BTLS trauma.ppt

5/24/2018 BTLS trauma.ppt

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BASIC TRAUMA LIFE SUPPORT

Initial Assessmentand Management

of Trauma

Purwoko Sugeng H


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Introduction

Trauma is the fourth leading cause ofdeath for all ages trauma is theleading cause of death for children &

adult under the age of 45 years Golden Hour

Time to reach operating room(or other definitive treatment)

EMS does NOT have a Golden Hour

EMS has a Platinum Ten Minutes
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Introduction

Patients in their Golden Hour must:

Be recognized quickly

Have only immediate life threats managed

Be transported to an APPROPRIATE facility

Survival depends on assessment skills

Good assessment results from

An organized approach Clearly defined priorities

Understanding available resources


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Trauma Assessment

Scene Size Up

Detailed Assessment Ongoing Assessment

FocusAssessment

RapidTraumaSurvey

Initial Assessment

Load and GoSituation ?

Load and Go

Situation ? HOSP


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Scene Size Up Safety

Body Surface Isolation (BSI)

Number of Patients Additional Resources

Mechanism of Injury(MOI)


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Safety Traffic

Smoke

Electricity

Haz-Mat Hostile

Persons

Weapons Drugs

Silence


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BODY SURFACE ISOLATION

Glovesfor minimal

fluids Goggles for eye

protection if theres

any chance of

splatter

Mask and Gown forgross contamination


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Number of Patients

Call for additional resources

ASAP


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Additional resources

Extrication

Traffic control

Utilities


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Home

Significant Mechanism

of InjuryEjection from vehicle

Death in same

passengercompartment

Fall of greater than

15 feet or

3 times the patients

height

Rollover of vehicle

High-speed vehicle

collision

Vehicle-pedestriancollision

Motorcycle crash

Unresponsive or alteredmental status

Penetrating injury of head,

chest, or abdomen


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Home

Bent Steering Wheel Broken Mirror

Distorted Pedals

Deformed

Dashboard

Spider-Webbed

Windshield


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Initial Assessment

General Impression

Mental Status

Airway

Breathing

Circulation


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General Impression

Age, Weight, Gender

Position (relative to posture andsurroundings)

Activity

Obvious Injuries/Bleeding


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Assess Mental Status

Take C-Spine control

A Alert and immediatelyresponsive

V Responsive to verbal stimuli

P Responsive to painful stimuli

U

Unresponsive


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Assess Airway Open if necessary using jaw-thrust

maneuver

Consider oro- or naso-pharyngeal

airway Note unusual sounds and correct

cause Snoring oro-/naso-pharyngeal airway

Gurgling suction

Stridor consider intubation

Silence


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Correcting silence

Attempt ventilation

Reposition

Heimlich

Visualize and remove

Intubate

Trans-laryngeal jet insuflation


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Assess Breathing Look, Listen, Feel

Rate, Rhythm, Depth (tidal volume)

Use of accessory muscles/retractions

Treat Absent ventilate x2, check pulse

< 12/min assist ventilation

Decreased tidal volume assist ventilation

Labored oxygen 10 liters NRB

Normal or rapid consider oxygen


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Assess CirculationPulses

Compare radialand corotid

Rate

Normal Fast

Slow

Rhythm

Regular

Irregular

Quality Weak

Thready

Bounding


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Assess CirculationSkin Color

Temperature

Moisture

Assess CirculationBleeding Direct pressure

Pressure dressing


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Determine priority

Poor general impression

Mental status changes Difficulty breathing

Shock

Chest pain Severe bleeding

Severe pain

Load and Go Situation ?


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Rapid Trauma Survey

Head to toe

Rapid sweep to identify majorinjuries which could prove life

threatening

DCAP-BTLS


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Inspect and Palpate forDCAP-BTLS

=

=

=

=

D

C

A

P

Deformities

Contusions

Abrasions

Punctures/

Penetrations

=

=

=

=

B

T

L

S

Burns

Tenderness

Lacerations

Swelling

Rapid Trauma Survey


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Deformities Contusions

Abrasions Punctures/Penetrations


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Burns Tenderness

Lacerations Swelling


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Rapid Trauma Survey

HeadNeck

Chest

Abdomen

Pelvis

Extremities

Posterior


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Head: DCAP-BTLS + Crepitation

Neck: DCAP-BTLS + Jugular Vein Distention and

Crepitation

Chest: DCAP-BTLS + Crepitation and

Breath Sounds (Presence and Equality)


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Mid-clavicular Mid-axillary

Listen to both sides of the chest. Is air entry present?

Absent? Equal on both sides? Compare left side to

right side.


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Abdomen: DCAP-BTLS + Firmness and Distention

Pelvis: DCAP-BTLS (Compress gently)

E t iti DCAP BTLS Di t l P l


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Extremities: DCAP-BTLS + Distal Pulse,

Sensation, Motor Function

Posterior: DCAP-BTLS


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Procedure that are done atthe scene & can be delegated

Initial airway management

Assist ventilation

Administer oxygen

Begin CPR

Control of major external bleeding

Seal sucking chest wounds

Stabilize flail chest Stabilize impaled objects

Complete packaging of the patient


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Package and begin transport

Immediateimmobilize, load, go Delayedimmobilize, treat as

necessary, transport


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If No Significant Mechanism

of 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 ofassessment

Assess baseline vital signs

Obtain SAMPLE history


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Focused History and Physical

Baseline vital signs

SAMPLE History

Focus on and treat injuries found

during initial assessment and rapid

trauma assessment as appropriate

considering priority


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SAMPLE History

S = Signs and symptoms

A = Allergies

M = Medications

P = Pertinent past history

L = Last oral intake

E = Events leading to injury

or illness


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Vital Signs

RespirationsPulse

Skin color, temperature,

condition

Pupils

Blood Pressure


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Detailed Physical Exam

As appropriate, consideringpriority

History and vital signs,

neurological

Repeat initial assessment

Complete critical interventions

Careful head to toe survey(DCAP/BTLS)


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Detailed Physical ExamHead to Toe

HeadDCAP/BTLS and creptiation

EarsDCAP/BTLS and blood/fluid

FaceDCAP/BTLS and blood/fluid

EyesDCAP/BTLS and discoloration,pupils, foreign bodies, blood

NoseDCAP/BTLS and blood/fluid

Mouth

DCAP/BTLS and teeth, foreignbodies, swelling, lacerations, odor


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Head to Toe


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Detailed Physical ExamHead to Toe

NeckDCAP/BTLS and JVD, crepitation

ChestDCAP/BTLS and palpate for paradoxicalmotion, symmetry, crepitation, and auscultate

breath soundsAbdomenDCAP/BTLS and tenderness,

rigidity, distention

PelvisDCAP/BTLS and pain, tenderness,motion, crepitation

Upper extremities DCAP/BTLS and PMS

Lower extremities DCAP/BTLS and PMS

PosteriorDCAP/BTLS


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On Going Assessment Subjective changes Reassess vital signs:neurological,ABC

Reassess injuries

Reassess interventions


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BTLS trauma.ppt

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