A to Z of trauma care management. This presentation details the various aspect of managing a trauma case in ER and Critical Care unit. Using the A to Z anagram for various aspects makes it easy to remember each and very step that one needs to follow when resuscitating and managing a trauma case. This presentation will be especially useful for trauma nurses and doctors in training.

1. Trauma Management for Nurses:
a -Z!
Dr VAIBHAV BAGARIA
MBBS, MS, FCPS
Joint Replacement & Sports Injury Surgeon
CARE Hospital, Nagpur, INDIA
www.drbagaria.com

2. Rules
Be not afraid to ask questions.
The only dumb question is not to ask
question.
Two way Interaction
If you donot ask questions, I will!

3. Goals
Assessment: Assess patient condition
rapidly & Accurately
Resuscitate and stabilize the petient
depending on priority
Care giving on routine basis

4. underlying concept
Treat the greatest threat to life first
Lack of definitive diagnosis should
never impede the application of
indicated treatment
Detailed history is not essential
What you do will vary based on
expertise, training and what is
available.

5. SEQUENCE
Primary Survey: ABCDE
Resuscitation
Secondary Survey: AMPLE history
Head to toe

6. Why a to Z
Because it is not over until its all over.
Nurses - Beyond
It is always nice to go back to School
and learn the basics!

7. Primary Survey
A
Airway maintenance with C spine
protection
B
Breathing and Ventilation
C
Circulation with Hemorrhage control
D
Disability: Neurologic status
E
Exposure / Environment / Extremity

8. A : Airway
with C Spine protection
Does
this patient have an adequate airway that
they can protect?
Look
- facial trauma, foreign body
Listen
Feel
Is
- stridor
- expanding neck hematoma
the patient talking to you?

9. Management of Airway
Open
chin
Clear
Airway
lift and/or jaw thrust
Airway
suction
Insert
Oral
Airway
or nasal

10. AIRWAY Management

11. Assessment of Breathing
Look
- chest excursion, tracheal deviation
Listen
- auscultation for absent decreased
breath sounds
Feel
- subque air, percussion for dullness

12. Identify
Tension
Frail
Pneumothorax
chest
Massive
Open
hemothorax
Pneumothorax

13. Management of
Breathing
Oxygen
Nasal
Bag
canula of non rebreather
- Valve - Mask
Intubation
Pulse
ox
Needle
or tube thoracotomy

14. C : Circulation
with Hemorrhage Control
Predominant
cause of post injury deaths that
are preventable in the hospital setting.
Hypotension
is due to hypovolemia blood loss
until proven otherwise.
Spinal
shock

15. Assessment of
Circulation
Level
Skin
of consciousness
Color
Pulse
Rate,
Blood
Quality
Pressure

16. Identify
External
Apply
No
hemorrhage
direct pressure
tourniquets except for traumatic
amputations

17. OCCULT HEMMORHAGE
Be
aware of possible sources of internal
bleeding both from blunt and penetrating
trauma
Chest
Abdomen
Pericardial
Pelvic
Long
Tamponade
Fractures
Bone Fractures

18. Management of
Circulation
Two
large bore IVs
Draw
blood for lab studies
CBC,
T&C, Chem, ABG, HCG, EtOH, Tox,
Ringer’s
wide
Lactate
open
Warmed
(37 to 40C)

19. D - Disability
Level
of Consciousness
A
: Alert
V
: responds to Verbal stimuli
P
: responds to Painful stimuli
U
: Unresponsive to all stimuli
May
use Glasgow Coma Scale
Pupils

20. E : Exposure /
Environmental
/ Extremity
No
surprises
Maintain
Limb
temperature
threatening injuries

23. EXPOSURE
Completely
Prevent
undress
Hypothermia
You
may feel hot
The
patient is naked on a metal table
Blankets,
Quick
Warm IVF
distal neurovascular check
Relocate
only if pulseless

24. F -full vitals & Info
Pts
name ,home no ,time ,appearance ,sex
,incident .
Baseline
vital signs ,initial medications –dose,
route and response . Fluid and rate .
Assessment
Accurate
,interventions and the outcome .
and up to date cadrex.

25. F - Full info
Mivt
– mechanic of injury , injuries sustained,
vital signs and treatment .
Patient
generated information .
AMPLE ;.
A-allergy , M- medications , P – past history , L –
last meal , E – events .

26. G – Give comfort
measures
Verbal
reassurance .
Tough
.
Pharmacologic
/ non - pharmacologic
management of pain .

27. H – Head To Toe
Head
- to – toe assessment ;-
Inspection,
auscultation, palpation, percussion
and general appearance.
Lacerations,
abrasions, contusions, avulsions,
puncture wounds, impaled objects, ecchymosis,
oedema .

28. H – Head to toe
Crackling,
Loose
subcutaneous emphysema .
teeth, depressions, angulations .
Applied
splints – cpd # must be irrigated with
water or n/saline .
Motor
functions and sensation .

29. I – Inspect posterior
surfaces .
Depressions
Deformity
Anal
, bumps .
.
bleeding .

30. J - JOB ALLOCATION
Plan ahead
Remember Team work
Distribute work
Ensure responsibility
Remember “ too many cook spoil the broth”

31. K - KEY NOTES
Mentally go over the case
Make key notes
Specific issues: look for cause of unconsciousness, any
specific history, alchol/drug.

32. L - LIMB EVALUATION
Assess distal neurovascular status.
Expose the parts
Palpate and elicit any boney tenderness.
Ask if it needs evaluation
Donot miss brachial plexus injury.

33. M - MONITOR
Monitor vitals.
Cradiac monitor
Urine Monitor
Pulse Ox monitor
Family Presence

34. N - NO
No Complacency
No Assumptions
No Goof ups
No giving Up!

35. O - OPERATION PLANNING
Inform operating room
Blood cross match
PAC & Part preparation.
Scheduling
Administration of medications - antibiotics ,
analgesics, sedations etc

36. P - PLAN AHEAD
Planning Planning Planning
A well thought of and well executed plan is
what is required.

37. Q - QUESTION TEAM LEADER
Refer to rule no #1
Ask for further plans.
Clear any doubts

38. R - Radiology
FAST Scan
CT Head with Cervical Spine
Any other investigation deemed fit

39. S - STABILIZATION
Application
Pelvic

of traction devices .
orthotic device ,
Pelvic sheet wrapping

40. T - TRANSFER PLANNING
Plan transfer
Prior Intimation
Manpower Arrangment
Consent

41. U - Remember Your self
You Can make a difference
Every one of us

42. V - VITALS RE EXAMINE
Continued
Detailed
Head to Toe
Complete
Special
“Tube
reevaluation of AVPU and ABCDE
Neuro exam
Procedures
or Finger in every hole”

43. W - WOUND CARE
Take Care of the wounds.
Primary treatment goes long way in
preventing infection and systemic
complications.
 Clean
dress
with running water or n/saline then

44. X - X RAYS
X
Rays (trauma series portable)
C
spine (cross table lateral)
Chest
Pelvis
Obvious
long bones

45. Y - SEARCH WHY?
Specific issues: look for cause of
unconsciousness, any specific history,
alchol/drug

46. Z: ZEST For life!

47. Two Short Videos
Cervical collar Application
Log Rolling

48. Log Rolling Video
QuickTime™ and a
decompressor
are needed to see this picture.

49. Cervical collar Video
QuickTime™ and a
decompressor
are needed to see this picture.

50. Thank You!
www.carehospital.com
www.drbagaria.com