Prehospital care 'n' trauma life support
•
18 likes•5,907 views
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Prehospital care 'n' trauma life support
Similar to Prehospital care 'n' trauma life support (20)
More from Dr.Venugopalan Poovathum Parambil
More from Dr.Venugopalan Poovathum Parambil (20)
Recently uploaded
Recently uploaded (20)
Prehospital care 'n' trauma life support
- 1. Initial Assessment and Management of 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 is the 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 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
- 4. Introduction
- 5. Injury “A bodily lesion due to acute exposure to energy beyond the physiological tolerance” “
- 6. Accidents ❏ Accidents are the 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 a disease 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 and Go 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 Call for 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 Broken Mirror 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 ❏ Open if 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 ❏ Attempt ventilation ❏ 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 ❏ Poor general 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 Palpate for DCAP-BTLS = = = = D C A P Deformities Contusions Abrasions Punctures/ Penetrations = = = = B T L S Burns Tenderness Lacerations Swelling Rapid Trauma Survey
- 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 to both 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 are done 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. Spine Motion restriction - SMR
- 37. Procedures : Airway OPA NPA Definitive Airway
- 38. Procedures : Airway in difficult situations LMA Combitude Kings Airway
- 39. Procedures : Airway in difficult situations Needle cric Surgical cric
- 40. Procedures : Ventilation and Oxygenation BVM Oxygen Therapy
- 41. Procedures : Ventilation and Oxygenation Needle Decompression
- 42. Procedures : Ventilation and Oxygenation Open sucking wound
- 43. Procedures : Ventilation and Oxygenation Flail chest
- 45. Procedures : Circulation Intravenous Access Intraosseous access
- 48. Procedures : Circulation Pelvic binders
- 49. Procedures : Splints and Bandages Thomas splint and Malleable splints
- 50. Package and begin transport • Immediate – immobilize, load, go • Delayed – immobilize, treat as necessary, transport
- 51. 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 of assessment • Assess baseline vital signs • Obtain SAMPLE history
- 52. Focused History and Physical 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 Head to 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. Head to Toe
- 58. Detailed Physical Exam Head to 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 • Subjective changes • Reassess vital signs:neurological,ABC • Reassess injuries • Reassess interventions