Who is the acute care provider?

(3)

Critical care providers

emergency medicine providers

primary care providers

beginnign from the time that traumatic injury occurs; golden hour refers to the following 60 minutes

Importance: interventions durin gthis time often dictate morbidity and mortality outcome

Define the trimodal distribution of mortality.

(3)

prehospital: usually due to devastating head or vascular injury

emergency department: head, chest, or abdominal injury

intensive care unit: frequently a result of systemic response to traumatic injury

Penetrating: localized, obvious

blunt: underlying structure, less obvious

Who are the prehospital personnnel?

What are they doing?

first responders: EMT, Fire Rescue, Paramedics, Police

Initial evaluation

Stabilize

Transportation to appropriate facility

"Eyes of the Emergency Department"

A airway

B breathing

C circulation

D disability/neurological status

Exposure: expose entire pt so you can see very part

What type of things are you looking for when accessing neck and thorax?

(5)

deviated trachea

chest wall movement, symmetry

sucking chest wound

neck or chest crepitus

rib fracture, sternal fracture

What is a subcutaneous emphysema?

How can you assess on physical exam?

rupture of pulmonary system- tracheal/esophageal or lung space into tissue

oxygen in subcutaneous tissue so will push on skin and hear crackling

if pregnant women having difficulty with circulation: what do you do?

why?

roll patient on L hip

taken pressure off vena cava

How do you assess for volume status?

(3)

What is Beck's triad?

What is it assessing?

Cardiac Tamponade

triad of low arterial blood pressure, jugular venous distention, and distant, muffled heart sounds

DISABILTY/NEURO EXAM

What are you looking for in the abbreviated neuro exam?

LPAM

level of consciousness

pupillary reactivity,

anisocria

motor functioning

What is the golden standard for determining neuro status?

What is imp about the neuro status?

Glasgow Coma Scale

Imp to continuously check

What is a trauma score?

What does it consist of?

physiologic scoring system

helps to determine if patient needs transport to trauma center

usually the resuscitiation physician, maybe the trauma surgeon

assigns duties of trauma team assistants

performs primary survey

receives information directly from prehospital personannel

directes primary care, ABCDS

1. Who performs the primary survery?

2. What are they looking for?

3. Name 5 things patient is looking for.

1. Team Captain

2. Rapid evaluation of lethal injuries

3. size, sex, body build, color, patient alertness

What is included in the pre-hospital report?

(7)

EPLIMBA

Evaluation and treatment of airway patency

pusle and respirations/vital signs

level of consciousness

immobilization

mechanism of injury

blood loss at scene

anatomic sites of apparent injury

What are assignments of the team members?

(6)

RPPIPD

restraining the pt

providing an easily visualized pt- cutting off clothing

palpation of a radial or brachial pulse

insertion of a large bore (14-16g) IV catheter into each arm, drawing pertinent bloods and transporting to laboratory

Placement of ECG monitor leads: avoid subclavian area incase of central line need

documentation of event

HEAD/SCALP

scalp injury

eyes/pupils

ears

mouth

nose

basal skull fracture

(located behind ear)

SECONDARY SURVERY

What do you do for neck and thorax?

xrays may have been taken

need to clear cervical spine, evaluate endotracheal tube placement- to clear cervical spine prefer, lateral, AP, odontoid views of neck

Need CXR: AP and alteral preferred

Consider stabilty of spine when choosing x-ray views, CT scan, MRI studies, what do you need to see

SECONDARY SURVERY:

ABDOMEN EXAM: what are you looking for?

any notes gross abnormality (seatbelt sign)

note contusion

NG tube placement, if only for prophylaxis

if worsening hypotension with unknown source for blood loss, consider diagnostic peritoneal lavage, also can utilize echo to evaluate for retroperitineal hemorrhage

SECONDARY SURVEY:

Gential area: What are you examining?

examine external, internal, perineum, scortal area, DO A RECTAL EXAM

foley placement, unless contraindicated

Must x-ray abdominal /pelvic area to evaluate bony structures, often can be used to assess internal injury

Consider KUB/urethrogram if blood noted on exam, signficant pelvic injury

necessary x-rays to evaluate

are injuries surgical emergencies

What do you consider when assssing hemorrhagic shock?

(5)

IMP SLIDE!!

LOC

Skin color

magnitude of peripheral pulses

HR (worse when tachy)

BP (SBP-DBP)

Class I: blood loss up to 15% of volume, may not be accompanied by signs and symptoms.

Class II: increasing blood loss, signs and symptoms may become apparent, blood loss to 25%

Class III: obvious shock, gross hypotension recognized as hypoperfusion

Class IV: blood loss over 40% volume, decreased BP, HR >140, decreased pulse pressure- fluid/colloid replacement critical

1. go back to the beginning: if the pt's condition worsens, return to step one, remember ABCs

2. BE THOROUGH- attention to detail by every team member is essential

3. BE SKILLED: time is essetnial, never attempt to perform any procedure unless you are adequately skilled

4. BE A TEAM PLAYER

5. BE SUSPICIOUS: always beawre of mechanism of injury

TRIAGE:

How do you classify an injury?