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Toms Basic And (Hopefully) High Speed

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Toms Basic And (Hopefully) High Speed

  1. 1. Toms basic and (hopefully) high speed Trauma and EMS Lecture …or…To much for one lecture, but here we go anyway….
  2. 2. Primary Survey - Immediate Threats to Life (Only!) A = Airway Obstructed? B = Breathing Breath Sounds Present? Bilaterally? C = Circulation Peripheral Pulse? Femoral? Carotid? (Not BP Measurement.)
  3. 3. Primary Survey - Immediate Threats to Life (Only!) D = Disability Global (AVPU or GCS) Gross Motor Function (i.e. spinal cord integrity) E = Exposure Nekkid!
  4. 4. Secondary Survey Now find out what happened, what’s injured.  History (AMPLE)  Physical.  Organized, complete head to toe exam.  Roll, check back.  Remember TM’s and rectal.  Foley. NG or OG tube.
  5. 5. Things to remember… The Ideal Trauma Resuscitation  Roles are pre-assigned  Clear direction & communication  Pertinent findings verbalized in proper order  All team members know all findings  Rapid, Efficient  Calm & Quiet!
  6. 6. 5places you can bleed out  Chest  Belly (and/or retroperitoneum)  Thighs  Pelvis  Street
  7. 7. Things to remember… Classification of Shock Class EBL Pulse BP Mental Treatment I <15% (<750ml) - - nl Fluids II 15-30% (750-1.5L)  - +/-anxious Fluids III 30-40% (1.5L-2.0L)   anxious Fluids + Blood IV >40% (>2.0L)    confused Fluids + Blood
  8. 8. Case for head injury  24yo fall off ladder in construction site  Per EMS…awake, short tempered, perseverating  What do you want to do?  What are you worried about?
  9. 9. Types of bleeding in the head  Epidural  Subdural  Subarachnoid  Intraparenchymal  Intraventricular
  10. 10. Why do we care about bleeding in the head  Increased intracranial pressure  Seizures  Prognosis
  11. 11. Cerebral perfusion pressure  Balance of forces  Blood pressure  Intracranial pressure  CPP = MAP - ICP
  12. 12. Management of Severe Head Injuries (increased ICP)  Secure airway - role of lidocaine  Hyperventilation  Mannitol 1g/kg  HOB 30o  Seizure prophylaxis  ICP monitors  Craniotomy
  13. 13. Case for chest trauma  24yo stabbed in chest  Per EMS…fine originally, then started complaining about short breath  What do you want to do now?  What are you worried about?
  14. 14. Life Threatening problems  TensionPTX  Flail chest  Tamponade  Massive HTX / PTX  Esophageal disruption  Aortic disruption  Diaphragm hernia  Tracheal disruption  Pulmonary contusion  Myocardial contusion  Simple PTX
  15. 15. Case for belly trauma  45yo male crushed between truck and wall  C/O dull achy pain right under ribs  Per EMS pain getting worse, getting confused and anxious looking…  What do you want to do??  What are you worried about?
  16. 16. How can you evaluate the belly?  Serial abdominal exams  CT  DPL  US  RUG/cystogram  Take a look (in the OR)
  17. 17. Neck Trauma  Clear c-spine/NEXUS  X-ray vs CT  Zones of the neck

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