Basic Trauma Life Support

Definition of Trauma• A term derived from the Greek for “WOUND”

• It refers to any bodily injury.

• It defined as tissue injury due to direct effects of externally applied energy. Energy may be mechanical, thermal, electrical, electromagnatic or nuclear.

• An emotional wound or shock that creates substantial, lasting damage to the psychological development of a person, often leading to neurosis.

• An event or situation that causes great distress and disruption.

• Included:burns, drowning, smoke, inhalation, slip & fall.

• Excluded: poisoning/toxic ingestion.

Primary Survey (Initial Assessment)

1. General Impression

2. Airway with Cervical Spine Stabilization

3. Breathing

4. Circulation

5. Disability or Neurologic Status (Level of Consciousness)

6. Expose or Environment

General Impression

• Impression of the patient's condition that is formed on first approach, based on patient's environment, chief complaint, and appearance.

Airway with Cervical Spine Stabilization

• Protection of the spine & spinal cord is the important management principle.

• Neurological exam alone does not exclude a cervical spine injury.

• Always assume a cervical spine injury in any patient with multi-system trauma, especially with an altered level of consciousness or blunt injury above the clavicle.

Breathing & Ventilation

• Airway patency does not assure adequate ventilation

Circulation

1. Blood Volume & Cardiac Output

a. level of consciousness

b. skin color

c. Pulse

2. Bleeding

• external bleeding is identified & controlled in the

• primary survey.

Disability or Neurologic Status (Level of Consciousness)Simple Mnemonic to describe level of

consciousness

A - Alert

V - Responds to Vocal stimuli

P - Responds to Painful stimuli

U - Unresponsive to all stimuli

Expose or Environment• Remove the patient’s clothes because exposure of the trauma

patient is critical to finding all injuries. Blood can collect in clothing and go undetected. Although it is important to expose the patient, hypothermia is a serious problem in the prehospital setting. Only what is necessary should be exposed to the outside environment.

• It is the patient’s body temp that is most important, not he comfort of the health care provider.

• Intravenous fluid should be warm.

• Warm environment (room tem) should be maintained.

• Early control of hemorrhage.

Transport

If life-threatening conditions are identified during primary survey, the patient should be rapidly packaged after initiating limited field intervention. Unless extenuating circumstances exist, limit scene time to 10 minutes or less.

Secondary Survey (Focused History and Physical Exam)

Rapid Trauma Assessment • It is a quick method, (60 to 90 seconds),

to identify hidden and obvious injuries in a trauma victim. The goal is to identify and treat immediate threats to life that may not have been obvious during an initial assessment.

DCAP-BTLS

D - Deformities

C - Contusions

A - Abrasions

P -Penetrations

B - Burns

T - Tenderness

L - Lacerations

S - Swelling

Focused History AssessmentS - signs and symptomsA - allergiesM - medicationsP - past or pertinent

medical historyL - last oral intakeE - events

Closed Soft Tissue Injuries Management (RICE)

R - restI - iceC -compressionE - elevation

Bleeding Management

D - Direct Pressure E - ElevationP - Pressure T - Tourniquets

Bandaging and Splinting

Function of Bandaging

1. First Aid

• Reduce Patient Pain/Discomfort

2. Protection of wound

• Dressing of open wound

• Decrease incidence of wound infection

• Stabilization or compression of tissues

3. Absorption of Exudates

• Enhancement of wound healing

4. Debridement of Wound

5. Immobilize Body Part

• Support or protection of body parts coaptation (e.g. splints, casts) prevent weight bearing

General Principle of Bandaging

• Must not be too lose • or too tight

Must not restrict circulation

• Should be absorptive if necessary

• Should avoid distortion of tissues

• Never leave foot or toes outside of bandage

• Requires serial examination and changing

Principles of Splinting

1. Reduce inflammation from trauma

2. Control of pain

3. Prevent further injury

4. Provision of external support

5. Protection of healing structures