TO TRAUMA Dr E.Memary Anesthesiologist Assistant Professor of SBMU Objectives Describe the initial approach to the injured patient, including the primary and secondary surveys. Identify the types
Chapter 29 - Chest Injuries
1 2 3 4 5 6 7 8 9 National EMS Education Standard Competencies (1 of 5) Trauma Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely
Aurora Health Care EMS Continuing Education Spring 2011 Packet THORACIC TRAUMA THE PREHOSPITAL APPROACH TO CHEST INJURY MANAGEMENT
Aurora Health Care EMS Continuing Education Spring 2011 Packet THORACIC TRAUMA Chest injuries are significant contributors to death from major trauma and can be difficult to assess adequately in the pre-hospital
Chest Trauma.
Chest Trauma www.fisiokinesiterapia.biz Objectives Anatomy of Thorax Main Causes of Chest Injuries S/S of Chest Injuries Different Types of Chest Injuries Treatments of Chest Injuries Anatomy of the chest
PEMSS PROTOCOLS INVASIVE PROCEDURES
PEMSS PROTOCOLS INVASIVE PROCEDURES Panhandle Emergency Medical Services System SURGICAL AND NEEDLE CRICOTHYROTOMY Inability to intubate is the primary indication for creating an artificial airway. Care
Chapter 34. Objectives. Objectives 01/09/2013. Chest Trauma
Chapter 34 Chest Trauma Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced
PRE-HOSPITAL EMERGENCY CARE COURSE.
PRE-HOSPITAL EMERGENCY CARE COURSE www.basics.org.uk Chest Assessment & Management BASICS Education March 2016 Objectives To understand the importance of oxygenation and ventilation To be able to describe
(SKILLS/HANDS-ON) Chest Tubes. Rebecca Carman, MSN, ACNP-BC. Amanda Shumway, PA-C. Thomas W. White, MD, FACS, CNSC
(SKILLS/HANDS-ON) Chest Tubes Rebecca Carman, MSN, ACNP-BC Nurse Practitioner, Trauma Services, Intermountain Medical Center, Intermountain Healthcare Amanda Shumway, PA-C APC Trauma and Critical Care
1. Which of the following organs is contained in the retroperitoneal region of the abdomen? A. Stomach B. Liver C. Kidney D.
1. Which of the following organs is contained in the retroperitoneal region of the abdomen? A. Stomach B. Liver C. Kidney D. Uterus 2. What is Sellick's maneuver? A. A method allowing the rescuer to hold
The Primary Survey. Clay Cothren Burlew, MD FACS
The Primary Survey Clay Cothren Burlew, MD FACS Director, Surgical Intensive Care Unit Attending Surgeon, Denver Health Medical Center Associate Professor of Surgery, University of Colorado Outlining the
Basic Assessment and Treatment of Trauma
Basic Assessment and Treatment of Trauma Final Exam Version 1 1. In which of the following scenarios would the potential for serious injury or death be the GREATEST? A. 77-kg (170-lb) man who falls 1.2
The ABC s of Chest Trauma
The ABC s of Chest Trauma J Bradley Pickhardt MD, FACS Providence St Patrick Hospital What s the Problem? 2/3 of trauma patients have chest trauma Responsible for 25% of all trauma deaths Most injuries
Pediatric Advanced Life Support
Pediatric Advanced Life Support Pediatric Chain of Survival Berg M D et al. Circulation 2010;122:S862-S875 Prevention Early cardiopulmonary resuscitation (CPR) Prompt access to the emergency response system
Anesthesia for multiple trauma: from the scene to the OR
Anesthesia for multiple trauma: from the scene to the OR Gary Hartstein,, M.D. Service d'anesthésie-réanimationsie-réanimation Service des Urgences CHU Liège B.35 4000 Liège Course outline philosophy of
9/10/2012. Chapter 49. Learning Objectives. Learning Objectives (Cont d) Thoracic Trauma
Chapter 49 Thoracic Trauma 1 Learning Objectives Explain relevance of thoracic injuries as part of the overall mortality rate from major trauma List thoracic injuries that may result in early death if
In ESH we usually see blunt chest trauma but penetrating injuries also treated here (usually as single injuries, like stab wound)
Chest Trauma Dr Csaba Dioszeghy MD PhD FRCEM FFICM FERC East Surrey Hospital Emergency Department Scope Thoracic injuries are common and can be life threatening In ESH we usually see blunt chest trauma
Shot Through the Heart (And You re to Blame): Penetrating Cardiac Trauma
Shot Through the Heart (And You re to Blame): Penetrating Cardiac Trauma Yalaunda M. Thomas, MD, FACS The American College of Osteopathic Emergency Physicians Spring Seminar April 5, 2018 Disclosures I
TRAUMA PATIENT ASSESSMENT
SECTION: Adult Trauma Emergencies PROTOCOL TITLE: Injury General Trauma Management REVISED: 06/2015 OVERVIEW Each year, one out of three Americans sustains a traumatic injury. Trauma is a major cause of
Patient Assessment. Chapter 8
Patient Assessment Chapter 8 Patient Assessment Scene size-up Initial assessment Focused history and physical exam Vital signs History Detailed physical exam Ongoing assessment Patient Assessment Process
Chapter 29 - Chest_and_Abdominal_Trauma
Introduction to Emergency Medical Care 1 OBJECTIVES 29.1 Define key terms introduced in this chapter. Slides 11, 15, 18, 27 29.2 Describe mechanisms of injury commonly associated with chest injuries. Slides
Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of
Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of Washington Seattle Children s Hospital Objectives Define
Pediatric Trauma Practice. Guideline for Management of the Child in Shock. Background
Pediatric Trauma Practice Guideline for Management of the Child in Shock Background Guideline for Management Trauma is the leading cause of death in children and adolescents in the United States. Although
Introduction to Advanced Trauma Life Support ATLS
Introduction to Advanced Trauma Life Support ATLS Objectives Concepts of primary & secondary survey Priorities & Life threatening conditions Clinical & Surgical skills Basic knowledge Rapid assessment
55-year-old male with 2nd and 3rd degree burns to face, chest, and arms on 25% of the body Respirations: 34 Pulse: 120 Mental Status: moans to painful stimulus Mucous membranes charred Stridor 10 cm scalp
Restore adequate respiratory and circulatory conditions. Reduce pain
Pre-hospital management of the trauma patient is best performed by an integrated team focused on minimizing the time from injury to definitive care at an appropriate trauma center. Dispatchers, first responders,
VAO BASIC SUPPORT CLINICAL APPROACH TO THE PATIENT HANDOUT
CLINICAL APPROACH TO THE PATIENT HANDOUT 1 I am the most important part of patient care. How can you expect to treat a patient appropriately if you don t follow through on basic primary care? Remember:
Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: ASSESSMENT Revised: 11/2013
Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: ASSESSMENT Revised: 11/2013 DEFINITIONS General Impression - EMT develops a plan of action from the
68W COMBAT MEDIC POCKET GUIDE
GTA 08-05-058 68W COMBAT MEDIC POCKET GUIDE PART I: TRAUMA TREATMENT This publication contains technical information that is for official Government use only. Distribution is limited to U.S. Government
Chapter 13. Objectives. Objectives 01/09/2013. Patient Assessment
Chapter 13 Patient Assessment Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it.
Author(s): Tim Maxim, BA, RN, 2011 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
ATLS: Initial Assessment and Management. SAUSHEC Medical Student Lecture Series
ATLS: Initial Assessment and Management SAUSHEC Medical Student Lecture Series Objectives Identify sequence of priorities in assessing the multiply injured patient Apply principles outlined in primary
History Data Panel. Case 030 Preg Trauma. Presenting Complaint Altered mental status s/p MVC. Person Giving Information EMS
History Data Panel Presenting Complaint Altered mental status s/p MVC Person Giving Information EMS History of Present Illness 28 year old woman, 35 weeks pregnant per report of her husband the passenger.
Focused History and Physical Examination of the
Henry: EMT Prehospital Care, Revised 3 rd Edition Lecture Notes Chapter 10: Focused History and Physical Examination of Trauma Patients Chapter 10 Focused History and Physical Examination of the Trauma
CHEST INJURIES. Jacek Piątkowski M.D., Ph. D.
CHEST INJURIES Jacek Piątkowski M.D., Ph. D. CHEST INJURIES 3-4% of all injuries 8% of patients hospitalized due to injuries 65% of patients who died at the accident place CLASSIFICATION OF THE CHEST INJURIES
RCH Trauma Guideline. Management of Traumatic Pneumothorax & Haemothorax. Trauma Service, Division of Surgery
RCH Trauma Guideline Management of Traumatic Pneumothorax & Haemothorax Trauma Service, Division of Surgery Aim To describe safe and competent management of traumatic pneumothorax and haemothorax at RCH.
PEDIATRIC TRAUMA EMERGENCIES
PEDIATRIC TRAUMA EMERGENCIES Last Revised: January 2015 1 PEDIATRIC COMA SCALE Indicator Eye Opening Spontaneous 4 To verbal stimuli 3 To pain only 2 No response 1 Verbal Response Oriented, appropriate
The Management of Chest Trauma. Tom Scaletta, MD FAAEM Immediate Past President, AAEM
The Management of Chest Trauma Tom Scaletta, MD FAAEM Immediate Past President, AAEM Trichotomizing Rib Fractures Upper 1-3 vascular injuries Middle 4-9 Lower 10-12 12 liver/spleen injuries Management
PEDIATRIC INITIAL ASSESSMENT - ALS
PEDIATRIC INITIAL ASSESSMENT - ALS I. SCENE SIZE-UP A. Protect from body substance through isolation (glasses, gloves, gown and mask). B. Assess the scene for safety and take appropriate steps. C. Determine
McHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2019 #3 Penetrating Neck Trauma
McHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2019 #3 Penetrating Neck Trauma Penetrating neck injury (PNI) comprises 5 to 10 percent of traumatic injuries
You Are the Emergency Medical Responder
Lesson 32: Injuries to the Chest, Abdomen and Genitalia You Are the Emergency Medical Responder Your police unit responds to a call in a part of town plagued by violence. When you arrive, you find the
HeartCode PALS. PALS Actions Overview > Legend. Contents
HeartCode PALS PALS Actions Overview > Legend Action buttons (round buttons) Clicking a round button initiates an action. Clicking this button, for example, checks the child s carotid pulse. Menu buttons
Student Guide Module 4: Pediatric Trauma
Student Guide Module 4: Pediatric Trauma Problem based learning exercise objectives Understand how to manage traumatic injuries in mass casualty events. Discuss the features and the approach to pediatric
Pediatric Shock. Hypovolemia. Sepsis. Most common cause of pediatric shock Small blood volumes (80cc/kg)
Critical Concepts: Shock Inadequate peripheral perfusion where oxygen delivery does not meet metabolic demand Adult vs Pediatric Shock - Same causes/different frequencies Pediatric Shock Hypovolemia Most
Lecture 2: Clinical anatomy of thoracic cage and cavity II
Lecture 2: Clinical anatomy of thoracic cage and cavity II Dr. Rehan Asad At the end of this session, the student should be able to: Identify and discuss clinical anatomy of mediastinum such as its deflection,
TRAUMA LIFE SUPPORT PRE-HOSPITAL EXAMINATION (TLS P) 1. A high-risk bodily fluid for spreading infection is. a. sweat b. saliva c. blood d. urine 2. Items that can be used to reduce the spread of infection
Competency Log Professional Responder Courses
Competency Log Professional Responder Courses Check off each competency once successfully demonstrated. This log may be used as a support tool when teaching a Professional Responder course. Refer to the
Trauma. Neck trauma zones. Neck Injuries 1/3/2018. Basic principles A ; Airway B ; Breathing C ; Circulation D ; Disability E ; Exposure
Trauma 45 minutes highest points Ahmed Mahmoud, MD Basic principles A ; Airway B ; Breathing C ; Circulation D ; Disability E ; Exposure Neck trauma zones Airway ;Rapid sequence intubation Breathing ;Needle
Pre-hospital Trauma Life Support. Rattiya Banjungam Emergency Physician, Khon Kaen Hospital
Pre-hospital Trauma Life Support Rattiya Banjungam Emergency Physician, Khon Kaen Hospital Golden principles of Prehospital Trauma Care Golden Hour There is a golden hour if you are critically injured,
Pre-hospital Response to Trauma and Brain Injury. Hans Notenboom, M.D. Asst. Medical Director Sacred Heart Medical Center
Pre-hospital Response to Trauma and Brain Injury Hans Notenboom, M.D. Asst. Medical Director Sacred Heart Medical Center Traumatic Brain Injury is Common 235,000 Americans hospitalized for non-fatal TBI
PEDIATRIC TRAUMA: Implications for Respiratory Care
PEDIATRIC TRAUMA: Implications for Respiratory Care 17 th Annual Rainbow Respiratory Conference - September 4, 2015 Mike Dingeldein, MD Pediatric Surgeon Pediatric Trauma Medical Director Disclosures none
Children are not small adults Children are Not Small Adults Anatomic considerations Pliable bony & cartilagenous structures - Significant thoracic inj
PEDIATRIC CHEST TRAUMA Children are not small adults Role of imaging Spectrum of injury Children are not small adults Children are Not Small Adults Anatomic considerations Pliable bony & cartilagenous
Activity Three: Where s the Bleeding?
Activity Three: Where s the Bleeding? There are five main sites of potentially fatal bleeding in trauma, remembered by the phrase on the floor and four more. On the floor refers to losing blood externally
Abdomen and Genitalia Injuries. Chapter 28
Abdomen and Genitalia Injuries Chapter 28 Hollow Organs in the Abdominal Cavity Signs of Peritonitis Abdominal pain Tenderness Muscle spasm Diminished bowel sounds Nausea/vomiting Distention Solid Organs
Chapter 8 Trauma Patient Assessment The Patient Assessment Process The Primary Assessment ABCDE s Airway, Breathing, Circulation while securing
1 2 3 4 5 6 Chapter 8 Trauma Patient Assessment The Patient Assessment Process The Primary Assessment ABCDE s Airway, Breathing, Circulation while securing D-Disability Chief complaint and/or Mechanism
Advanced Assessment and Treatment of Trauma
Advanced Assessment and Treatment of Trauma Final Exam Version 1 1. In which of the following scenarios would the potential for serious injury or death be the GREATEST? A. 77-kg (170-lb) man who falls
Professional Development & Training MM3. Firefighter Prehospital Care Program. Maintenance Module 3 Course Mill Version
Professional Development & Training MM3 Firefighter Prehospital Care Program F T Maintenance Module 3 Course Mill Version S Objectives Upon successful completion of the Firefighter Prehospital Care Maintenance
11. Spinal cord injury
11. Spinal cord injury Introduction Always think spinal (vertebral) and/or spinal cord injury (SCI) in children with trauma. Remember SCIWORA cord injury may be present without abnormalities on routine
Shenandoah Co. Fire & Rescue. Injuries to. and Spine. December EMS Training Bill Streett Training Section Chief
Shenandoah Co. Fire & Rescue Injuries to the Head and Spine December EMS Training Bill Streett Training Section Chief C.E. Card Information BLS Providers 2 Cards / Provider Category 1 Course # Blank Topic#
Evaluation & Management of Penetrating Wounds to the NECK
Evaluation & Management of Penetrating Wounds to the NECK Goal Effectively identify patients with a high probability of injury requiring surgical intervention Define the role of diagnostic tests in assessing
INJURIES CHEST, ABDOMEN, LIMBS. FN Brno November 2011
INJURIES CHEST, ABDOMEN, LIMBS FN Brno November 2011 Injury Chest Abdomen Limbs Injury to the rib cage Fractured one or more ribs Sharp pain at the site of fracture Pain on taking a deep breath Shallow
Hypotension / Shock. Adult Medical Section Protocols. Protocol 30
Hypotension / Shock History Blood loss - vaginal or gastrointestinal bleeding, AAA, ectopic Fluid loss - vomiting, diarrhea, fever nfection Cardiac ischemia (M, CHF) Medications Allergic reaction regnancy
Emergency Care Progress Log
Emergency Care Progress Log For further details on the National Occupational Competencies for EMRs, please visit www.paramedic.ca. Check off each skill once successfully demonstrated the Instructor. All
Post-Anesthesia Care In the ICU
Post-Anesthesia Care In the ICU The following is based on current research and regional standards of care. At completion you will be able to identify Basic equipment needed at the bedside. Aldrete scoring
FIRST AID WRITTEN EXAM. Team Name: 1. Participation in a critical incident stress debriefing (CISD) is mandatory. a. TRUE b. FALSE
2015 NEW IBERIA MINE RESCUE CONTEST FIRST AID WRITTEN EXAM Name: Date: 1. Participation in a critical incident stress debriefing (CISD) is mandatory. 2. The use of accessory muscles in the chest, abdomen
Trauma Overview. Chapter 22
Trauma Overview Chapter 22 Kinematics of Trauma Injuries are the leading cause of death among children and young adults. Kinematics introduces the basic physical concepts that dictate how injuries occur
PRE-HOSPITAL PATIENT CARE PROTOCOLS BASIC LIFE SUPPORT/ADVANCED LIFE SUPPORT
PRE-HOSPITAL PATIENT CARE PROTOCOLS BASIC LIFE SUPPORT/ADVANCED LIFE SUPPORT Board Approved June 2007 Revised December 2009 Revised July 2011 Revised June 2015 435 Hunter Street Fredericksburg, VA 22401
Northwest Community EMS System September 2017: Head and Chest Trauma Credit Questions
NWC EMSS Sept 2017 CE: Head & Chest Trauma. Credit Questions - page 1 Northwest Community EMS System September 2017: Head and Chest Trauma Credit Questions Name: EMS Agency EMSC/Educator reviewer: Date
CARDIAC ARREST IN SPECIAL CIRCUMSTANCES 2
CARDIAC ARREST IN SPECIAL CIRCUMSTANCES 2 M1 Objectives To understand how resuscitation techniques should be modified in the special circumstances of: Hypothermia Immersion and submersion Poisoning Pregnancy
Trauma is a Disease Lets Get it Right A Good Trauma Examination Gives Your Patient Increased Odds for a Good Outcome
A Good Trauma Examination Gives Your Patient Increased Odds for a Good Outcome druffol@lumc.edu 708.216.4541 Lets Get it Right Trauma is a Disease Importance of Trauma Care and the trauma provider role
10/6/2017. Notice. Traumatic Brain Injury & Head Trauma
Notice All EMS Live@Nite presentations will be recorded (both audio and video) and available for public viewing online. By participating in EMS Live@Nite, you consent to audio and video recording and its/their
Pediatric Trauma. July 27 th, Suzana Buac, PGY4. Dr. Neil Merritt
Pediatric Trauma July 27 th, 2016. Suzana Buac, PGY4 Dr. Neil Merritt Case 5yoM fall from roof Fall from roof of home while father was shingling 5yoM fall from roof Fall from roof of home while father
I look forward to seeing you in the coming month. If you have any questions or comments please feel free to contact me thru or by phone.
Board of County Commissioners Pete Gerken President Tina Skeldon Wozniak Carol Contrada Emergency Medical Services Dennis Cole Director TO: FROM: ALL LUCAS COUNTY PARAMEDICS Brent Parquette, NREMT-P Lucas
Purpose This Operating Procedure provides guidance on the management of blunt thoracic traumatic injury
Blunt Thoracic Trauma HELI.CLI.09 Purpose This Operating Procedure provides guidance on the management of blunt thoracic traumatic injury Procedure Management of Blunt Thoracic Traumatic Injury For Review
Pneumothorax. Defined as air in the pleural space which can occur through a number of mechanisms
Pneumothorax Defined as air in the pleural space which can occur through a number of mechanisms Traumatic pneumothorax Penetrating chest trauma Common secondary to bullet or knife penetration Chest tube
oriented evaluation of your patient and establishing priorities of care based on existing and
1 Chapter 12: Patient Assessment in the Field 2 Patient assessment means conducting a - oriented evaluation of your patient and establishing priorities of care based on existing and potential threats to
TNP Teaching Station E Focus: Intubated Patient, Interpersonal Violence
TNP Teaching Station E Focus: Intubated Patient, Interpersonal Violence Objective Upon completion of this teaching station the learner will be able to: 1. demonstrate appropriate assessment for a hemodynamically
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH OFFICE OF EMERGENCY MEDICAL SERVICES Basic EMT Practical Examination Cardiac Arrest Management
Basic EMT Practical Examination 6.0 - Cardiac Arrest Management Station 1 RESUSCITATION & DEFIBRILLATION No Point WHILE FUNCTIONING AS FIRST RESCUER: Point 1. Verbalizes or takes body substance isolation
Introduction to Emergency Medical Care 1
Introduction to Emergency Medical Care 1 OBJECTIVES 31.1 Define key terms introduced in this chapter. Slides 13 15, 17, 19, 28 31.2 Describe the components and function of the nervous system and the anatomy
ED Thoracotomy Left chest opened and extended across sternum with 1000mL blood drained Pericardium opened with 100mL blood drained 1cm laceration in t
Case Report 39yM stabbed in the left upper chest by wife with kitchen knife. Intubated in the field. Loss of vitals on arrival to hospital while in ambulance. In ED, (-) palpable pulse and (+) organized
Adult Intubation Skill Sheet
Adult Intubation 2. Opens the airway manually and inserts an oral airway *** 3. Ventilates the patient with BVM attached to oxygen at 15 lpm *** 4. Directs assistant to oxygenate the patient 5. Selects
CRITICAL CARE FOUNDATION POLYTRAUMA
CRITICAL CARE FOUNDATION Rungta Hospital, Malviya Nagar, Jaipur (Supported by Indian Society of Critical Care Medicine, Jaipur Chapter) MODULE 2 POLYTRAUMA Note : All rights reserved. No part of this module
APPROACH TO TRAUMA CARE
APPROACH TO TRAUMA CARE Timothy Murray, RN, CFRN Jan 2017 OBJECTIVES Demonstrate Concepts of Primary and Secondary Patient Assessment Establish Management Priorities in Trauma Situations Initiating Interventions
Chapter 28. Objectives. Objectives 01/09/2013. Bleeding and Soft-Tissue Trauma
Chapter 28 Bleeding and Soft-Tissue Trauma Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define
OUTLINE SHEET 5.4 PRIMARY SURVEY
ENABLING OBJECTIVES: 4.7 List the procedures used in a primary survey. 4.8 Demonstrate primary survey procedures used in a mock trauma (moulage) scenario without injury to personnel or damage to equipment.
Assessment and Scoring Tools
Assessment and Scoring Tools 2013 APGAR Scale 0 points 1 point 2 points Heart Rate Absent 100 Respiratory Rate Absent Slow, irregular Good, drying Irritability Flaccid Some flexion Active motion
Chapter 26 Head and Spine Trauma The Nervous System The nervous system controls virtually all of our body activities including reflex, voluntary and
1 2 3 4 5 Chapter 26 Head and Spine Trauma The Nervous System The nervous system controls virtually all of our body activities including reflex, voluntary and involuntary activities Voluntary activities
Pediatric Trauma. Sept 2nd, Patrick Murphy Neil Merritt
Pediatric Trauma Sept 2nd, 2015 Patrick Murphy Neil Merritt Objectives Objectives Medical Expert 1. Describe the types of pediatric injuries sustained with a given mode of trauma, and identify the most