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Prehospital care 'n' trauma life support
The document outlines the initial assessment and management of trauma, emphasizing the importance of timely pre-hospital care. It highlights the rapid assessment of life-threatening conditions and the organized approach to treatment, focusing on ABCs (Airway, Breathing, Circulation) and DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling). Additionally, it discusses procedural interventions, prioritization of patient care, and various assessment techniques to optimize trauma outcomes.
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Prehospital care 'n' trauma life support
- 1. Initial Assessment and Managementof Trauma BASIC TRAUMA LIFE SUPPORT in Pre-Hospital Care Scenario Dr.Venugopalan P P DA,DNB, MNAMS, MEM-GW Director ,Aster DM Healthcare Founder and Executive director ANGELS- Active Network Group of Emergency Life Savers Expert committee Member, Kerala Road Safety Authority Regional Faculty American Heart Association
- 2. Introduction • Trauma isthe fourth leading cause of death for all ages • Trauma is the leading cause of death for children & adult under the age of 45 years • Golden Hour – Time to reach operating room (or other definitive treatment) • Prehospital care(PHC) does NOT have a Golden Hour • PHC has a Platinum Ten Minutes
- 3. Introduction • Patients intheir 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
- 4.
- 5. Injury “A bodily lesiondue to acute exposure to energy beyond the physiological tolerance” “
- 6. Accidents ❏ Accidents arethe part of prize we are paying for technological advances ❏ Like other diseases accidents are also having ❏ Natural history of disease ❏ Agent ❏ Host ❏ Environmental factors
- 7. Accidents as adisease Pathology Host Agent Vector/Vehic le Interact ion Malaria Human Plasmodiu m Vivax Mosquito Bite Skull fracture Human Mechanica l Injury Motor vehicle Crash
- 9. Trauma Assessment Load andGo Situation ? Load and Go Situation ? HOSP
- 10. Scene Size-Up 1. Safety 2.Body Surface Isolation (BSI) 3. Number of Patients 4. Additional Resources 5. Mechanism of Injury(MOI)
- 11. Safety • Traffic • Smoke •Electricity • Hazmat • Hostile Persons • Weapons • Drugs • Silence
- 12. BODY SURFACE ISOLATION •Gloves for minimal fluids • Goggles for eye protection if there’s any chance of splatter • Mask and Gown for gross contamination
- 13. Number of Patients Callfor additional resources ASAP
- 14. Additional resources • Extrication •Traffic control • Utilities
- 15. Significant Mechanism of 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
- 16. Bent Steering Wheel BrokenMirror Distorted Pedals Deformed Dashboard Spiderwebbed Windshield Vital informations from the field
- 17. Initial Assessment • General Impression •Mental Status • Airway • Breathing • Circulation
- 18. General Impression • Age,Weight, Gender • Position (relative to posture and surroundings) • Activity • Obvious Injuries/Bleeding
- 19. Assess Mental Status •Take C-Spine control • A – Alert and immediately responsive • V – Responsive to verbal stimuli • P – Responsive to painful stimuli • U – Unresponsive A V P U
- 20. Assess Airway ❏ Openif necessary using jaw-thrust maneuver ❏ Consider oropharyngeal or nasopharyngeal airway ❏ Note unusual sounds and correct cause ❏ Snoring – oro-/nasopharyngeal airway ❏ Gurgling – suction ❏ Stridor – consider intubation ❏ Silence
- 21. Correcting silence ❏ Attemptventilation ❏ Reposition ❏ Heimlich ❏ Visualize and remove ❏ Intubate ❏ Translaryngeal jet insufflation
- 22. 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
- 23. Assess Circulation - Pulses •Compare radial and carotid • Rate – Normal – Fast – Slow • Rhythm – Regular – Irregular • Quality – Weak – Thready – Bounding
- 24. Assess Circulation - Skin •Color • Temperature • Moisture • Capillary refill time Assess Circulation - Bleeding • Direct pressure • Pressure dressing
- 25. Determine priority ❏ Poorgeneral impression ❏ Mental status changes ❏ Difficulty breathing ❏ Shock ❏ Chest pain ❏ Severe bleeding ❏ Severe pain Load and Go Situation ?
- 26. Rapid Trauma Survey •Head to toe • Rapid sweep to identify major injuries which could prove life threatening • DCAP-BTLS
- 27. Inspect and Palpatefor DCAP-BTLS = = = = D C A P Deformities Contusions Abrasions Punctures/ Penetrations = = = = B T L S Burns Tenderness Lacerations Swelling Rapid Trauma Survey
- 28.
- 29.
- 30. Rapid Trauma Survey •Head • Neck • Chest • Abdomen • Pelvis • Extremities • Posterior
- 31. ❑Head: DCAP-BTLS +Crepitation ❑Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation ❑Chest: DCAP-BTLS + Crepitation and Breath Sounds (Presence and Equality)
- 32. Mid-clavicular Mid-axillary Listen toboth sides of the chest. Is air entry present? Absent? Equal on both sides? Compare left side to right side.
- 33. ❑Abdomen: DCAP-BTLS +Firmness and Distention ❑Pelvis: DCAP-BTLS (Compress gently)
- 34. ❑Extremities: DCAP-BTLS +Distal Pulse, Sensation, Motor Function ❑Posterior: DCAP-BTLS
- 35. Procedure that aredone at the scene & can be delegated • Seal sucking chest wounds • Needle decompression • Stabilize flail chest • Stabilize impaled objects • Complete packaging of the patient • Initial airway management • Assist ventilation • Administer oxygen • Begin CPR • Control of major external bleeding • IV access and fliuds
- 36.
- 37. Procedures : Airway OPANPA Definitive Airway
- 38. Procedures : Airwayin difficult situations LMA Combitude Kings Airway
- 39. Procedures : Airwayin difficult situations Needle cric Surgical cric
- 40. Procedures : Ventilationand Oxygenation BVM Oxygen Therapy
- 41. Procedures : Ventilationand Oxygenation Needle Decompression
- 42. Procedures : Ventilationand Oxygenation Open sucking wound
- 43. Procedures : Ventilationand Oxygenation Flail chest
- 44.
- 45. Procedures : Circulation IntravenousAccess Intraosseous access
- 46.
- 47.
- 48.
- 49. Procedures : Splintsand Bandages Thomas splint and Malleable splints
- 50. Package and begintransport • Immediate – immobilize, load, go • Delayed – immobilize, treat as necessary, transport
- 51. If No SignificantMechanism 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 of assessment • Assess baseline vital signs • Obtain SAMPLE history
- 52. Focused History andPhysical exam • Baseline vital signs • SAMPLE History • Focus on and treat injuries found during initial assessment and rapid trauma assessment as appropriate considering priority
- 53. 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
- 54. Vital Signs • Respirations •Pulse • Skin color, temperature, condition • Pupils • Blood Pressure
- 55. Detailed Physical Exam •As appropriate, considering priority • History and vital signs, neurological • Repeat initial assessment • Complete critical interventions • Careful head to toe survey (DCAP/BTLS)
- 56. Detailed Physical Exam Headto Toe • Head – DCAP/BTLS and crepitation • Ears – DCAP/BTLS and blood/fluid • Face – DCAP/BTLS and blood/fluid • Eyes – DCAP/BTLS and discoloration, pupils, foreign bodies, blood • Nose – DCAP/BTLS and blood/fluid • Mouth – DCAP/BTLS and teeth, foreign bodies, swelling, lacerations, odor HEENT
- 57.
- 58. Detailed Physical Exam Headto Toe • Neck – DCAP/BTLS and JVD, crepitation • Chest – DCAP/BTLS and palpate for paradoxical motion, symmetry, crepitation, and auscultate breath sounds • Abdomen – DCAP/BTLS and tenderness, rigidity, distention • Pelvis – DCAP/BTLS and pain, tenderness, motion, crepitation • Upper extremities – DCAP/BTLS and PMS • Lower extremities – DCAP/BTLS and PMS • Posterior – DCAP/BTLS
- 59. Ongoing Assessment • Subjectivechanges • Reassess vital signs:neurological,ABC • Reassess injuries • Reassess interventions
- 61.