1. Basic Trauma Care
Principles
Teodoro Herbosa, M.D. FPCS
Division of Trauma
Dept. of Surgery
College of Medicine
University of the Philippines,
Manila

2. Introduction
Emergencies are situations that
require immediate action
Preparedness is the key to
success
Prehospital Care
Golden Hour of Trauma

3. Treatment Priorities
Advanced Trauma Life Support
(ATLS)
Determinants:
severity of injury
hemodynamic stability
ability to deliver prompt, definitive
surgical care
Minimize mortality, disability, &
cosmesis

4. Resuscitation and
Treatment
Brain
cardiopulmonary viscera
airway
abdominal viscera
extremities
vascular
orthopedic injuries
maxillofacial

5. Topics of Discussion
ABC’s
Airway Obstruction
Bleeding and Shock
Soft Tissue Injuries
Muscle and Skeletal Injuries
Occupational Injuries
Prehospital
care

6. ABC’s of Trauma
Airway and C-spine control
Breathing
Circulation
Deficits on Neurologic Exam
Exposure and Environment Control

7. Airway
Unconscious
Position of Recovery (lateral
decubitus)
Two Finger Sweep
Choking techniques
Chin lift maneuver
Jaw Thrust Maneuver
Cervical Spine Control

8. Bleeding and Shock
Circulatory system (Heart, arteries,
veins, capillaries)
Total Circulating blood volume 4-5
liters
Types of bleeding
Arterial Bleeding-bright red,
spurting, pulsating
Venous Bleeding-Steady slow flow,
dark red
Capillaries-slow, even flow

9. External Bleeding
Direct pressure to control
hemorrhage
Elevate the injured extremity
Immobilize the extremity
Pressure Points
Tourniquet when all other methods
failed

10. Bleeding from the Nose,
Ears and Mouth
Possible Causes:
Skull injury; Facial Trauma; Digital
trauma; Sinusitis, ARI,
Hypertension, Clotting disorders
Head Injury-do not stop the blood
flow-loose dressing
Epistaxis-Nosebleed
have the patient sit and lean
Pinch the fleshy part of the nose

11. Internal Bleeding
Causes: Blunt Trauma, clotting
disorder, rupture of blood vessel,
fractures
Always suspect internal bleeding in
cases of unexplained shock
Transport to the Emergency
Department ASAP

12. Soft Tissue Injuries
Closed Soft Tissue Injuries
Contusions
Hematomas
Crush Injuries
Treatment is Rest, Immobilzation,
Compress, Elevate (RICE)

13. Soft Tissue Injuries
Open Soft Tissue Injuries
Abrasion
Laceration
Avulsion
Amputation
Puncture
Expose wound; Control bleeding;
Prevent further contamination;
dress wound/bandage

14. Other Injuries
Chest Injuries (occlusive dressing)
Abdominal wounds with
evisceration
cover exposed organs; try not to
replace them
flex hips and knees
Impaled objects
Manually secure object
Use bulky dressing to stabilize the
object

15. Musculoskeletal Injuries
Muscles, Tendons, Ligaments
Skeletal System

16. Signs of bone/joint injury
Deformity or angulation
pain and tenderness
Grating or crepitus
Swelling
Disfigurement
Severe weakness or loss of
function
Bruising (discoloration)
Exposed bone end
Joint locked into position

17. Basics of Splinting
Prevents further movement
Lessens the pain
Minimizes complications
damage to nerves and blood
vessels
conversion to an open fracture
Excessive bleeding
Paralysis

18. General Rules of Splinting
Assess pulse before and after
splint application
Immobilize one joint above and
below injury
Cut away clothing
Cover all wounds
gentle traction before splinting if
bluish
Never replace exposed bone
Pad splints

19. General Rules of
Splinting
Apply splint before moving the
patient
When in doubt splint the injury
If there is shock, transport
immediately to ER

20. Splints
Rigid Splints
Traction Splints
Pressure Splints
Improvised Splints
cardboard
cane
ironing board
rolled-up magazine
umbrella
broom handle

21. Occupational
Injuries

22. Vision Statement
No injury in the workplace is ever
going to be acceptable
Trauma/Injury is NOT an Accident!
Trauma/Injury is a Disease
Host
Agent
Environment

23. Goal and Objective
Algorithm for Acute Wounds
Wound healing threats
Tetanus prone wounds
Local Anesthetic overdose

24. Acute Wounds
Initial assessment
Establish priorities
Treat life-threatening problems
Control bleeding with pressure
Prophylaxis (tetanus and
antibiotics)

25. Major or Complex wound
Devitalized tissue
Heavy contamination
Associated |injury
Visceral
Neuro-vascular
Fracture
Tendon
Perineal wound
OPERATING ROOM

26. Minor Wound
Careful wound inspection
Search for associated injuries
Obtain time of injury

27. Minimal
contamination
< 6 hrs from injury
No risk factors
Facial or scalp wound
Primary Closure in ER
Anesthesia; Skin preparation;
Irrigation; Hemostasis; Closure;
Dressing

28. Moderate Contamination
High risk for infection
>6 hrs from injury
Other risk factors
Irrigation
Leave open-consider DPC
Dressing

29. Associated Injury
Requiring operation
Operating room

30. Threats to Infection-free
wound healing
Necrotic tissue
Inadequate hemostasis
Foreign body
Heavy contamination
Local ischemia
local conditions
shock

31. Threats to Infection-free
wound healing
Systemic conditions
Malnutrition
Immunosuppression
Shock
Diabetes
Renal Insufficiency
Steroids
Cytotoxic drugs
Vitamin and trace metal deficiency
Collagen vascular disease

32. Conditions requiring
management in the
operating room
Large or complicated soft-tissue injury
Extensive amount of necrotic or ischemic tissue
Heavy contamination
Associated injury
Visceral
Vascular
Fracture
Perineal wounds
Compartment syndrome
High pressure injection injuries

33. Wound Characteristics relating
to likelihood of Tetanus
Clinical features Non-tetanus Tetanus
prone prone
Age of wound <6hrs >6hrs
Configuration Linear Stellate wound,
avulsion, abrasion
Depth <1cm >1cm
Mech of Injury Sharp Crush, burn, missile
surface wound, other
Sign of Infection Absent Present
Devitalized tissue Absent Present
Contamination Absent Present
(dirt, soil, grease)
Ischemic or Absent Present
Denervated tissue

34. Tetanus Prophylaxis
Non-tetanus Tetanus
prone Wounds prone Wounds
Hx of adsorbed Td TIG Td TIG
Tetanus toxoid (doses)
Unknown or less Yes No Yes Yes
than three doses
Three or more No No No No
doses

35. Symptoms of Local
Anesthestic Overdose
Central Nervous
System
Excitability
Dizziness
Tinnitus
Nystagmus
Seizures
Cardiopulmonary
Hypotension
Myocardial
Collapse
Respiratory arrest

36. Summary
ABC’s
Airway Obstruction
Bleeding and Shock
Soft Tissue Injuries
Musculoskeletal Injuries