refresher course c

7/27/2019 Refresher Course C

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Prehospital Trauma Life Support

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Trauma

Mega-Trends

4thEdition



PHTLS Refresher Course

Trauma Today & Tomorrow

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PHTLS Trauma Update

Objectives.Current ATLS guidelines.

Controversial topics (PASG, IV, etc.).Possible changes based on availableresearch.

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Trends

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Injury Prevention

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Motor Vehicle Injury PreventionRequires stricter:

Safety belt use.Helmet use.Child safety seat use.Enforcement of impaired driving laws.Guidelines for improved vehicle safetydevices and designs.

Opposition to increased speed limits.Reduces availability and consumptionof drugs and alcohol.

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Prevention of Violence &

Violent InjuriesDevelop violence prevention andintervention programs (Safe Kids, etc.).Improve recognition, referral, treatment, andtracking of victims of violence.Improve recognition, referral, treatment, andtracking of violent people.Increase awareness of, and education about,firearm safety.

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continued...



Reduce use of drugs and alcohol byviolent and potentially violent persons.

Provide early childhood interventionprograms.

Educate and protect potential victims of violent injury.

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cont’d. Prevention of Violence &

Violent Injuries



Home & Leisure Injury

PreventionEducate public about potential

hazards in the home.Enforce design standards to makehome equipment safer.

Support community efforts in first aidand basic life support (BLS).

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Occupational Injury Prevention

Maintain federal safety standards.

Reward injury prevention programs.

Establish injury surveillance systems.

Expand coverage of workers underfederal programs.

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Injury prevention should be

everyone’s goal!

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Intraosseous Infusion

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Has become widely acceptedstandard for pediatric care.

Quick technique.

Relatively safe and easy to perform.



Pulse Oximetry

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Measures:Estimation of pulmonary oxygenation.RBC oxygen saturation.

Does not measure:Tissue oxygenation.Oxygen delivery.Aerobic versus anaerobic metabolism.



Ventilation Evaluation

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Hospital care: PaCO 2.

Prehospital: Respiratory rate. 12 - 20 per minute = Good.Greater than 20 = Questionable.

Less than 10 = Bad.



Bloodborne Infections

Hepatitis is still more hazardousto EMS than the HIV/AIDS virus.

Less contamination required.One contact may cause infection.

Hepatitis B vaccines are available.

Death rate among health carepersonnel annually is much higherthan for HIV/AIDS.

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Prevention of Bloodborne Infections

Prior immunization.

Body surface isolation (BSI) skin

protection.Wash carefully after contact.

Consult physician after significantcontact.

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Patient Movement

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Log roll only when necessary.

Roll only as high as required.

Use scoop when possible.




Controversies

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Pneumatic Anti-Shock Garment (PASG)

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Increases systemic vascular resistance.

Performs auto-transfusion.

Tamponades bleeding.

Stabilizes fractures.



PASG Limitations

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Prolong scene time.

Cause metabolic acidosis and/orcompartment syndrome.

Limit physical examination.

Worsen thoracic injury outcomes.



Hypertonic Saline

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Replenishes intravascular space andcirculating volume.

Causes rapid fluid shift from intracellularand interstitial compartments intointravascular space.

Current evidence does not support routineuse of hypertonic solutions.

continued...



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May prove useful in post-traumatichypotension and head injury.

Hypertonic solutions may have somepotential benefit.

Hypertonic Saline cont’d.




Intubation/Airway Management

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Double-Lumen Airway Devices

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EsophagealTracheal

Combitube(ETC)

Pharyngeal

Tracheal

Lumen Airway

(PTL)



Ease of use.

Placement done by blind technique.

Provides a more definitive airway than basictechniques.

May be placed in the esophagus or trachea.

High success, and low complication rates.

Can be placed without C-spine manipulation.

Advantages of the ETC/PTL

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Limited studies on prehospital use.

Cannot be used in children or adults under4 feet in height.

Not nearly as definitive as ET intubation.

Contraindications:

Presence of a gag reflex.Conscious or unconscious and breathing patients.Obstructed airway.Caustic ingestion or esophageal disease.

Disadvantages of the ETC/PTL

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Endotracheal Intubation

ET intubation remains the airwayof choice.



Summary

Trauma prevention.Intraosseous Infusion.Pulse oximetry.Bloodborne infections.Spine fractures.

Pneumatic Anti-Shock Garment.Hypertonic saline.Double-lumen airway devices.

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refresher course c

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