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DR FARZAD PANAHI. ASSOCIATE PROFESSOR OF GENERAL SURGERY HEAD OF TRAUMA AND DISASTER RESEARCH CENTER (BMSU) BAQUITOLLAH MEDICAL SCHOOL UNIVERSITY. ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT. OVERVIEW. SCENE SIZE-UP BTLS PRIMARY SURVEY TRANSPORT DECISION AND CRITICAL INTERVENTIONS

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DR FARZAD PANAHI

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Dr farzad panahi

DR FARZAD PANAHI

ASSOCIATE PROFESSOR OF GENERAL SURGERY

HEAD OF TRAUMA AND DISASTER RESEARCH CENTER

(BMSU)

BAQUITOLLAH MEDICAL SCHOOL UNIVERSITY


Assessment and management of the trauma patient

ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT


Overview

OVERVIEW

  • SCENE SIZE-UP

  • BTLS PRIMARY SURVEY

  • TRANSPORT DECISION AND CRITICAL INTERVENTIONS

  • DETAILED EXAM

  • ONGOING EXAM


Scene size up

SCENE SIZE-UP

  • SCENE SAFETY

  • TOTAL NUMBER OF PATIENTS

  • ESSENTIAL EQUIPMENT

  • ARE ADDITIONAL RESOURCES NEEDED

  • MECHANISM OF INJURY


Essential equpment

ESSENTIAL EQUPMENT

  • PERSONAL PROTECTIVE EQUIPMENT

  • BACKBOARD, STRAPS, AND HEAD IMMOBILIZER

  • C-COLLAR

  • OXYGEN & AIRWAY EQUIPMENT

  • TRAUMA BOX


Btls primary survey

BTLS PRIMARY SURVEY

  • INITIAL ASSESSMENT

  • RAPID TRAUMA SURVEY OR FOCUSED EXAM


Initial assessment

INITIAL ASSESSMENT

  • GENERAL IMPRESSION OF PATIENT ON APPROACH

  • CONTROL C-SPINE AND ASSESS LEVEL OF CONSCIOUSNESS

  • AIRWAY

  • BREATHING

  • CIRCULATION


Do not interrupt the initial assessment except for

DO NOT INTERRUPT THE INITIAL ASSESSMENT EXCEPT FOR

  • Airway Obstruction

  • Cardiac Arrest


Levels of mental status

LEVELS OF MENTAL STATUS

  • A – ALERT

  • V – RESPONDS TO VERBAL STIMULI

  • P – RESPONDS TO PAIN

  • U – UNRESPONSIVE


Priority patients

PRIORITY PATIENTS

  • Dangerous mechanism of injury

  • History reveals:

    • Loss of consciousness

    • Difficulty breathing

  • Abnormal Initial Assessment

  • Poor general impression


  • Rapid trauma survey or focused exam

    RAPID TRAUMA SURVEY OR FOCUSED EXAM?

    • Dangerous generalizedmechanism or altered mental status = Rapid Trauma Survey

    • Dangerous focused mechanism suggesting isolated injury or no significant life threat = Focused Exam


    Rapid trauma survey

    RAPID TRAUMA SURVEY

    • Brief assessment of head, neck, chest, abdomen, pelvis, and extremities to identify immediate life threats

    • SAMPLE history

    • Baseline vital signs

    • If altered LOC do brief neurological exam


    Sample history

    SAMPLE HISTORY

    • S – SYMPTOMS

    • A – ALLERGIES

    • M –MEDICATIONS

    • P – PAST MEDICAL HISTORY

    • L – LAST MEAL

    • E – EVENTS PRIOR TO INJURY


    If altered loc

    IF ALTERED LOC

    • DO BRIEF NEURO EXAM TO RULE OUT INCREASED INTRACRANIAL PRESSURE

      • LOC

      • PUPILS

      • GCS

      • SIGNS OF CUSHINGS REFLEX

      • MEDICAL IDENTIFICATION DEVICES?


    Finishing the btls primary survey

    FINISHING THE BTLS PRIMARY SURVEY

    • Check the patient’s back

    • Transfer the patient to the backboard

    • Load-and-Go situation = immediate transport


    Load and go situations

    LOAD-AND-GO SITUATIONS

    • Significant mechanism of injury or poor general impression

    • Initial Assessment reveals

      • Altered mental status

      • Abnormal airway or respiration

      • Abnormal circulation (shock or uncontrolled bleeding)


    Load and go situations continued

    LOAD-AND-GO SITUATIONS continued

    • Signs discovered during Rapid Trauma Survey suggesting impending shock

      • Abnormal chest exam

      • Tender, distended abdomen

      • Unstable pelvis

      • Bilateral femur fractures


    Interventions that may be done on scene

    INTERVENTIONS THAT MAY BE DONE ON-SCENE

    • Initial airway management

    • Oxygen/ventilatory assistance

    • CPR

    • Control major bleeding

    • Seal sucking chest wounds


    Interventions that may be done on scene1

    INTERVENTIONS THAT MAY BE DONE ON-SCENE

    • Stabilize flail chest

    • Decompress tension pneumothorax

    • Stabilize impaled objects

    • Immobilize spine


    Detailed exam

    DETAILED EXAM

    • Detailed exam to find injuries other than life-threats

    • Provides baseline for future decisions

    • Performed en route on critical patients

    • Record your findings


    Detailed exam1

    DETAILED EXAM

    • Record vital signs

    • Neurological exam

    • Consider monitors

    • Do head-to-toe exam

    • Further bandaging and splinting

    • Continually observe


    Detailed neurological exam

    DETAILED NEUROLOGICAL EXAM

    • LOC

    • Pupils

    • Motor function

    • Sensation

    • If altered mental status, perform Glasgow Coma Score


    Ongoing exam

    ONGOING EXAM

    • Ask patient about changes in symptoms

    • Reassess mental status

    • Reassess ABCs

    • Reassess abdomen

    • Reassess identified injuries

    • Reassess interventions


    Communications with medical direction

    COMMUNICATIONS WITH MEDICAL DIRECTION

    • Contact early if patient is critical

    • Be concise and to the point

    • Give your destination and ETA

    • Identify any special preparations that should be done before your arrival


    Pitfalls

    PITFALLS

    • Approaching the patient before performing a Scene Size-Up

    • Trying to do too much on-scene

      • Attempting to “stabilize” the patient in the field


    Summary

    SUMMARY

    • Scene Size-Up

    • BTLS Primary Survey

      • Initial Assessment

      • Rapid Trauma Survey or Focused Exam

    • Critical interventions and transport decision

    • Detailed Exam

    • Ongoing Exam


    Questions

    QUESTIONS?


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