Transcript
BASIC TRAUMA LIFE SUPPORTBASIC TRAUMA LIFE SUPPORT
Initial Initial Assessment and Assessment and Management of Management of
TraumaTrauma
Purwoko Sugeng Purwoko Sugeng HH
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IntroductionIntroduction• Golden HourGolden Hour
– Time to reach operating roomTime to reach operating room(or other definitive treatment)(or other definitive treatment)
– NOTNOT time for transport to ED time for transport to ED– NOTNOT time in Emergency Department time in Emergency Department
• EMS does EMS does NOTNOT have a Golden have a Golden HourHour
• EMS has a EMS has a Platinum Ten Platinum Ten MinutesMinutes
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IntroductionIntroduction• Patients in their Golden Hour must:Patients in their Golden Hour must:
– Be recognized quicklyBe recognized quickly– Have Have onlyonly immediate life threats managed immediate life threats managed– Be transported to an Be transported to an APPROPRIATEAPPROPRIATE facility facility
• Survival depends on assessment skillsSurvival depends on assessment skills• Good assessment results fromGood assessment results from
– An organized approachAn organized approach– Clearly defined prioritiesClearly defined priorities– Understanding available resourcesUnderstanding available resources
Trauma AssessmentTrauma Assessment
Load and Go Load and Go Situation ?Situation ?
Load and Go Load and Go Situation ?Situation ? HOSPHOSP
Scene Size-UpScene Size-Up• SafetySafety• Body Surface Isolation (BSI)Body Surface Isolation (BSI)• Number of PatientsNumber of Patients• Additional ResourcesAdditional Resources• Mechanism of Injury(MOI)Mechanism of Injury(MOI)
SafetySafety• TrafficTraffic• SmokeSmoke• ElectricityElectricity• Haz-MatHaz-Mat• Hostile Hostile
PersonsPersons• WeaponsWeapons• DrugsDrugs• SilenceSilence
BODY SURFACE ISOLATIONBODY SURFACE ISOLATION
• GlovesGloves for minimal fluids
• Goggles Goggles for eye protection if there’s any chance of splatter
• Mask and Gown Mask and Gown for gross contamination
Number of PatientsNumber of Patients
Call for additional resources ASAP
Additional resourcesAdditional resources
• ExtricationExtrication• Traffic controlTraffic control• UtilitiesUtilities
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Significant Mechanism Significant Mechanism of Injuryof Injury
Ejection from vehicle
Death in same passenger compartment
Fall of greater than 15 feet or 3 times the patient’s height
Rollover of vehicle
High-speed vehicle collision
Vehicle-pedestrian collision
Motorcycle crash
Unresponsive or altered mental status
Penetrating injury of head, chest, or abdomen
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Bent Steering WheelBent Steering Wheel Broken MirrorBroken Mirror
Distorted PedalsDistorted PedalsDeformed Deformed DashboardDashboard
Spider-Webbed Spider-Webbed WindshieldWindshield
Initial AssessmentInitial Assessment• General ImpressionGeneral Impression• Mental StatusMental Status• AirwayAirway• BreathingBreathing• CirculationCirculation
General ImpressionGeneral Impression
• Age, Weight, GenderAge, Weight, Gender• Position (relative to posture Position (relative to posture
and surroundings)and surroundings)• ActivityActivity• Obvious Injuries/BleedingObvious Injuries/Bleeding
Assess Mental StatusAssess Mental Status
• Take C-Spine controlTake C-Spine control• A – Alert and immediately A – Alert and immediately
responsiveresponsive• V – Responsive to verbal V – Responsive to verbal
stimulistimuli• P – Responsive to painful P – Responsive to painful
stimulistimuli• U – UnresponsiveU – Unresponsive
Assess AirwayAssess Airway• Open if necessary using jaw-thrust Open if necessary using jaw-thrust
maneuvermaneuver• Consider oro- or naso-pharyngeal Consider oro- or naso-pharyngeal
airwayairway• Note unusual sounds and correct Note unusual sounds and correct
causecause– Snoring – oro-/naso-pharyngeal airwaySnoring – oro-/naso-pharyngeal airway– Gurgling – suctionGurgling – suction– Stridor – consider intubationStridor – consider intubation– Silence Silence
Correcting silenceCorrecting silence
• Attempt ventilationAttempt ventilation• RepositionReposition• HeimlichHeimlich• Visualize and removeVisualize and remove• IntubateIntubate• Trans-laryngeal jet insuflationTrans-laryngeal jet insuflation
Assess BreathingAssess Breathing
• Look, Listen, FeelLook, Listen, Feel• Rate, Rhythm, Depth (tidal volume)Rate, Rhythm, Depth (tidal volume)• Use of accessory Use of accessory
muscles/retractionsmuscles/retractions• TreatTreat
– Absent – ventilate x2, check pulseAbsent – ventilate x2, check pulse– < 12/min – assist ventilation< 12/min – assist ventilation– Decreased tidal volume – assist ventilationDecreased tidal volume – assist ventilation– Labored – oxygen 10 liters NRBLabored – oxygen 10 liters NRB– Normal or rapid – consider oxygenNormal or rapid – consider oxygen
Assess Circulation - Assess Circulation - Pulses Pulses
• Compare radial Compare radial and corotidand corotid
• RateRate– NormalNormal– FastFast– SlowSlow
• RhythmRhythm– RegularRegular– IrregularIrregular
• QualityQuality– WeakWeak– ThreadyThready– BoundingBounding
Assess Circulation - Assess Circulation - SkinSkin
• ColorColor• TemperatureTemperature• MoistureMoisture
Assess Circulation - Assess Circulation - BleedingBleeding
• Direct pressureDirect pressure• Pressure dressingPressure dressing
Determine priorityDetermine priority
– Poor general impressionPoor general impression– Mental status changesMental status changes– Difficulty breathingDifficulty breathing– ShockShock– Chest painChest pain– Severe bleedingSevere bleeding– Severe painSevere pain
Load and Go Load and Go Situation ?Situation ?
Rapid Trauma SurveyRapid Trauma Survey• Head to toeHead to toe• Rapid sweep to identify major Rapid sweep to identify major
injuries which could prove life injuries which could prove life threateningthreatening
• DCAP-BTLSDCAP-BTLS
Inspect and Palpate forInspect and Palpate forDCAP-BTLSDCAP-BTLS
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DCAP
DeformitiesContusionsAbrasionsPunctures/
Penetrations
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BTLS
BurnsTendernessLacerationsSwelling
Rapid Trauma SurveyRapid Trauma Survey
DeformitiesDeformities ContusionsContusions
AbrasionsAbrasions Punctures/PenetrationsPunctures/Penetrations
BurnsBurns TendernessTenderness
LacerationsLacerations SwellingSwelling
Rapid Trauma SurveyRapid Trauma Survey
HeadNeckChestAbdomenPelvisExtremitiesPosterior
Head: DCAP-BTLS + CrepitationHead: DCAP-BTLS + Crepitation
Neck: DCAP-BTLS + Jugular Vein Distention and Neck: DCAP-BTLS + Jugular Vein Distention and CrepitationCrepitation
Chest: DCAP-BTLS + Crepitation and Chest: DCAP-BTLS + Crepitation and Breath Sounds (Presence and Equality)Breath Sounds (Presence and Equality)
Mid-clavicular Mid-clavicular Mid-axillaryMid-axillary
Listen to both sides of the chest. Is air entry present? Listen to both sides of the chest. Is air entry present? Absent? Equal on both sides? Compare left side to Absent? Equal on both sides? Compare left side to
right side.right side.
Abdomen: DCAP-BTLS + Firmness and DistentionAbdomen: DCAP-BTLS + Firmness and Distention
Pelvis: DCAP-BTLS (Pelvis: DCAP-BTLS (Compress gently)
Extremities: DCAP-BTLS + Distal Pulse,Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor FunctionSensation, Motor Function
Posterior: DCAP-BTLSPosterior: DCAP-BTLS
Package and begin transportPackage and begin transport• ImmediateImmediate – immobilize, load, go – immobilize, load, go• DelayedDelayed – immobilize, treat as – immobilize, treat as
necessary, transportnecessary, transport
If No Significant MechanismIf No Significant Mechanismof Injuryof Injury
Reconsider mechanism of injury
Determine chief complaint
Perform focused physical exam based on:
Chief complaint
Mechanism of injury
Use DCAP-BTLS on focused area of assessment
Assess baseline vital signs
Obtain SAMPLE history
Focused History and Focused History and PhysicalPhysical• Baseline vital signsBaseline vital signs• SAMPLE HistorySAMPLE History• Focus on and treat injuries found Focus on and treat injuries found
during initial assessment and rapid during initial assessment and rapid trauma assessment as appropriate trauma assessment as appropriate considering priorityconsidering priority
SAMPLE HistorySAMPLE HistorySS == Signs and symptomsSigns and symptomsAA == AllergiesAllergiesMM == MedicationsMedicationsPP == Pertinent past historyPertinent past historyLL == Last oral intakeLast oral intakeEE == Events leading to injury Events leading to injury
or illnessor illness
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Vital SignsRespirations
Pulse
Skin color, temperature, condition
Pupils
Blood Pressure
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Detailed Physical Detailed Physical ExamExam
• As appropriate, considering As appropriate, considering prioritypriority
• History and vital signs, History and vital signs, neurologicalneurological
• Repeat initial assessmentRepeat initial assessment• Complete critical interventionsComplete critical interventions• Careful head to toe survey Careful head to toe survey
(DCAP/BTLS)(DCAP/BTLS)
Detailed Physical ExamDetailed Physical ExamHead to ToeHead to Toe
• HeadHead – – DCAP/BTLS and creptiationDCAP/BTLS and creptiation• EarsEars – – DCAP/BTLS and blood/fluidDCAP/BTLS and blood/fluid• FaceFace – – DCAP/BTLS and blood/fluidDCAP/BTLS and blood/fluid• EyesEyes – – DCAP/BTLS and discoloration, DCAP/BTLS and discoloration,
pupils, foreign bodies, bloodpupils, foreign bodies, blood• NoseNose – – DCAP/BTLS and blood/fluidDCAP/BTLS and blood/fluid• MouthMouth – – DCAP/BTLS and teeth, DCAP/BTLS and teeth,
foreign bodies, swelling, lacerations, foreign bodies, swelling, lacerations, odorodor
Head to ToeHead to Toe
Detailed Physical Detailed Physical ExamExam
Head to ToeHead to Toe• NeckNeck – – DCAP/BTLS and JVD, crepitationDCAP/BTLS and JVD, crepitation• ChestChest – – DCAP/BTLS and palpate for DCAP/BTLS and palpate for
paradoxical motion, symmetry, crepitation, paradoxical motion, symmetry, crepitation, and auscultate breath soundsand auscultate breath sounds
• AbdomenAbdomen – – DCAP/BTLS and tenderness, DCAP/BTLS and tenderness, rigidity, distentionrigidity, distention
• PelvisPelvis – – DCAP/BTLS and pain, tenderness, DCAP/BTLS and pain, tenderness, motion, crepitationmotion, crepitation
• Upper extremities Upper extremities – DCAP/BTLS and PMS– DCAP/BTLS and PMS• Lower extremities Lower extremities – DCAP/BTLS and PMS– DCAP/BTLS and PMS• PosteriorPosterior – DCAP/BTLS – DCAP/BTLS
On-Going Assessment On-Going Assessment • Subjective changesSubjective changes• Reassess vital signs:neurological,ABCReassess vital signs:neurological,ABC• Reassess injuries Reassess injuries • Reassess interventionsReassess interventions
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