The document provides information on a continuing medical education session for paramedics, including objectives, demonstrations of new equipment, and case reviews. It discusses new intravenous catheters and solution sets being used, and provides instructions on preparing and accessing them. Two medical cases are then reviewed involving a woman found unresponsive at home and a man who fell from a third floor window. For each case, the document outlines the assessment approach, initial findings, further history, detailed exam, treatment, and questions from participants.
Initial Assessment of Trauma Patient What, Why and How ABCDE
The document discusses the initial assessment of trauma patients using the ABCDE approach. It covers:
- Assessment of airway, management of airway, and indications for definitive airway placement.
- Assessment of breathing, management of immediate life-threatening injuries like tension pneumothorax, and potential life-threatening injuries.
- Diagnosis and management of shock, including types of shock and stopping bleeding.
- Assessment of disability using GCS and management to prevent secondary brain injury.
- Restriction of cervical spine motion, when it is needed, how to implement it, and when cervical spine clearance is appropriate.
Assesment and treatment of acutely ill adultUzair Siddiqui
The document outlines an ABCDE approach for assessing and treating acutely ill adult patients, with A representing airway assessment, B for breathing, C for circulation, D for disability, and E for exposure. It provides guidance on evaluating each component through history, examination, and monitoring, while simultaneously aiming to reach a diagnosis to allow for definitive treatment. The approach emphasizes beginning oxygen therapy, intravenous access, fluid resuscitation, and monitoring as needed based on the patient's condition.
This is an open-source of the course overview for the Respiratory Care Board Exam, preparation, and review with a focus on the Clinical Simulation Exam (CSE) testing.
The document discusses basic life support (BLS) principles and procedures. It covers the ABCs of BLS - maintaining airway, breathing, and circulation. It describes the steps of CPR for adults, children, and infants, including assessment, calling for help, chest compressions, and rescue breathing. It also discusses special considerations for airway obstruction, shock, and triage in emergencies and disasters.
1. A 25-year-old male patient arrived at the ED after a motorcycle collision with signs of airway compromise, reduced breathing, and bleeding requiring immediate intubation, chest tube placement, and fluid resuscitation to address life-threatening injuries.
2. Management of major trauma involves a primary survey addressing the immediate ABCDE threats with airway control, breathing support, hemorrhage control, and disability assessment as the highest priorities.
3. Burn management similarly focuses first on securing the airway, assessing for inhalation injury, and aggressively resuscitating to prevent shock from ongoing fluid losses through the burned skin.
This document discusses various medical and surgical conditions considered emergencies. It covers assessments and management of acute conditions like abdominal emergencies, shock, respiratory issues, cardiac events, neurological emergencies, trauma, and poisoning. Key aspects addressed include vital sign monitoring, diagnostic testing, establishment of IV access, oxygen administration, ventilation support, treatment of underlying causes, and prevention of complications through nursing care.
This document outlines the initial assessment and management of multiply injured patients according to ATLS guidelines. It describes conducting a primary survey to address life threats and establish stability, including airway, breathing, circulation, disability, and exposure. Adjuncts aid the primary survey. Next is a full secondary survey with patient history and head-to-toe examination. Special diagnostic tests, reevaluation, and definitive care such as transfer to a higher level of care follow. Key steps include rapid assessment and treatment of vital functions, prevention of missed injuries, and thorough documentation.
Initial assessment and management of traumaVASS Yukon
The document provides guidance on the initial assessment and management of trauma patients. It emphasizes that the golden hour refers to time to definitive treatment, not time in transport or the ED. For critical patients, EMS has just 10 minutes to provide lifesaving interventions. The primary survey involves assessing the patient's airway, breathing, circulation, disability and exposure to identify and treat life threats. Oxygenation and control of hemorrhage are top priorities. Only after life threats are addressed should providers begin the more detailed secondary exam and assessment. Rapid transport to the appropriate facility is critical for trauma patients.
Initial Assessment of Trauma Patient What, Why and How ABCDE
The document discusses the initial assessment of trauma patients using the ABCDE approach. It covers:
- Assessment of airway, management of airway, and indications for definitive airway placement.
- Assessment of breathing, management of immediate life-threatening injuries like tension pneumothorax, and potential life-threatening injuries.
- Diagnosis and management of shock, including types of shock and stopping bleeding.
- Assessment of disability using GCS and management to prevent secondary brain injury.
- Restriction of cervical spine motion, when it is needed, how to implement it, and when cervical spine clearance is appropriate.
Assesment and treatment of acutely ill adultUzair Siddiqui
The document outlines an ABCDE approach for assessing and treating acutely ill adult patients, with A representing airway assessment, B for breathing, C for circulation, D for disability, and E for exposure. It provides guidance on evaluating each component through history, examination, and monitoring, while simultaneously aiming to reach a diagnosis to allow for definitive treatment. The approach emphasizes beginning oxygen therapy, intravenous access, fluid resuscitation, and monitoring as needed based on the patient's condition.
This is an open-source of the course overview for the Respiratory Care Board Exam, preparation, and review with a focus on the Clinical Simulation Exam (CSE) testing.
The document discusses basic life support (BLS) principles and procedures. It covers the ABCs of BLS - maintaining airway, breathing, and circulation. It describes the steps of CPR for adults, children, and infants, including assessment, calling for help, chest compressions, and rescue breathing. It also discusses special considerations for airway obstruction, shock, and triage in emergencies and disasters.
1. A 25-year-old male patient arrived at the ED after a motorcycle collision with signs of airway compromise, reduced breathing, and bleeding requiring immediate intubation, chest tube placement, and fluid resuscitation to address life-threatening injuries.
2. Management of major trauma involves a primary survey addressing the immediate ABCDE threats with airway control, breathing support, hemorrhage control, and disability assessment as the highest priorities.
3. Burn management similarly focuses first on securing the airway, assessing for inhalation injury, and aggressively resuscitating to prevent shock from ongoing fluid losses through the burned skin.
This document discusses various medical and surgical conditions considered emergencies. It covers assessments and management of acute conditions like abdominal emergencies, shock, respiratory issues, cardiac events, neurological emergencies, trauma, and poisoning. Key aspects addressed include vital sign monitoring, diagnostic testing, establishment of IV access, oxygen administration, ventilation support, treatment of underlying causes, and prevention of complications through nursing care.
This document outlines the initial assessment and management of multiply injured patients according to ATLS guidelines. It describes conducting a primary survey to address life threats and establish stability, including airway, breathing, circulation, disability, and exposure. Adjuncts aid the primary survey. Next is a full secondary survey with patient history and head-to-toe examination. Special diagnostic tests, reevaluation, and definitive care such as transfer to a higher level of care follow. Key steps include rapid assessment and treatment of vital functions, prevention of missed injuries, and thorough documentation.
Initial assessment and management of traumaVASS Yukon
The document provides guidance on the initial assessment and management of trauma patients. It emphasizes that the golden hour refers to time to definitive treatment, not time in transport or the ED. For critical patients, EMS has just 10 minutes to provide lifesaving interventions. The primary survey involves assessing the patient's airway, breathing, circulation, disability and exposure to identify and treat life threats. Oxygenation and control of hemorrhage are top priorities. Only after life threats are addressed should providers begin the more detailed secondary exam and assessment. Rapid transport to the appropriate facility is critical for trauma patients.
- The document provides guidance on initial assessment and management of trauma patients, emphasizing the importance of quickly identifying and correcting life threats during the primary survey.
- The primary survey focuses on the ABCs - Airway, Breathing, Circulation. Oxygen should be given immediately if needed and breathing/ventilation issues addressed. Serious bleeding must be controlled.
- Only after life threats are stabilized should a more detailed exam and history be performed, and the patient transported without delay to definitive care. Rapid assessment and treatment is critical for trauma patients.
هنتعامل ازاي مع مريض عده مشاكل في القلب بعد قبل و بعد عملية جراحية؟
والاهم ازاي نشخص ان مريض حصل له ازمة قلبية و هو محجوز في قسم الجراحة بعد عملية
دي دردسة باستخدام الطريقة اللي ناقشناها في الفيديو دا
https://www.youtube.com/watch?v=f6j4VQloB6k&t=1000s
عن ازاي نتعامل مع المرضي دول
الفيديو مناسب للزملاء المتقدمين لامتحان الMRCS
و للزملاء اللي منتقلين حديثا للعمل بالمملكة المتحدة او بينو العمل فيها
عنوان فيديو المحاضرة علي اليوتيوب
https://youtu.be/V3nUgSzbf9w
تابعونا علي الصفحة الجراح
https://www.facebook.com/algarra7/
The patient is a 50-year-old male presenting with severe abdominal pain radiating to his back. He has a fever of 101.3F and is vomiting. His history includes diabetes mellitus. On examination, his abdomen is distended and tender in the right upper quadrant. Initial management should include oxygen, IV fluids, analgesia and antiemetics to make the patient more comfortable. Bedside investigations including an ECG, ABG and urinalysis should be obtained. Laboratory tests including a CBC, coagulation screen, HbA1c, liver function tests and a renal profile are needed.
This document provides guidelines for cardiac arrest treatment in adults. It outlines the steps of cardiopulmonary resuscitation (CPR), use of an automated external defibrillator, and management of shockable versus non-shockable rhythms. Key interventions include high-quality chest compressions, use of an advanced airway with capnography, epinephrine and amiodarone administration, and treatment of reversible causes of cardiac arrest.
This document provides an overview of various medical and surgical emergencies, including trauma injuries like abrasions, lacerations, avulsions, and contusions, as well as fractures, crush injuries, amputations, and hemorrhage. It also covers poisoning, myocardial infarction, and their associated signs, symptoms, and management approaches. The goals are to control bleeding, maintain circulating blood volume, prevent shock, remove or inactivate poisons, provide supportive care, and administer antidotes when available.
Anesthesiology often involves medical crises due to the complex and dynamic nature of anesthesia. Effective crisis management relies on core mental processes including observation, verification, problem recognition, prediction, decision-making, action, and reevaluation. However, not all crises are managed well, even by experienced anesthesiologists. Key elements of crisis management during anesthesia include identifying precipitating factors, looking for signs and symptoms, and taking appropriate emergency actions to address the crisis while ensuring patient oxygenation and ventilation. Proper documentation is also important.
1. The document discusses the key principles of emergency nursing including establishing an open airway, controlling hemorrhage, maintaining circulation, assessing neurological status, and rapidly assessing patients.
2. Common medical emergencies covered include acute abdomen, shock, respiratory issues, cardiac emergencies, neurological emergencies, trauma, and poisoning. Signs, symptoms, diagnostic tests, and treatment approaches are described for each condition.
3. The principles of emergency management are also summarized, which include early detection, reporting, response, providing good on-scene care and transportation to definitive care.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
1. Emergency nursing is a specialty that cares for patients during the critical phase of illness or injury when the cause is unknown. Emergency nurses treat a wide range of issues from minor to life-threatening for all ages.
2. The primary goals in emergency nursing are to assess patients, establish airways, control bleeding, and determine ability to follow commands in order to guide initial treatment and monitoring.
3. Emergency nurses must be prepared to assess and treat many different medical conditions and injuries ranging from minor illnesses to trauma emergencies in patients of all ages.
This document provides information on cardiopulmonary resuscitation (CPR) including its history, techniques, terminology, diagnosis of cardiac arrest, and guidelines from the American Heart Association (AHA). It discusses the development of CPR from the 19th century to modern times. The 2010 AHA guidelines emphasize high-quality chest compressions, early defibrillation, and post-cardiac arrest care including therapeutic hypothermia. The guidelines provide updated recommendations for compression rate, depth, ventilation rates, and other aspects of CPR for adults, children, and infants.
The document is a clinical skills guide that was created by the author for a competition. It contains instructions for over 20 different clinical skills including hand washing, taking vital signs, blood pressure measurement, various types of injections, and other procedures. The guide provides step-by-step explanations of how to properly perform each skill for assessment in the competition.
This document provides instructions for performing various clinical skills assessments including: resuscitation, assessing peripheral pulses, measuring blood pressure, examining the cardiovascular and respiratory systems, performing an electrocardiogram, assessing peak flow, and using a vitalograph machine. Key steps are outlined for each skill, such as procedures for opening an airway, performing chest compressions, locating and feeling different pulse points, correctly applying a blood pressure cuff, examining heart sounds and murmurs, and interpreting vital sign readings.
Central venous pressure (CVP) describes the blood pressure in the thoracic vena cava near the right atrium. Normal CVP ranges from 0-15 cm H2O depending on measurement point. CVP is affected by factors like volume status, respiration, and heart function. Central venous catheters are used to monitor CVP and administer IV medications and fluids long-term. Types include non-tunneled short term catheters and tunneled or implanted ports for longer term use. Nurses must properly insert, maintain, and discontinue central lines to prevent complications and ensure accurate CVP readings.
This document provides information on central venous catheterization including definitions, indications, contraindications, complications, approaches, and care. It defines a central venous catheter as a catheter placed into a large central vein to access the vena cava for purposes such as monitoring, resuscitation, and infusion of medications. The document outlines the internal jugular, subclavian, and femoral approaches and considerations for each site. It also discusses patient assessment, education, and post-procedure care including dressing, securing, and imaging of the catheter.
Early recognition of deteriorating patients is key to preventing cardiac arrest. The ABCDE approach is used to assess airway, breathing, circulation, disability, and exposure. Effective CPR involves high-quality chest compressions at a rate of 100-120 per minute with a depth of 5-6 cm, as well as use of an AED to deliver shocks for shockable rhythms like ventricular fibrillation and ventricular tachycardia. Non-shockable rhythms like asystole and pulseless electrical activity require continued CPR and administration of adrenaline every 3-5 minutes.
This document provides an overview of emergency medicine as a specialty. It discusses the top causes of death, the reception process in emergency departments, how cases are triaged from life-threatening to non-urgent, and examples of common illnesses and injuries seen in emergency medicine including chest pain, fractures, seizures, and psychiatric illnesses. It also outlines both the appeals and challenges of working in emergency medicine as well as potential career paths within the specialty.
Cardiac catheterization involves inserting hollow plastic tubes into the heart chambers and vessels under x-ray guidance to diagnose and treat heart disease. Common procedures include angiography to evaluate blood flow, intracardiac pressure recordings to assess pressure within chambers/vessels, and oximetry to measure oxygen saturation. Techniques for accessing the heart include the Sones method through the brachial artery and the Judkins method through the femoral or radial artery using the Seldinger technique. The roles of catheterization technicians include assisting with diagnostic and interventional procedures in the catheterization lab.
CPR involves procedures to manually maintain heartbeat and breathing when these functions have stopped. It provides oxygen to vital organs until medical treatment can restore normal heart function. CPR consists of opening the airway, providing rescue breaths, and external chest compressions to circulate blood. The goals are to keep oxygenated blood flowing to the brain and heart until definitive treatments like defibrillation can be applied. CPR is used to treat cardiac arrest from conditions like heart attacks, drug overdoses, and respiratory issues.
The document discusses trauma management and activation of a trauma team. It outlines the Advanced Trauma Life Support (ATLS) protocol which involves a primary survey to identify life-threatening injuries, followed by a secondary survey and development of a treatment plan. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure/Environment. It provides details on assessing each component and treating critical issues like tension pneumothorax, massive bleeding, and neurological impairment.
The document provides guidance on evaluating and treating polytrauma patients. It outlines the goals of trauma resuscitation which include identifying life-threatening injuries. The Advanced Trauma Life Support (ATLS) approach is recommended as a safe standardized method, beginning with the primary survey of ABCDE (airway, breathing, circulation, disability, exposure). Key assessments include mechanism of injury, vital signs, neurological status, and bleeding control. A thorough secondary survey then involves a full head-to-toe examination. Guidance is given on managing specific injuries such as abdominal trauma, with operative intervention prioritized for unstable patients or those with signs of internal bleeding.
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
- The document provides guidance on initial assessment and management of trauma patients, emphasizing the importance of quickly identifying and correcting life threats during the primary survey.
- The primary survey focuses on the ABCs - Airway, Breathing, Circulation. Oxygen should be given immediately if needed and breathing/ventilation issues addressed. Serious bleeding must be controlled.
- Only after life threats are stabilized should a more detailed exam and history be performed, and the patient transported without delay to definitive care. Rapid assessment and treatment is critical for trauma patients.
هنتعامل ازاي مع مريض عده مشاكل في القلب بعد قبل و بعد عملية جراحية؟
والاهم ازاي نشخص ان مريض حصل له ازمة قلبية و هو محجوز في قسم الجراحة بعد عملية
دي دردسة باستخدام الطريقة اللي ناقشناها في الفيديو دا
https://www.youtube.com/watch?v=f6j4VQloB6k&t=1000s
عن ازاي نتعامل مع المرضي دول
الفيديو مناسب للزملاء المتقدمين لامتحان الMRCS
و للزملاء اللي منتقلين حديثا للعمل بالمملكة المتحدة او بينو العمل فيها
عنوان فيديو المحاضرة علي اليوتيوب
https://youtu.be/V3nUgSzbf9w
تابعونا علي الصفحة الجراح
https://www.facebook.com/algarra7/
The patient is a 50-year-old male presenting with severe abdominal pain radiating to his back. He has a fever of 101.3F and is vomiting. His history includes diabetes mellitus. On examination, his abdomen is distended and tender in the right upper quadrant. Initial management should include oxygen, IV fluids, analgesia and antiemetics to make the patient more comfortable. Bedside investigations including an ECG, ABG and urinalysis should be obtained. Laboratory tests including a CBC, coagulation screen, HbA1c, liver function tests and a renal profile are needed.
This document provides guidelines for cardiac arrest treatment in adults. It outlines the steps of cardiopulmonary resuscitation (CPR), use of an automated external defibrillator, and management of shockable versus non-shockable rhythms. Key interventions include high-quality chest compressions, use of an advanced airway with capnography, epinephrine and amiodarone administration, and treatment of reversible causes of cardiac arrest.
This document provides an overview of various medical and surgical emergencies, including trauma injuries like abrasions, lacerations, avulsions, and contusions, as well as fractures, crush injuries, amputations, and hemorrhage. It also covers poisoning, myocardial infarction, and their associated signs, symptoms, and management approaches. The goals are to control bleeding, maintain circulating blood volume, prevent shock, remove or inactivate poisons, provide supportive care, and administer antidotes when available.
Anesthesiology often involves medical crises due to the complex and dynamic nature of anesthesia. Effective crisis management relies on core mental processes including observation, verification, problem recognition, prediction, decision-making, action, and reevaluation. However, not all crises are managed well, even by experienced anesthesiologists. Key elements of crisis management during anesthesia include identifying precipitating factors, looking for signs and symptoms, and taking appropriate emergency actions to address the crisis while ensuring patient oxygenation and ventilation. Proper documentation is also important.
1. The document discusses the key principles of emergency nursing including establishing an open airway, controlling hemorrhage, maintaining circulation, assessing neurological status, and rapidly assessing patients.
2. Common medical emergencies covered include acute abdomen, shock, respiratory issues, cardiac emergencies, neurological emergencies, trauma, and poisoning. Signs, symptoms, diagnostic tests, and treatment approaches are described for each condition.
3. The principles of emergency management are also summarized, which include early detection, reporting, response, providing good on-scene care and transportation to definitive care.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
1. Emergency nursing is a specialty that cares for patients during the critical phase of illness or injury when the cause is unknown. Emergency nurses treat a wide range of issues from minor to life-threatening for all ages.
2. The primary goals in emergency nursing are to assess patients, establish airways, control bleeding, and determine ability to follow commands in order to guide initial treatment and monitoring.
3. Emergency nurses must be prepared to assess and treat many different medical conditions and injuries ranging from minor illnesses to trauma emergencies in patients of all ages.
This document provides information on cardiopulmonary resuscitation (CPR) including its history, techniques, terminology, diagnosis of cardiac arrest, and guidelines from the American Heart Association (AHA). It discusses the development of CPR from the 19th century to modern times. The 2010 AHA guidelines emphasize high-quality chest compressions, early defibrillation, and post-cardiac arrest care including therapeutic hypothermia. The guidelines provide updated recommendations for compression rate, depth, ventilation rates, and other aspects of CPR for adults, children, and infants.
The document is a clinical skills guide that was created by the author for a competition. It contains instructions for over 20 different clinical skills including hand washing, taking vital signs, blood pressure measurement, various types of injections, and other procedures. The guide provides step-by-step explanations of how to properly perform each skill for assessment in the competition.
This document provides instructions for performing various clinical skills assessments including: resuscitation, assessing peripheral pulses, measuring blood pressure, examining the cardiovascular and respiratory systems, performing an electrocardiogram, assessing peak flow, and using a vitalograph machine. Key steps are outlined for each skill, such as procedures for opening an airway, performing chest compressions, locating and feeling different pulse points, correctly applying a blood pressure cuff, examining heart sounds and murmurs, and interpreting vital sign readings.
Central venous pressure (CVP) describes the blood pressure in the thoracic vena cava near the right atrium. Normal CVP ranges from 0-15 cm H2O depending on measurement point. CVP is affected by factors like volume status, respiration, and heart function. Central venous catheters are used to monitor CVP and administer IV medications and fluids long-term. Types include non-tunneled short term catheters and tunneled or implanted ports for longer term use. Nurses must properly insert, maintain, and discontinue central lines to prevent complications and ensure accurate CVP readings.
This document provides information on central venous catheterization including definitions, indications, contraindications, complications, approaches, and care. It defines a central venous catheter as a catheter placed into a large central vein to access the vena cava for purposes such as monitoring, resuscitation, and infusion of medications. The document outlines the internal jugular, subclavian, and femoral approaches and considerations for each site. It also discusses patient assessment, education, and post-procedure care including dressing, securing, and imaging of the catheter.
Early recognition of deteriorating patients is key to preventing cardiac arrest. The ABCDE approach is used to assess airway, breathing, circulation, disability, and exposure. Effective CPR involves high-quality chest compressions at a rate of 100-120 per minute with a depth of 5-6 cm, as well as use of an AED to deliver shocks for shockable rhythms like ventricular fibrillation and ventricular tachycardia. Non-shockable rhythms like asystole and pulseless electrical activity require continued CPR and administration of adrenaline every 3-5 minutes.
This document provides an overview of emergency medicine as a specialty. It discusses the top causes of death, the reception process in emergency departments, how cases are triaged from life-threatening to non-urgent, and examples of common illnesses and injuries seen in emergency medicine including chest pain, fractures, seizures, and psychiatric illnesses. It also outlines both the appeals and challenges of working in emergency medicine as well as potential career paths within the specialty.
Cardiac catheterization involves inserting hollow plastic tubes into the heart chambers and vessels under x-ray guidance to diagnose and treat heart disease. Common procedures include angiography to evaluate blood flow, intracardiac pressure recordings to assess pressure within chambers/vessels, and oximetry to measure oxygen saturation. Techniques for accessing the heart include the Sones method through the brachial artery and the Judkins method through the femoral or radial artery using the Seldinger technique. The roles of catheterization technicians include assisting with diagnostic and interventional procedures in the catheterization lab.
CPR involves procedures to manually maintain heartbeat and breathing when these functions have stopped. It provides oxygen to vital organs until medical treatment can restore normal heart function. CPR consists of opening the airway, providing rescue breaths, and external chest compressions to circulate blood. The goals are to keep oxygenated blood flowing to the brain and heart until definitive treatments like defibrillation can be applied. CPR is used to treat cardiac arrest from conditions like heart attacks, drug overdoses, and respiratory issues.
The document discusses trauma management and activation of a trauma team. It outlines the Advanced Trauma Life Support (ATLS) protocol which involves a primary survey to identify life-threatening injuries, followed by a secondary survey and development of a treatment plan. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure/Environment. It provides details on assessing each component and treating critical issues like tension pneumothorax, massive bleeding, and neurological impairment.
The document provides guidance on evaluating and treating polytrauma patients. It outlines the goals of trauma resuscitation which include identifying life-threatening injuries. The Advanced Trauma Life Support (ATLS) approach is recommended as a safe standardized method, beginning with the primary survey of ABCDE (airway, breathing, circulation, disability, exposure). Key assessments include mechanism of injury, vital signs, neurological status, and bleeding control. A thorough secondary survey then involves a full head-to-toe examination. Guidance is given on managing specific injuries such as abdominal trauma, with operative intervention prioritized for unstable patients or those with signs of internal bleeding.
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
Initial assessment of a trauma patient involves a primary survey using the ABCDE approach to identify life-threatening injuries. For the described trauma scenario, the initial steps would be:
1) Assess the airway and give high-flow oxygen. The patient's ability to speak suggests his airway is not compromised.
2) Evaluate breathing and circulation. His breathing is compromised as shown by the low respiratory rate and high pulse.
3) Expose the patient fully to identify injuries and monitor for hypothermia. The abrasion on his chest indicates potential internal injuries.
4) Begin resuscitation with IV fluids and monitor vitals closely given his unstable condition from potential internal bleeding and shock.
5)
The document provides information on a 2-day PHTLS course, including the course plan, lesson topics, and assessment sequence. It also includes review materials and a pre-test for participants. The goal is to review trauma guidelines and management criteria prior to the course.
The document provides guidance on assessing and managing patients at an emergency scene. It outlines establishing scene safety and patient priorities, performing a primary survey to assess airway, breathing, circulation, disability and environment, identifying critical patients needing rapid transport, and ongoing reassessment during transport. It emphasizes treating critical injuries, rapidly packaging and transporting critical patients to the closest appropriate facility like a trauma center.
The document discusses various aspects of trauma management including:
1. The importance of an effective trauma system with coordination between EMS, emergency departments, trauma surgeons and other specialists.
2. Key phases in trauma management including the pre-hospital phase where the closest appropriate facility is notified, and the in-hospital phase involving trauma team activation and summoning of extra assistance.
3. Triage principles for multiple or mass casualty situations.
4. The "Golden Hour" concept where immediate care within 60 minutes of injury is crucial for survival.
Multiple trauma and it’s definition , classificationShehinSalim3
This document discusses multiple trauma and its management according to ATLS (Advanced Trauma Life Support) guidelines. It defines multiple trauma as injuries to two or more body systems that endanger vital signs. The mechanisms of injury include penetrating, blunt, blast, thermal and chemical injuries. It describes the trimodal distribution of death in trauma patients and the goals of prehospital retrieval and management. The core steps of ATLS including primary survey, resuscitation, secondary survey and definitive care are outlined. Key elements like airway management, breathing, circulation, disability and exposure are explained in detail.
A 6-year-old child was injured while sledding using a car hood pulled by an ATV. The child collided with a tree. Upon arrival, responders found the child with a positive level of consciousness but increased work of breathing. The remote winter location and snowing conditions complicated the response. The child was packaged for transport back to the vehicles, as the terrain prevented vehicle access to the scene.
This orientation provides information on medical emergency management (MEM) for healthcare providers. It outlines common medical emergencies like hemorrhage, anaphylaxis, sepsis, seizures, fainting, hypoglycemia, and cardiac issues. It teaches the ABCDE approach for assessing and treating patients, including airway management, breathing support, circulation support, disability assessment, exposure and environmental checks. It details basic life support skills like chest compressions and providing rescue breaths. The orientation emphasizes the importance of having emergency equipment and medicines accessible, trained staff, and arrangements for emergency transport and referral. It presents MEM as a team effort requiring everyone to understand their roles.
Autonomic dysreflexia (AD) is an abnormal response to painful stimuli below the level of spinal cord injury that causes dangerous increases in blood pressure. It is most common in patients with injuries above T6. The main symptoms are high blood pressure and headaches. Nurses should locate the cause, which is often a full bladder or bowel, remove the stimuli, monitor blood pressure, and contact the doctor if not resolved. Educating patients on prevention through regular care and avoiding tight clothing is key to preventing future episodes.
Thoracentesis is a procedure to drain excess fluid from the pleural space between the lungs and chest wall. It involves inserting a needle through the chest wall under local anesthesia to remove fluid for analysis or to relieve symptoms like shortness of breath. Precautions are taken before and during the procedure to monitor vital signs and breathing. After the procedure, the patient is observed for complications and a chest x-ray may be taken to evaluate the drainage.
1. The document outlines the initial assessment and management of multiply injured patients, including preparation, triage, primary survey, resuscitation, secondary survey, and definitive care.
2. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure/Environmental control to identify life-threatening conditions.
3. The secondary survey includes a full physical exam and history taking to identify additional injuries before transferring the patient to definitive care. Continuous reevaluation is important to detect any deterioration.
This document provides information on cardiovascular disorders and two case studies involving patients presenting with chest discomfort.
The first case involves an elderly male patient at a nursing home with chest pain and difficulty breathing. After assessment, the patient is diagnosed with a spontaneous pneumothorax.
The second case involves a young male camper with chest pain that has worsened over 36 hours. Additional information reveals recent recreational drug use. Assessment findings include subcutaneous emphysema and early repolarization on ECG. He is diagnosed with pneumomediastinum from increased intrathoracic pressure from holding in marijuana smoke.
Both cases demonstrate use of the AMLS assessment pathway to evaluate patients with chest discomfort and identify differential diagnoses
Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10% of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death.
Critical care medicine specializes in caring for the most seriously ill patients. These patients are best treated in an intensive care unit (ICU) staffed by experienced personnel. Some hospitals maintain separate units for special populations (eg, cardiac, trauma, surgical, neurologic, pediatric, or neonatal patients). ICUs have a high nurse:patient ratio to provide the necessary high intensity of service, including treatment and monitoring of physiologic parameters.
The document discusses the evaluation and management of hypotensive trauma patients. It covers assessing the airway, breathing, circulation, disability and exposure (ABCDE) and performing a focused physical exam looking for signs of bleeding. Diagnostic tests include bedside ultrasound, pelvis x-rays, and CT scans. Pathologies addressed include hemorrhage, pneumothorax, and brain injuries. Management involves securing the airway, controlling bleeding through direct pressure and blood transfusions, and treating for shock with fluids and possible inotropes or surgery. Special considerations are given for the elderly, athletes, pregnancy and hypothermia patients.
Advanced Trauma Life Support : Part 1 - Basic Life SupportMayank Jain
For medical students, pg residents, nursing students, and other medical professionals. Contains medical jargon and advice, not for use by general public. For use only under a trained instructor.
This document provides information on autonomic dysreflexia (AD), including what it is, how to manage an acute crisis, and ways to prevent episodes. It defines AD as an abnormal response to painful stimuli below the spinal cord injury level that causes a dangerous rise in blood pressure. The document outlines assessment and treatment steps to take during a crisis, including checking for sources of pain and monitoring blood pressure. It emphasizes prevention through regular bladder and bowel care to avoid triggering AD. The document educates on educating patients and caregivers on AD management and prevention.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. Objectives
Provide opportunity for questions
Demonstrate, practice with new
equipment
◦ Zoll X Series
◦ Nexiva and Clear Link
Case-based review of:
◦ Cardiac Emergencies
◦ Bleeding and Shock
6. BD Q-Syte Split Septum
Smooth surface is
easily cleaned prior to
access
No crevices or
gaps around the
surface to harbor
bacteria
Clear housing
allows visual
assessment of
fluid path
Simple fluid path
design reduces
places for microbes to
grow
Simple Luer Lock System – eliminates multiple pieces
9. ClearLink Solution Set
Luer ports – residual 0.03cc of air
Flush line – age considerations
Disinfect site prior to access
No need to “pinch line” due to back
check valve
Flush with 1ml of saline after
medication administration
10. Preparing Solution Set
6 month – Adult: remove air from
back check valve and Y luer ports by
inverting and tapping to flush out
bubbles
0 – 6 month: remove air from back
check valve by inverting and tapping
to flush out bubbles. Disinfect each (3)
Y luer port and withdraw air using a 10
cc syringe until saline enters syringe.
15. Case 1
04:30 call for a 58 year
old female,
unresponsive, but
breathing
Patient’s husband called
911, wife had
complained of chest
discomfort/nausea then
collapsed on way to
bathroom
On arrival: you find the
patient lying on the floor,
16. Assessment Approach
What would you like to know?
What are your assessment priorities?
What are some differential diagnoses?
17. Initial Findings Vital Signs
AVPU: patient
responds to loud
voice/painful
stimulation
A: airway is patent
B: mildly
tachypnea
C: Weak, slow
radial pulses
No evidence of
trauma
Palpated pulse: 38
Spo2: not reading
RR: 26
BP: 106/68
Temp: 36.8
18. Further History
HPI:
◦ Woke to chest
pain/nausea
◦ Collapsed on way to
bathroom
◦ Assisted onto floor by
husband
◦ Regained
consciousness once
supine, but now
confused
PMHx:
◦ HTN
◦ Thyroid
◦ Arthritis
◦ Positive family cardiac
history
◦ Hyperlipidemia: diet
controlled
Meds:
◦ Metoprolol
◦ Levothroid
◦ Arthrotec
20. Detailed Exam
CNS: Alert to pain/strong voice,
improves when supine, confused to
events
CVS: C/O non-specific chest
discomfort, ECG Third Degree block,
weak peripheral pulses, skin pale,
cool, diaphoretic
RESP: A/E clear=bilat, difficulty
obtaining sats
GI/GU: C/O nausea prior to collapse
21. Treatment
ABC’s
Oxygen
Establish IV
Nitrates?
◦ Nitro patch? When do you administer?
12 Lead?
STEMI?
Transport
22. Slightly Different Situation
What if this patient’s BP was 88/60?
How would this change your treatment?
Nitrates?
12 lead/ look for STEMI?
Atropine 0.5 - 1.0 mg IV
◦ Responsive? Repeat q 3 to max of 0.04
mg/kg
Not responsive to Atropine? Establish
TCP
◦ Fentanyl?
◦ Midazolam?
Transport
◦ Destination?
23. 12 Lead Contest
Ten 12-Lead ECG’s for your
consideration
Equal number of positive for STEMI
and negative for STEMI
All are actual 12 Leads transmitted by
WFPS
Are you up for it?
45. Case 2
21:30 call for a 22
year old male,
thrown? or jumped?
from a third floor
window at the
McLaren Hotel to
sidewalk
Police arrive on
scene, report
conscious male,
requesting “rush”
On arrival,
bystanders report
approximately 5
minute period of
unconsciousness
46. Prehospital Trauma Life
Support
Recall our PHTLS approach to trauma?
“Find it, manage it, move on”
Search for life threatening injuries and
take immediate action: treat as you go
◦ If unable to manage, transport immediately
Limited interventions on scene, do this
enroute
◦ Recognizing that time taken with
interventions increases time to blood,
surgery, CT, etc.
Consider if interventions on scene
actually harm the critical patient by
increasing time to definitive care
49. Other Key PHTLS Concepts
Limited scene intervention:
◦ Control bleeds, correct life-threatening
airway/breathing/circulation concerns
◦ Assist ventilations as required
Other interventions (eg. IV and fluid
resuscitation) to occur enroute
Limited scene time/ expedited
transportation to appropriate facility
Ideally; Trauma center
50. Other Key PHTLS Concepts
For a critical patient:
◦ Vitals on scene?
◦ Detailed history on scene?
◦ Detailed physical exam on scene?
51. Back to the Patient
21:30 call for a 22
year old male,
thrown? or jumped?
from a third floor
window at the
McLaren Hotel to
sidewalk
Police arrive on
scene, report
conscious male,
requesting “rush”
On arrival,
bystanders report
approximately 5
minute period of
unconsciousness
52. Assessment Approach
What would you like to know?
What are your assessment priorities?
What are some expected injuries
given the kinematics of the fall?
53. Scene Assessment
WPS has arrived and secured scene
Scene is safe us and everyone else
Patient is in back lane and traffic has
been blocked from entering
Appears to be only one patient
EMS unit and Fire unit arrive together
◦ No need for further resources
◦ Everyone has taken standard precautions
62. Internal Hemorrhage
If suspected, quickly expose the
abdomen and pelvis
Palpate abdomen and pelvis
63. There it is!
When you palpate the pelvis the patient
groans loudly and it does not feel stable
When you expose you note that the
patient’s scrotum/inner thigh area is turning
purple
Later at hospital, staff sees this:
64. Time to go?
Set of vitals first?
Start one IV on scene?
How do we package the patient?
2 new products:
Nexiva:
Dual ports
BD Q syte luer access split septum
All in one closed system
Built in stabilization device
BD instaflash needle technology
Clearlink:
Luer access, not interlink
Needless system
Cover septum with transparent dressing and tape over – not a port. White sponge to clean off needle as it’s withdrawn from the catheter.
No interlink or needle, just luer lock
Smooth surface for cleaning with alcohol swab – 20 – 30 seconds with good rub/good scrub ie friction
We will be using 5ml posiflushes
Break seal on posiflush prior to removing white cap by pushng forward on syringe (prevents saline from shooting out)
Functions of PosiFlush: Flush Nexiva for IV lock, flush after medication administration with 1ml of saline, use to pre-prime Nexiva for use with 0-6month age group, used with trouble shooting techniques
Not to be used to mix medication – not vetted for this use, syringe volume markings are less precise
Straight on approach
Push and twist
No needles or blunt plastic cannulas required, only syringe
All our syringes have luer connects (1, 3, 10cc)
2C8537 – 3 port, DEHP Solution set
Meets the needs of the ER’s as well as the Stemi program
Hospitals plan to be converted by end of April – then they will discontinue interlink
WFPS plans to convert end of April to mid May - once ARML training complete
Best practice 20 – 30 sec good rub, good scrub with alcohol swap to disinfect port.
Refer to SWP, explain concern with air in ports re: neonatal population vs 6 month- adult population
Fire/PCP’s will need to be proficient with setting up the CLearLink
Invert and tap back check valve to remove air bubbles
Invert and tap “y” luer ports to remove air bubbles
Discuss that kinking the IV tubing to administer meds is no longer required due to the back check valves
- can use the dyed IV solution to demonstrate
0.03 cc residual air between the valves
Luer connection
Push and twist
Straight on approach
Use 10 cc syringe to remove air from ports when using with infants 0 -6 months (<8Kg) – disinfect prior to access and withdraw on syringe until fluid aspirated.
Solicit responses to assessment approach and priorities, differentials
Have FF/PCP set up ClearLink, flush tubing. Focus on aseptic technique (identified by MS’s as an issue)
Have discussion around use of nitrates. Patient meets requirements, but is the chest pain rate related? Will this patient tolerate nitrates with BP 106/68 and pulse rate of 38?
Have discussion around nitro patch admin with second nitro spray. Why not with initial spray?
Have discussion around doing 12 lead vs treating for bradycardia right away. Is this patient “stable” enough: not hypotensive, but has chest pain/ decreased LOC/ signs of poor perfusion.
Would be a good candidate for 12 lead, but need to be concerned about criticality of patient.
Nitrates? Obviously no.
12 lead/ look for STEMI? This should not take priority over treating symptomatic bradycardia in this critical patient. Could it be performed after administering Atropine while briefly waiting to see if Atropine is effective?
Fentanyl/Midazolam? Contraindicated due to BP less than 90 systolic and difficulty obtaining sats. Have discussion around why contraindicated (besides being in protocol)
- ask ACP’s about dosages if it was indicated: Fentanyl 25 mcg q 5 for first three doses then q 10
Midazolam 1 – 2.5 mg q 5 for first three doses then q 10
- ask ACP’s how they would determine Midaz dose
Have ACP’s set up X Series and use pacer (connected to rhythm generator)
Positive STEMI
Positive STEMI according to ZOLL
Negative STEMI
Discuss need for elevation in 2 or more contiguous leads
Negative STEMI
Positive STEMI
Positive STEMI
Negative STEMI
Discuss pericarditis on 12 lead
Negative STEMI per ZOLL, possible limb lead reversal
Positive STEMI
Negative STEMI
Introduce PHTLS approach to FF/PCPs and EMS providers not trained in PHTLS and explain its principles
Reinforce with EMS the importance of this approach, the need to change old methods (eg. start one IV on scene, another enroute). What is going to save the patient: taking time to get an IV on scene or getting them to blood, surgery, CT, etc.?
With certain patients does taking the time to immobilize to a backboard help or hurt them? Eg. a GSW to the lateral chest. (Delays time to surgery)
Work through approach to the patient with the algorithm. Please draw attention to the footnotes and that our system doesn’t employ all of the interventions on the list. (eg PASG)
Please emphasize that this is meant to increase awareness of PHTLS for the FF/PCPs and non-trained EMS providers is a very brief review of some concepts/vs taking the course, and to be a review for trained EMS providers.
Also draw attention (especially to Fire/PCPs) to how different it is from a BLS/ACLS approach to a medical patient
ARRIVAL ON SCENE:
- safety for all
- recognizing multiple patients and need for additional resources.
GENERAL IMPRESSION:
- global overview of the patient’s appearance, respiratory, circulatory, neurologic status as you are walking up.
- color, WOB, AVPU?
AIRWAY AND C-SPINE STABILIZATION:
- airway management and manual c-spine stabilization should be considered one step. Can rule out/rule in need for immobilization with further assessment
- lead provider to delegate c-spine control and focus on airway if enough resources on scene
- airway patent? If not- manage it: jaw-thrust, suction
- If not managed: OPA, ETT, needle cricothyroidotomy if needed.
- Don’t progress past “A” if you can’t manage it- transport!
BREATHING (VENTILATION):
- breathing? If apneic, too slow (eg less than 10) or ventilatory depth at any rate is inadequate- begin immediate BVM assist
- if breathing fast (over 20) or abnormally fast (over 30), assess ventilatory depth and consider BVM assist
- ensure patient’s airway is adequate enough with BVM assist, if further managing is needed (not done at “A”) do it now
- auscultate breath sounds
- ACP: consider chest decompression (refer to footnotes)
- Don’t progress past “B” if you can’t manage it- transport!
CIRCULATION (HEMORRHAGE AND PERFUSION):
- Hemorrhage: searching for bleeds and controlling (note using direct pressure, and PHTLS teaching that if that fails moving to tourniquet)
- if internal bleed suspected: expose thorax and abdomen and palpate for injuries. Palpate pelvis if required. Bind pelvis if required.
- Perfusion: Quick check of pulse (presence, quality, regularity), skin (color, temperature, moisture), cap refill to assess for presence of shock.
- Don’t progress past “C” if you can’t manage it or patient is in shock- transport!
DISABILITY:
- Steps A, B, and C will have evaluated (and controlled to the extent possible) factors involved in delivering O2 to lungs and perfusing vital organs. If we were unable to manage we would have transported.
- “D” will assess cerebral function and therefore, cerebral oxygenation.
- Determine GCS: Eyes opening: (spontaneous, on command, to pain, none), Best verbal response: (answers appropriately, confused, inappropriate, unintelligible, none),
Best motor response: (follows commands, localizes to pain, withdraws from pain, responds with abnormal flexion, responds with abnormal extension, no response)
- If patient unresponsive, not oriented- check pupils.
DISABILITY:
- Steps A, B, and C will have evaluated (and controlled to the extent possible) factors involved in delivering O2 to lungs and perfusing vital organs. If we were unable to manage we would have transported.
- “D” will assess cerebral function and therefore, cerebral oxygenation.
- Determine GCS: Eyes opening: (spontaneous, on command, to pain, none), Best verbal response: (answers appropriately, confused, inappropriate, unintelligible, none),
Best motor response: (follows commands, localizes to pain, withdraws from pain, responds with abnormal flexion, responds with abnormal extension, no response)
- If patient unresponsive, not oriented- check pupils.
EXPOSE/ENVIRONMENT:
- remove all clothing necessary to ensure finding all wounds. Clothing can trap/hide blood and injuries.
- secondary concern: consider how we are removing clothing of victims of crime (forensic evidence preservation)
- hypothermia in the trauma patient is a serious concern- always cover patient with a blanket.
SPINAL IMMOBILIZATION: some differences from WFPS protocol (eg foregoing immobilization in presence of penetrating trauma with no neural deficits). **However, decisions like this are to be made by PHTLS trained and certified providers only** Otherwise, follow WFPS protocol.
NO vitals, detailed history or physical exam on scene with a critical patient. Time to be spent managing life threats and packaging for rapid transport.
Solicit responses to assessment approach and priorities, differentials
Police confirm fall from third story
Solicit what they will look for in general appearance.
GENERAL APPEARANCE: As pictured, moderate amount of blood under/adjacent to head
- Right leg contorted
- Looks pale and unresponsive
AVPU: Moans to strong painful stimulation
Airway assessment (concurrent with manual c-spine immobilization)
OPA not tolerated
Provider that is immobilizing can consider jaw thrust
BREATHING:
- provider should expose, palpate, and auscultate
- respirations estimated at 28, increased WOB noted, equal chest rise, no fractures or flail noted, lungs clear
- SPO2? No- don’t spend time getting vitals during primary
HEMORRHAGE CONTROL:
Moderate bleed to head controlled with direct pressure/abd pad
No other bleeds noted
PERFUSION:
- Barely palpable radial pulse estimated at 120 +
- Skin cool, pale, moist
Question the group if the respiratory rate and pulse rate/strength/skin condition fit the picture with a moderate external bleed?
Is the patient in shock?
What else could be going on?
What else should we assess?
Should we do vitals now? NO!
Where could a massive bleed go unnoticed?
Patient’s GCS: E-2, V-2, M-4
Need to expose patient, blood can collect and be hidden in clothing.
We have had incidents at WFPS where grievous injuries were not discovered until in the ER
Don’t forget to cover the patient! Treat the shock state by keeping patient warm as possible.
If there is unexplained tachycardia/hypotension (shock state)
Try to find the cause of the shock state after exposing the patient
A pelvis fracture is capable of producing the largest internal bleed of any fracture in the body (intra-abdominal bleed). It is possible to have a internal loss of minimum 1000 ml- up to massive loss of several liters
Frequently overlooked
Picture is meant to depict bruising to buttocks/pelvis area from internal bleeding. (Not many good pictures of this!)
Take vitals now? NO- do this enroute
Start one IV on scene- NO do this enroute
Need to package for immediate transport
Package patient by binding pelvis with sheet
Absolutely need to immobilize this patient, but do it quickly and expedite transport!
Log roll the patient after binding the pelvis
Will need to straighten this patients leg- no practical way to transport otherwise, but don’t spend time using traction splints, etc in the critical patient
Key point: keep patient warm/treat for shock shock
Destination? Trauma Center
Solicit: what do we do enroute?
Reassess A, B, C
Consider need for advanced airway
Consider need for BVM assist
VITALS, finally!
Establish two large bore IV’s.
Ask the ACP’s how much fluid?
Titrate to maintain 80-90 SBP
Detailed physical exam/ SAMPLE if time permits
Solicit what patient code for the patch?
Get someone to do a verbal report for hospital.