refresher program

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

Prehospital Trauma Prehospital Trauma Life Support Life Support

PHTLSPHTLS Refresher ProgramRefresher Program

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2

Course Purpose

• Reaffirm knowledge of prehospital trauma care

• Introduce recent changes in trauma care as it affects the prehospital patient

• Demonstrate proficiency at performing skills necessary in the care of critically injured patients


Prehospital Trauma Life SupportPrehospital Trauma Life Support

Managing the Multisystem Managing the Multisystem Trauma PatientTrauma Patient

Part IPart I


Objectives

• Discuss the laws of energy and motion

• Discuss trauma associated with blunt impact and penetrating injury

• Overview of the effects of energy distribution in MVCs

• Review the kinematics of blast and violent injuries

• Use kinematics to predict injury patterns


Predicting Injury

In a 50 mph (80 km/h) MVC, what types of injuries would occur if the patient were to strike the windshield?


What type of injury patterns might you see in a frontal impact?

Frontal Impact


What types of injuries would you expect?What types of injuries would you expect?

Rear Impact


What types of injuries would you expect?

Lateral Impact


What types of injuries would you expect?

Rotational Impact


What injury patterns might you see following this crash?

Rollover


Warfare/terrorismWarfare/terrorism Industrial/residentialIndustrial/residential

What types of explosions may occur in your area?What types of explosions may occur in your area?

Blast InjuriesBlast Injuries


Three injury patternsThree injury patterns PrimaryPrimary SecondarySecondary TertiaryTertiary

Blast-Related InjuriesBlast-Related Injuries


Cause: pressure/heat wave Cause: pressure/heat wave

from blastfrom blastAffected area:Affected area:

Gas-containing organsGas-containing organs SkinSkin


Primary Blast InjuriesPrimary Blast Injuries


Cause: flying debrisCause: flying debris Affected areasAffected areas

SkinSkin Internal organsInternal organs SkeletonSkeleton


Secondary Blast InjuriesSecondary Blast Injuries


Cause: victim thrown Cause: victim thrown

against an objectagainst an object Affected areaAffected area

Area of impact orArea of impact or

referred energyreferred energy


Tertiary Blast InjuriesTertiary Blast Injuries


Low velocityLow velocityMultiple wounds from a single Multiple wounds from a single

weaponweaponCone of injuryCone of injuryA knife, ice pick, and scissors are A knife, ice pick, and scissors are

common weapons. Injuries are common weapons. Injuries are usually limited to depth and area usually limited to depth and area of penetrationof penetration

Stab WoundsStab Wounds

Would a longer knife have a largercone of injury?


Stab Wounds: Key IssuesStab Wounds: Key Issues

Type of weaponType of weapon Number of woundsNumber of wounds Depth of penetrationDepth of penetration Anatomic structures along potential pathAnatomic structures along potential path


Gunshot WoundsGunshot Wounds

How do the injuries differ when created by How do the injuries differ when created by medium- or high-velocity weapons?medium- or high-velocity weapons?


Projectiles: Key IssuesProjectiles: Key Issues

ProfileProfile FragmentationFragmentation Tumble/pathwayTumble/pathway VelocityVelocity


To what is cavitation related?To what is cavitation related?

Gunshot Wounds: CavitationGunshot Wounds: Cavitation


Entrance and exit woundsEntrance and exit wounds

Gunshot WoundsGunshot Wounds


The ultimate in fragmentation is The ultimate in fragmentation is created by shotgun woundscreated by shotgun wounds

Shotgun WoundsShotgun Wounds


Scene safety is the top priority!Scene safety is the top priority! Weapon typeWeapon type Anatomic structures along potential pathAnatomic structures along potential path Crime scene preservationCrime scene preservation

Patient care takes precedencePatient care takes precedence

Considerations forConsiderations forPenetrating TraumaPenetrating Trauma


ObjectivesObjectives

Discuss the importance of scene assessmentDiscuss the importance of scene assessment

Identify components of the primary surveyIdentify components of the primary survey

Differentiate between critical and noncritical Differentiate between critical and noncritical patientspatients

Defend the need for early transport of critical Defend the need for early transport of critical patientspatients

Describe when to perform a secondary Describe when to perform a secondary surveysurvey


It’s mid-January and you have been dispatched to It’s mid-January and you have been dispatched to a multivehicle crash on the interstate. Initial a multivehicle crash on the interstate. Initial reports indicate there are multiple patients and a reports indicate there are multiple patients and a fuel tanker is involved.fuel tanker is involved.

When does your scene assessment begin?When does your scene assessment begin?

ScenarioScenario


What are the components of scene assessment?What are the components of scene assessment?


Scene SafetyScene Safety

Ensure safety of rescuers and patientsEnsure safety of rescuers and patients Threatening situations may include:Threatening situations may include:

FireFire Electrical linesElectrical lines Hazardous materialsHazardous materials Blood and body fluidsBlood and body fluids

Can you think of any other hazards?Can you think of any other hazards?

Traffic Weapons Environmental conditions


Scene SituationScene Situation

What really happened?What really happened? What are the kinematics?What are the kinematics? How many patients involved? Ages?How many patients involved? Ages? Additional resources needed?Additional resources needed? How will patients be transported?How will patients be transported?


Your patient is the 32-year-old female Your patient is the 32-year-old female unrestrained driver who is found slumped over unrestrained driver who is found slumped over in the vehicle. She has no obvious external in the vehicle. She has no obvious external hemorrhage, is breathing rapidly, and is hemorrhage, is breathing rapidly, and is mumbling inappropriate words.mumbling inappropriate words.

What do these findings suggest?What do these findings suggest? How should you assess this patient?How should you assess this patient?

ScenarioScenario


Patient AssessmentPatient Assessment

Primary surveyPrimary survey ““Treat as you go”Treat as you go”

ResuscitationResuscitation Secondary surveySecondary survey Definitive care in the fieldDefinitive care in the field


Glasgow Coma ScaleGlasgow Coma Scale

EyesEyes ““Open your eyes”Open your eyes” Nailbed pressure or axillary tissue squeezeNailbed pressure or axillary tissue squeeze

VerbalVerbal ““What happened to you?”What happened to you?” Add “T” to score if intubatedAdd “T” to score if intubated

MotorMotor ““Hold up two fingers”Hold up two fingers” Nailbed pressure or axillary tissue squeezeNailbed pressure or axillary tissue squeeze


Glasgow Coma ScaleGlasgow Coma ScaleEye Opening Spontaneous 4

To Voice 3To Pain 2None 1

Verbal Response Oriented 5Confused 4Inappropriate Words 3Incomprehensible Words 2None 1

Motor Response Obeys Command 6Localizes Pain 5Withdraws (pain) 4Flexion (pain) 3Extension (pain) 2None 1


Expose/EnvironmentExpose/Environment

Expose patient as environment allows to Expose patient as environment allows to assess for other life-threatening conditions; assess for other life-threatening conditions; then preserve/maintain body heatthen preserve/maintain body heat Life-threatening conditions missed because Life-threatening conditions missed because

of failure to adequately expose the patientof failure to adequately expose the patient Failing to preserve body heat and to Failing to preserve body heat and to

consider environmental conditionsconsider environmental conditions


Breathing

Airway

Kinematics

Circulation

Disability

Expose/Environment

Simultaneous AssessmentSimultaneous Assessment


Decision MakingDecision MakingTrauma-related incident

Scene assessment

Primary survey

Life -threatening or multisystem injuries

NoYes

Initiate rapid transport

Reassess

Secondary survey

Secondary survey

Reassess

Manage injuries as appropriate

Initiate transport


A 16-year-old loses control of his bicycle on A 16-year-old loses control of his bicycle on gravel. Your patient is found on the side of the gravel. Your patient is found on the side of the road holding his right wrist. Multiple abrasions road holding his right wrist. Multiple abrasions are noted on his face and upper extremities. are noted on his face and upper extremities. The scene is safe.The scene is safe.

ScenarioScenario


Primary SurveyPrimary Survey

A:A: PatentPatent

B:B: Normal; BS clearNormal; BS clear

C:C: Minor bleeding from chin laceration; radial Minor bleeding from chin laceration; radial pulse normal; skin warm, pink, and drypulse normal; skin warm, pink, and dry

D:D: GCS score 15GCS score 15

E:E: Deformity noted to right wristDeformity noted to right wrist

How do you proceed?How do you proceed?


Secondary SurveySecondary Survey

Vital signsVital signs AMPLE historyAMPLE history Head-to-toe examHead-to-toe exam

Performing a secondary survey on a critical Performing a secondary survey on a critical patient prior to initiating resuscitationpatient prior to initiating resuscitation

Failing to complete a secondary survey on a Failing to complete a secondary survey on a noncritical patientnoncritical patient


Head-to-Toe ExamHead-to-Toe Exam

Systematic and CompleteSystematic and Complete ObservationObservation

What do we What do we look look for?for?

AuscultationAuscultation What do we What do we listenlisten for? for?

PalpationPalpation What do we What do we feelfeel for? for?


Definitive Care in the FieldDefinitive Care in the Field

PackagingPackaging Spinal immobilization if indicatedSpinal immobilization if indicated Splint musculoskeletal injuriesSplint musculoskeletal injuries Dress woundsDress wounds


TransportationTransportation

Closest Closest appropriateappropriate facility facility In general, bypass closest facility to reach trauma In general, bypass closest facility to reach trauma

centercenter Receiving facilities should be determined by local Receiving facilities should be determined by local

protocolprotocol ModeMode

GroundGround AeromedicalAeromedical


Trauma Center CandidatesTrauma Center Candidates

Triage to trauma centers determined by:Triage to trauma centers determined by: Physiologic criteriaPhysiologic criteria Anatomic criteriaAnatomic criteria Mechanism of injuryMechanism of injury Preexisting conditionsPreexisting conditions

Follow local protocolFollow local protocol


Pain ManagementPain Management

Consider analgesia for:Consider analgesia for: Isolated extremity injury Isolated extremity injury Spinal fractureSpinal fracture

NarcoticsNarcotics Titrate in small increments IVTitrate in small increments IV Beware of ventilatory depression and vasodilation Beware of ventilatory depression and vasodilation

(hypotension)(hypotension)


You are dispatched to a motorcycle and vehicle You are dispatched to a motorcycle and vehicle collision. Bystanders report that the motorcycle collision. Bystanders report that the motorcycle was traveling at about 40 mph (65 km/h) when was traveling at about 40 mph (65 km/h) when a car pulled in front of the motorcycle. You find a car pulled in front of the motorcycle. You find the patient lying on the pavement 30 ft (9 m) the patient lying on the pavement 30 ft (9 m) away from the crash. His helmet is heavily away from the crash. His helmet is heavily damaged and has been removed by a damaged and has been removed by a bystander.bystander.

ScenarioScenario


FindingsFindings

Gurgling ventilationsGurgling ventilations Blood is seen in the upper airwayBlood is seen in the upper airway Ventilations are rapid and laboredVentilations are rapid and labored Patient is cyanoticPatient is cyanotic

Is this airway compromised?Is this airway compromised?


You arrive on the scene of a single vehicle MVC. You arrive on the scene of a single vehicle MVC. Your patient is a 25-year-old female who is Your patient is a 25-year-old female who is trapped upright in the driver’s seat. Her VR is 36 trapped upright in the driver’s seat. Her VR is 36 and she is cyanotic. Gurgling sounds do not and she is cyanotic. Gurgling sounds do not improve with suctioning or manual maneuvers. improve with suctioning or manual maneuvers. The fire department estimates that it will be 10 The fire department estimates that it will be 10 minutes before she is extricated.minutes before she is extricated.

How would you manage her airway at this point? How would you manage her airway at this point?

ScenarioScenario


Face-to-Face IntubationFace-to-Face Intubation

Oral endotracheal intubation Oral endotracheal intubation cancan be accomplished be accomplished by using nontraditional by using nontraditional methodsmethods


Your patient is a 35-year-old construction Your patient is a 35-year-old construction worker who fell 25 ft (7.6 m) and landed on his worker who fell 25 ft (7.6 m) and landed on his head. His GCS score is 3. He is apneic and is head. His GCS score is 3. He is apneic and is being ventilated with a BVM. Three attempts at being ventilated with a BVM. Three attempts at orotracheal intubation are unsuccessful.orotracheal intubation are unsuccessful.

What are the airway management options at What are the airway management options at this point?this point?

ScenarioScenario


Alternative Airway Procedures Alternative Airway Procedures

Laryngeal mask airway (LMA)Laryngeal mask airway (LMA) Digital intubationDigital intubation Retrograde intubationRetrograde intubation Percutaneous transtracheal ventilation (PTV)Percutaneous transtracheal ventilation (PTV) Surgical cricothyrotomySurgical cricothyrotomy


At a college baseball game a 22-year-old third At a college baseball game a 22-year-old third baseman is struck in the head by a line drive. baseman is struck in the head by a line drive. Upon your arrival his GCS score is 7 (E-1, V-Upon your arrival his GCS score is 7 (E-1, V-1, M-5). His teeth are clenched and he is 1, M-5). His teeth are clenched and he is vomiting.vomiting.

How would you manage his airway?How would you manage his airway?

ScenarioScenario



Describe the pathophysiology of shockDescribe the pathophysiology of shock Identify the types of shockIdentify the types of shock Differentiate between signs of compensated Differentiate between signs of compensated

and decompensated shockand decompensated shock Discuss the role of hemorrhage control, Discuss the role of hemorrhage control,

hypothermia, PASG, and volume resuscitation hypothermia, PASG, and volume resuscitation in shock managementin shock management


ShockShock

““The patient is in The patient is in shock!shock!””What does this term mean?What does this term mean?


Staged DeathStaged DeathHypoperfusionHypoperfusion

Cellular hypoxiaCellular hypoxia

Anaerobic metabolismAnaerobic metabolism

Cell deathCell death

Organ failureOrgan failure

Patient deathPatient death


What conditions can interfere with each What conditions can interfere with each component of the Fick principle?component of the Fick principle?

Alveolus

Capillaries

Red blood cells

CapillariesKidney

O2

O2


Your patient is a 30-year-old woman who lost Your patient is a 30-year-old woman who lost control of her vehicle, which then struck a light control of her vehicle, which then struck a light pole. The patient was unrestrained. There is pole. The patient was unrestrained. There is significant damage to the vehicle. You find the significant damage to the vehicle. You find the patient slumped over in the driver’s seat. You patient slumped over in the driver’s seat. You see that the steering wheel is bent. The scene see that the steering wheel is bent. The scene is safe.is safe.

ScenarioScenario



A:A: PatentPatent

B:B: Fast; BS clearFast; BS clear

C:C: No external hemorrhage; weak and rapid radial No external hemorrhage; weak and rapid radial pulse; cool and diaphoretic skinpulse; cool and diaphoretic skin

D:D: GCS score 14 (E-4, V-4, M-6); anxiousGCS score 14 (E-4, V-4, M-6); anxious

E:E: Bruising across abdomen and right thigh deformityBruising across abdomen and right thigh deformity

Vitals: VR, 24; pulse, 118; BP, 112/82Vitals: VR, 24; pulse, 118; BP, 112/82

Is this patient in shock? Why?Is this patient in shock? Why?


What is the most likely cause of the patient’s shock?What is the most likely cause of the patient’s shock?

Why is the patient’s BP normal?Why is the patient’s BP normal?



Estimated Blood LossEstimated Blood Loss

Approximate internalBone blood loss (mL)

Rib 125Radius or ulna 250–500Humerus 500–750Tibia or fibula 500–1000Femur 1000–2000Pelvis 1000–massive


Hemorrhagic Shock Hemorrhagic Shock


Your patient is a 27-Your patient is a 27-year-old male who was year-old male who was working in a grain silo. working in a grain silo. His left leg became His left leg became entrapped in an auger. entrapped in an auger. After a 45-minute After a 45-minute extrication process, the extrication process, the fire department fire department manages to release his manages to release his mangled leg. mangled leg.

ScenarioScenario



A:A: PatentPatent

B:B: Marked tachypneaMarked tachypnea

C:C: Moderate hemorrhage from extensive soft tissue Moderate hemorrhage from extensive soft tissue injury to lower left leg; no radial pulse; very fast, injury to lower left leg; no radial pulse; very fast, weak carotid pulse; pale, cool, diaphoretic skinweak carotid pulse; pale, cool, diaphoretic skin

D:D: GCS score 12 (E-3, V-3, M-6)GCS score 12 (E-3, V-3, M-6)


What stage of shock is the patient in?What stage of shock is the patient in?


A 27-year-old male dock worker was pinned between a fork lift and a loading dock. Upon your arrival, the patient is lying supine on the ground complaining of severe lower abdominal pain. The ambient temperature is 35° F (1° C). You are 25 minutes from the trauma center.

ScenarioScenario



A:A: PatentPatent

B:B: VR fastVR fast

C:C: No external hemorrhage; rapid and weak radial No external hemorrhage; rapid and weak radial pulse; pale, cool, moist skinpulse; pale, cool, moist skin


E:E: Significant pain on palpation of lower abdomen and Significant pain on palpation of lower abdomen and pelvispelvis

What are the principles of shockWhat are the principles of shockmanagement?management?


PASGPASG IndicationsIndications

Suspected pelvic fractures Suspected pelvic fractures with with

SBP less than 90 mm HgSBP less than 90 mm Hg Suspected intraperitoneal Suspected intraperitoneal

hemorrhage with hemorrhage with

SBP less than 90 mm HgSBP less than 90 mm Hg Suspected retroperitoneal Suspected retroperitoneal

hemorrhage with hemorrhage with

SBP less than 90 mm HgSBP less than 90 mm Hg SBP less than 60 mm HgSBP less than 60 mm Hg

What are contraindications for PASG?


Volume ResuscitationVolume Resuscitation

Preferably two large-bore peripheral IVs Preferably two large-bore peripheral IVs Lactated Ringer’s Lactated Ringer’s Warmed fluid if possible (102° F/39 ° C)Warmed fluid if possible (102° F/39 ° C) Initial bolusInitial bolus

Adults: 1 to 2 LAdults: 1 to 2 L Pediatric: 20 mL/kgPediatric: 20 mL/kg

Delaying transport of critical patients to initiate IVs on sceneDelaying transport of critical patients to initiate IVs on scene




Part IIPart II



Review the anatomy of the chestReview the anatomy of the chest Discuss the mechanics of breathingDiscuss the mechanics of breathing Detail the assessment processDetail the assessment process Cover the management of: Cover the management of:

Rib fractureRib fracture Flail chest injuryFlail chest injury Pulmonary contusionPulmonary contusion Pneumothorax (open and tension)Pneumothorax (open and tension) HemothoraxHemothorax Blunt cardiac injuryBlunt cardiac injury


Responding to a call at a police station, you Responding to a call at a police station, you encounter a 19-year-old male complaining of encounter a 19-year-old male complaining of chest pain and dyspnea. You learn that your chest pain and dyspnea. You learn that your patient was kicked in the chest during a fight.patient was kicked in the chest during a fight.

What injuries could occur with this mechanism?What injuries could occur with this mechanism?

ScenarioScenario



A:A: PatentPatent

B:B: Left chest pain during inspiration; BS equal, Left chest pain during inspiration; BS equal, VR fastVR fast

C:C: No external bleeding, normal pulse rateNo external bleeding, normal pulse rate


What injuries can you rule out?What injuries can you rule out?

How should this patient be managed?How should this patient be managed?


Your patient sustained a close-range shotgun Your patient sustained a close-range shotgun blast to the abdomen. A segment of bowel is blast to the abdomen. A segment of bowel is eviscerated.eviscerated.

How are eviscerations managed?

ScenarioScenario


A 24-year-old female fell down a flight of stairs. A 24-year-old female fell down a flight of stairs. She is 36 weeks pregnant. She is complaining of She is 36 weeks pregnant. She is complaining of severe back pain. severe back pain.

What physiologic changes occur during What physiologic changes occur during pregnancy?pregnancy?

What are the common causes of injury What are the common causes of injury in the pregnant patient?in the pregnant patient?

ScenarioScenario



A:A: PatentPatent

B:B: NormalNormal

C:C: Pulse rapid; skin warm and dryPulse rapid; skin warm and dry

D:D: AnxiousAnxious

E:E: No obvious injury notedNo obvious injury noted

Vitals: pulse, 114; VR, 20; BP, 92/56Vitals: pulse, 114; VR, 20; BP, 92/56

Are these findings due to trauma or pregnancy?Are these findings due to trauma or pregnancy?


After immobilization to a long backboard, After immobilization to a long backboard, reassessment shows her radial pulse to bereassessment shows her radial pulse to be140 and weak. Her BP is 80/60.140 and weak. Her BP is 80/60.

What could explain these findings?What could explain these findings?

How would you manage this patient?How would you manage this patient?

ScenarioScenario


Long BackboardLong Backboard



Define primary and secondary brain injuryDefine primary and secondary brain injury Discuss how assessment findings suggest Discuss how assessment findings suggest

traumatic brain injurytraumatic brain injury Discuss management for suspected traumatic Discuss management for suspected traumatic

brain injurybrain injury


Traumatic Brain Injury (TBI)Traumatic Brain Injury (TBI)

Commonly occurs in young adultsCommonly occurs in young adults Major contributing cause of trauma deathsMajor contributing cause of trauma deaths Many survivors have permanent disabilityMany survivors have permanent disability


SkullPeriosteum

Dura mater} One functional layer

Arachnoid membrane

Pia mater (directly attachedto brain surface and not removable

Vessels in subarachnoid

space

Epidural space

Subdural space

Subarachnoid space

AnatomyAnatomy


The BrainThe Brain


PathophysiologyPathophysiology

Primary brain injuryPrimary brain injury Secondary brain injurySecondary brain injury

Systemic causesSystemic causes Intracranial causesIntracranial causes

Can you name some examples of systemic Can you name some examples of systemic and intracranial causes?and intracranial causes?


Your patient is a 12-year-old Little League Your patient is a 12-year-old Little League baseball player who was struck in the head by baseball player who was struck in the head by a line drive. How could TBI affect:a line drive. How could TBI affect: Airway?Airway? Breathing?Breathing? Circulation?Circulation? Disability?Disability?

ScenarioScenario



Bystanders report a 5-minute loss of Bystanders report a 5-minute loss of consciousness. The child is now awake and consciousness. The child is now awake and complaining of a headache and has vomited complaining of a headache and has vomited once.once.A: IntactA: IntactB: NormalB: NormalC: NormalC: NormalD: GCS score 14 (E-4, V-4, M-6), PERLD: GCS score 14 (E-4, V-4, M-6), PERL

What is a concussion?What is a concussion?


You are called to a local bar where a 22-year-You are called to a local bar where a 22-year-old male has been in a fight. Bystanders state old male has been in a fight. Bystanders state that your patient was beaten with a pool cue. that your patient was beaten with a pool cue. The scene is safe.The scene is safe.

ScenarioScenario



A:A: Snoring noisesSnoring noises

B:B: VR slow and shallow; BS equalVR slow and shallow; BS equal

C:C: No external hemorrhage, radial pulse fastNo external hemorrhage, radial pulse fast

D:D: GCS score 6 (E-1, V-1, M-4); pupils R>L, GCS score 6 (E-1, V-1, M-4); pupils R>L, sluggishsluggish

E:E: Multiple hematomas on scalp and faceMultiple hematomas on scalp and face


What injuries do these findings suggest?What injuries do these findings suggest?


You are called to the You are called to the scene of a rollover MVC scene of a rollover MVC where a 16-year-old where a 16-year-old female was ejected from female was ejected from the vehicle. You see the the vehicle. You see the patient lying supine on patient lying supine on the ground. Her the ground. Her breathing is noisy and breathing is noisy and rapid. She has a large rapid. She has a large scalp laceration. You scalp laceration. You identify no hazards.identify no hazards.

ScenarioScenario



A:A: Snoring, gurgling noisesSnoring, gurgling noises

B:B: VR rapid and shallow; BS decreased VR rapid and shallow; BS decreased bilaterallybilaterally

C:C: Moderate bleeding from scalp; rapid, bounding Moderate bleeding from scalp; rapid, bounding carotid pulsecarotid pulse


Vitals: VR, 38; pulse, 124; BP, 80/PVitals: VR, 38; pulse, 124; BP, 80/P


What life-threatening conditions do you identify?What life-threatening conditions do you identify?

What could be causing her shock?What could be causing her shock?



ManagementManagement

Goals for the TBI patient include preventing and Goals for the TBI patient include preventing and reversing causes of secondary brain injuryreversing causes of secondary brain injury



Identify life-threatening conditions associated Identify life-threatening conditions associated with spinal traumawith spinal trauma

Recognize the indications for spinal Recognize the indications for spinal immobilizationimmobilization

Discuss the principles of spinal immobilizationDiscuss the principles of spinal immobilization

Describe use of rapid extricationDescribe use of rapid extrication


Spinal TraumaSpinal Trauma

As many as 15,000 to 20,000 spinal injuries As many as 15,000 to 20,000 spinal injuries occur annuallyoccur annually

The most common age is 16 to 35 years oldThe most common age is 16 to 35 years old CausesCauses

MVCsMVCs FallsFalls Penetrating injuriesPenetrating injuries Sports injuriesSports injuries


You are called to a public pool for a 16-year-old You are called to a public pool for a 16-year-old male who sustained an injury while diving. Upon male who sustained an injury while diving. Upon your arrival he has been removed from the pool.your arrival he has been removed from the pool.

ScenarioScenario



A:A: PatentPatent

B:B: Rapid and shallowRapid and shallow

C:C: Slow heart rate; weak radial pulse; warm Slow heart rate; weak radial pulse; warm

extremitiesextremities

D:D: GCS score 15, loss of motor and sensory GCS score 15, loss of motor and sensory

function in extremitiesfunction in extremities

E:E: No other obvious injuriesNo other obvious injuries

What is the life-threatening problem?What is the life-threatening problem?


Sensory AssessmentSensory Assessment

Nipple line = T4Nipple line = T4 Umbilical line = T10 Umbilical line = T10



ScenarioScenario


A 28-year-old male has been shot in the neck A 28-year-old male has been shot in the neck by his girlfriend. by his girlfriend.

ScenarioScenario



A:A: PatentPatent

B:B: Fast; BS equalFast; BS equal

C:C: Copious external hemorrhage from neck wound, Copious external hemorrhage from neck wound, radial pulse fast and weakradial pulse fast and weak

D:D: GCS score 15; no neurological deficits in GCS score 15; no neurological deficits in extremitiesextremities

E:E: Expanding hematoma to left side of neckExpanding hematoma to left side of neck

When is spinal immobilization indicated When is spinal immobilization indicated for penetrating trauma?for penetrating trauma?


Unstable spinal fractures from penetrating Unstable spinal fractures from penetrating trauma are extremely raretrauma are extremely rare

Life-threatening conditions take priorityLife-threatening conditions take priority

Penetrating Trauma

Neurological deficit/complaint?

NoYes

IMMOBILIZE IMMOBILIZATION NOT INDICATED

Rapid transportRapid transport


You are called to a nightclub where a 35-year-You are called to a nightclub where a 35-year-old female has fallen down a flight of stairs. old female has fallen down a flight of stairs. Your patient denies neck and back pain but Your patient denies neck and back pain but complains of severe left ankle pain. You smell complains of severe left ankle pain. You smell alcohol on her breath.alcohol on her breath.

ScenarioScenario



A:A: PatentPatent


C:C: Minor bleeding from small scalp laceration; Minor bleeding from small scalp laceration; normal radial pulsenormal radial pulse

D:D: Slurred speech; GCS score 15Slurred speech; GCS score 15

E:E: Grossly deformed left ankleGrossly deformed left ankle

When is spinal immobilization indicated When is spinal immobilization indicated

for blunt trauma?for blunt trauma?


Blunt Trauma

Altered level of consciousness (GCS less than 15)

NoYes

IMMOBILIZE

Rapid transport

Spinal pain or tenderness?or

Neurological deficit or complaint?or

Anatomic deformity of spine?

NoYes

IMMOBILIZE

Rapid transport

Concerning mechanism of

injury?


Concerning Mechanism of InjuryConcerning Mechanism of Injury

Violent impact to the head, neck, torso, Violent impact to the head, neck, torso, or pelvisor pelvis

Sudden acceleration, deceleration, or lateral Sudden acceleration, deceleration, or lateral bending forces to neck or torsobending forces to neck or torso

Any fallAny fall Ejection or fall from any motorized or human-Ejection or fall from any motorized or human-

powered transport devicepowered transport device Shallow-water diving incidentShallow-water diving incident


Distracting InjuriesDistracting Injuries

Any injury that may have the potential to Any injury that may have the potential to impair the patient’s ability to appreciate other impair the patient’s ability to appreciate other injuriesinjuries Long bone fractureLong bone fracture Suspected visceral injurySuspected visceral injury Large laceration, degloving, or crush injuryLarge laceration, degloving, or crush injury Large burnsLarge burns Any other injury that produces acute functional Any other injury that produces acute functional

impairmentimpairment


Inability to CommunicateInability to Communicate

Speech or hearing impairedSpeech or hearing impaired Speaks foreign languageSpeaks foreign language Small childrenSmall children


Presence of:Evidence of alcohol/drugs

orDistracting injury

orInability to communicate

When in doubt, immobilize!When in doubt, immobilize!

Concerning Mechanism of Injury

NoYes

IMMOBILIZE

IMMOBILIZATION NOT INDICATED

Rapid transport

Transport

NoYes

IMMOBILIZATION NOT INDICATED

Transport


You are called to the scene of a multivehicle You are called to the scene of a multivehicle crash on a highway. After your patient’s vehicle crash on a highway. After your patient’s vehicle was rear-ended, it was propelled into the was rear-ended, it was propelled into the vehicle in front of it. The vehicle has moderate vehicle in front of it. The vehicle has moderate damage. The driver was unrestrained and the damage. The driver was unrestrained and the windshield is spider-webbed.windshield is spider-webbed.

On the basis of kinematics, why should On the basis of kinematics, why should spinal injury be suspected? spinal injury be suspected?

ScenarioScenario



A:A: PatentPatent


C:C: Normal radial pulseNormal radial pulse


E:E: Abrasion on foreheadAbrasion on forehead

What are the indications for rapid extrication?What are the indications for rapid extrication?


The patient is complaining of neck pain. The patient is complaining of neck pain.

What role does a cervical collar play What role does a cervical collar play in spinal immobilization?in spinal immobilization?

How is spinal immobilization performed?How is spinal immobilization performed?





Part IIIPart III



Discuss the pathophysiology of musculoskeletal Discuss the pathophysiology of musculoskeletal traumatrauma

Discuss the management of musculoskeletal Discuss the management of musculoskeletal trauma in isolated trauma and multisystem trauma in isolated trauma and multisystem traumatrauma


You are called to the scene where an intoxicated You are called to the scene where an intoxicated male has stumbled and put his hand through a male has stumbled and put his hand through a window. On your arrival you see a large amount of window. On your arrival you see a large amount of blood and broken glass by the front door. The blood and broken glass by the front door. The police direct you to a 40-year-old male sitting in a police direct you to a 40-year-old male sitting in a chair, bleeding heavily from the upper arm. On chair, bleeding heavily from the upper arm. On examination you see a laceration to the antecubital examination you see a laceration to the antecubital fossa with copious, bright-red bleeding.fossa with copious, bright-red bleeding.

ScenarioScenario


What, if any, life-threatening injuries What, if any, life-threatening injuries are present?are present?

What are some examples of life-threatening What are some examples of life-threatening musculoskeletal injuries?musculoskeletal injuries?

What ways exist to control the bleeding?What ways exist to control the bleeding?

Does this injury require rapid packaging Does this injury require rapid packaging and transport?and transport?

ScenarioScenario


A 28-year-old female fell while skiing. Ski patrol A 28-year-old female fell while skiing. Ski patrol has brought her to the lodge. She complains of has brought her to the lodge. She complains of severe right thigh pain.severe right thigh pain.

ScenarioScenario



A:A: PatentPatent

B:B: Normal Normal

C:C: No external hemorrhage; normal pulse rate; No external hemorrhage; normal pulse rate; skin warm and dryskin warm and dry


What are your conclusions based What are your conclusions based on these findings?on these findings?



You find a swollen angulated right thigh.You find a swollen angulated right thigh.

How much blood could a patient lose from How much blood could a patient lose from this type of injury?this type of injury?

Is this enough to cause shock?Is this enough to cause shock?

How would you manage this injury?How would you manage this injury?


Your patient is a 45-year-old male pedestrian Your patient is a 45-year-old male pedestrian who was struck by an SUV. He smells of who was struck by an SUV. He smells of alcohol.alcohol.

ScenarioScenario



A:A: PatentPatent

B:B: VR rapid and shallow; clear BSVR rapid and shallow; clear BS

C:C: Blood oozing from multiple soft tissue Blood oozing from multiple soft tissue injuries; weak and rapid radial pulseinjuries; weak and rapid radial pulse


When you gently stress his pelvis, crepitus When you gently stress his pelvis, crepitus is noted and the patient screams in pain.is noted and the patient screams in pain.


What are your conclusions based on the What are your conclusions based on the primary survey?primary survey?

What are your management priorities What are your management priorities for this patient?for this patient?



A 22-year-old male crashed while riding a A 22-year-old male crashed while riding a mountain bike. Because of the remote location, mountain bike. Because of the remote location, you reach the patient about 1½ hours after the you reach the patient about 1½ hours after the injury occurred.injury occurred.

A:A: PatentPatent

B:B: VR slightly increasedVR slightly increased

C:C: No external hemorrhage; rapid and weak radial No external hemorrhage; rapid and weak radial pulsepulse


E:E: Deformities noted to left upper arm andDeformities noted to left upper arm andto both lower legsto both lower legs

Scenario & Primary SurveyScenario & Primary Survey



VR, 24; pulse, 122; BP, 104/72VR, 24; pulse, 122; BP, 104/72

There is no abdominal or pelvic tenderness.There is no abdominal or pelvic tenderness.

How do you explain these findings?How do you explain these findings?


Table of Estimated Blood LossTable of Estimated Blood Loss

Approximate internalBone blood loss (mL)

Rib 125Radius or ulna 250–500Humerus 500–750Tibia or fibula 500–1000Femur 1000–2000Pelvis 1000–massive


A 70-year-old woman slipped on some ice and A 70-year-old woman slipped on some ice and fallen down a staircase. On your arrival she is fallen down a staircase. On your arrival she is complaining of pain in her left wrist and left complaining of pain in her left wrist and left ankle. On examination, deformities are found in ankle. On examination, deformities are found in both extremities.both extremities.

ScenarioScenario



A:A: PatentPatent

B:B: VR slightly fastVR slightly fast

C:C: Moderate hemorrhage from oozing and open Moderate hemorrhage from oozing and open ankle; irregular pulseankle; irregular pulse


VR, 22; pulse, 105; BP, 110/70VR, 22; pulse, 105; BP, 110/70

Complains of pain at fracture sitesComplains of pain at fracture sites


Are life-threatening injuries present?Are life-threatening injuries present?

How are you going to manage this patient?How are you going to manage this patient?




Identify, manage, and differentiate critical and Identify, manage, and differentiate critical and noncritical burnsnoncritical burns

Identify how chemical and electrical burns differ Identify how chemical and electrical burns differ from thermal burnsfrom thermal burns

Discuss assessment and care of CO inhalationDiscuss assessment and care of CO inhalation

Address the priorities for assessing and Address the priorities for assessing and managing heat-related injuriesmanaging heat-related injuries

Discuss the priorities for assessing and Discuss the priorities for assessing and managing cold-related injuriesmanaging cold-related injuries


You are called to care for a patient who has You are called to care for a patient who has been burned while fueling his lawn mower. As been burned while fueling his lawn mower. As you approach, you see a 65-year-old male with you approach, you see a 65-year-old male with burns to his right arm and anterior chest. The burns to his right arm and anterior chest. The fire is now extinguished.fire is now extinguished.

ScenarioScenario



A:A: PatentPatent

B:B: Normal; clear BSNormal; clear BS

C:C: No external bleeding; normal pulse rateNo external bleeding; normal pulse rate

DLDL GCS score 15GCS score 15

E:E: Bright-red skin with blisters on chest and entire Bright-red skin with blisters on chest and entire right armright arm

What are the key issues in assessing thermal burns?


Rule of NinesRule of Nines

What percent of BSA is burned?What percent of BSA is burned?

9%

18%9% 9% 18%

18%18%

1% 18%

18%9% 9%

18%

1%13.5% 13.5%


What are other factors in assessing patients What are other factors in assessing patients with thermal burns?with thermal burns?

How are you going to treat this patient?How are you going to treat this patient?

When is pain management indicated?When is pain management indicated?



ResuscitationResuscitation

Parkland formula Parkland formula 4 mL 4 mL ×× BSA BSA ×× weight (kg) weight (kg)

Calculate the Parkland formula for this patient (wt=70 kg)Calculate the Parkland formula for this patient (wt=70 kg)

How is this administered?How is this administered?


Wound ManagementWound Management

Superficial (first degree)Superficial (first degree) Generally no field treatment neededGenerally no field treatment needed

Partial thickness/full thickness (second Partial thickness/full thickness (second degree/third degree)degree/third degree) Dry, clean dressings preferredDry, clean dressings preferred

Do not apply ointments or salvesDo not apply ointments or salves

Do not attempt to break blistersDo not attempt to break blisters

Do not remove clothing that is melted to skinDo not remove clothing that is melted to skin


Pain ManagementPain Management

Administer analgesics if indicatedAdminister analgesics if indicated Intermittent IV doses of narcoticsIntermittent IV doses of narcotics Nitrous oxideNitrous oxide

Moist dressingsMoist dressings ONLYONLY if less than 10% BSA burned if less than 10% BSA burned If more than 10%, wet dressings can cause If more than 10%, wet dressings can cause

hypothermiahypothermia


You respond to a structure fire/explosion. On your You respond to a structure fire/explosion. On your arrival you see a 40-year-old male who has just arrival you see a 40-year-old male who has just been removed from the building and appears been removed from the building and appears unresponsive. unresponsive.

What are your first priorities?

ScenarioScenario



A:A: Stridor noted; oral mucosa appears redStridor noted; oral mucosa appears red

B:B: Rapid; BS equal; rhonchi in all fieldsRapid; BS equal; rhonchi in all fields

C:C: No external bleeding; weak and rapid pulseNo external bleeding; weak and rapid pulse


E:E: Partial-thickness burns of upper chest (9% BSA)Partial-thickness burns of upper chest (9% BSA)

What are your immediate concerns?What are your immediate concerns?

Why is he showing signs and Why is he showing signs and symptoms of shock?symptoms of shock?


Possible InjuriesPossible Injuries

Airway and pulmonary burns secondary to Airway and pulmonary burns secondary to inhalation of superheated gasesinhalation of superheated gases

Associated injuriesAssociated injuries CO poisoningCO poisoning BurnsBurns

How are you going to treat this patient?How are you going to treat this patient?


Special Burn SituationsSpecial Burn Situations

Chemical burnsChemical burns What is different about these burns?What is different about these burns? How would you treat chemical burns?How would you treat chemical burns?


Electrical BurnsElectrical Burns

Current burnsCurrent burnsArc (flash) injuriesArc (flash) injuriesContact burnsContact burns

How do you manage these injuries?


Patients Requiring Patients Requiring Burn CentersBurn Centers

Inhalation injuriesInhalation injuries Partial-thickness burns more than 10%Partial-thickness burns more than 10% Full-thickness burnsFull-thickness burns Burns to face, hands, feet, genitalia, perineum, or Burns to face, hands, feet, genitalia, perineum, or

major jointsmajor joints Electrical burnsElectrical burns Chemical burnsChemical burns Burn injury in compromised patientBurn injury in compromised patient Other special situationsOther special situations


Burns: SummaryBurns: Summary

DO NOT DO NOT become a victim yourselfbecome a victim yourself Airway management and oxygenation are Airway management and oxygenation are

criticalcritical Early shock after burns points to other injuriesEarly shock after burns points to other injuries Avoid hypothermiaAvoid hypothermia Transport patient to an appropriate facilityTransport patient to an appropriate facility Pain managementPain management Fluid therapy as indicatedFluid therapy as indicated


Environmental InjuriesEnvironmental Injuries


You are doing race coverage for a 10-km (6-mile) You are doing race coverage for a 10-km (6-mile) race. The temperature is 90° F (32° C) with 90% race. The temperature is 90° F (32° C) with 90% humidity. On finishing the race, a 55-year-old humidity. On finishing the race, a 55-year-old male collapsed. On your arrival you find the male collapsed. On your arrival you find the patient confused.patient confused.

What places this patient at high risk What places this patient at high risk for a heat emergency?for a heat emergency?

How would you treat him?How would you treat him?

ScenarioScenario


Other Heat-Related InjuriesOther Heat-Related Injuries

How do the presentations and How do the presentations and management differ for each of the management differ for each of the following?following?

Heat crampsHeat cramps Heat exhaustionHeat exhaustion Heat strokeHeat stroke


HypothermiaHypothermia

Hypothermia begins when body temperature Hypothermia begins when body temperature reaches 95° F (35° C)reaches 95° F (35° C) Shivering beginsShivering begins Heart rate, ventilations, and BP begin to decreaseHeart rate, ventilations, and BP begin to decrease CNS impairmentCNS impairment

Below 90° F (32° C), shivering ceasesBelow 90° F (32° C), shivering ceases Below 82° F (28° C), ventricular fibrillation Below 82° F (28° C), ventricular fibrillation

possiblepossible


You respond to the You respond to the scene where a 34-year-scene where a 34-year-old male has slipped in old male has slipped in mud and fallen into a mud and fallen into a sewer. You are on the sewer. You are on the scene when, after 10 scene when, after 10 minutes, the rescue minutes, the rescue team brings up a limp team brings up a limp body.body.

ScenarioScenario



A:A: Water in oropharynxWater in oropharynx

B:B: ApneicApneic

C:C: No active hemorrhage; very slow and weak No active hemorrhage; very slow and weak carotid pulsecarotid pulse

D:D: Unresponsive; GCS score 3 (E-1, V-1, M-1)Unresponsive; GCS score 3 (E-1, V-1, M-1)

E:E: Clothing is wetClothing is wet

How are you going to manage this patient?How are you going to manage this patient?



Identify injury patterns common to geriatric Identify injury patterns common to geriatric and pediatric trauma patientsand pediatric trauma patients

Identify anatomic and physiologic differences Identify anatomic and physiologic differences in pediatric and geriatric patientsin pediatric and geriatric patients

Discuss the importance of obtaining history Discuss the importance of obtaining history for pediatric and geriatric trauma patientsfor pediatric and geriatric trauma patients

Discuss the management of pediatric and Discuss the management of pediatric and geriatric trauma patientsgeriatric trauma patients


Pediatric TraumaPediatric Trauma

Injury is the most frequent cause of deathInjury is the most frequent cause of death Approximately 20% to 40% of deaths may be Approximately 20% to 40% of deaths may be

preventablepreventable

What are the common mechanisms of injury in children?What are the common mechanisms of injury in children?


You respond to a call You respond to a call for an injured child. You for an injured child. You arrive to find a 5-year-arrive to find a 5-year-old boy on the ground old boy on the ground next to his bicycle. next to his bicycle.

How will your assessment differ for children?

ScenarioScenario


Pediatric Vital SignsPediatric Vital Signs

Age 0-2 months3 months6 months

1 year2 years3 years4 years5 years6 years7 years8 years9 years

Mean Weight

(kg)3.06.08.010.012.514.517.018.521.023.025.028.0

PulseRange

100-170100-170100-17090-17090-17070-13070-13070-13060-11060-11060-11060-110

Hypotensive Systolic Blood

Pressure606060707070708080808080

VentilatoryRange30-6030-6030-6030-6030-6020-4020-4020-4015-3015-3015-3015-30



A:A: Snoring noisesSnoring noises

B:B: Rapid and shallow ventilationsRapid and shallow ventilations

C:C: No obvious bleeding; weak and rapid pulseNo obvious bleeding; weak and rapid pulse

D:D: GCS score 10 (E-2, V-3, M-5); contusion to GCS score 10 (E-2, V-3, M-5); contusion to

foreheadforehead

E:E: Air is 50° F (10° C) and dampAir is 50° F (10° C) and damp



Fluid ManagementFluid Management

AccessAccess Peripheral IV preferredPeripheral IV preferred Intraosseous (second-line)Intraosseous (second-line)

AdministrationAdministration Bolus 20 mL/kg and repeat up to 3 timesBolus 20 mL/kg and repeat up to 3 times


You are on the scene with an 85-year-old You are on the scene with an 85-year-old woman who slipped and fell in her home. woman who slipped and fell in her home.

How does the assessment of the elderly How does the assessment of the elderly patient differ from the younger adult?patient differ from the younger adult?

ScenarioScenario



A:A: OpenOpen

B:B: VR rapid with slight wheezeVR rapid with slight wheeze

C:C: No obvious bleeding; normal and regular pulseNo obvious bleeding; normal and regular pulse

D:D: Unable to move legs due to pain; GCS score 12 Unable to move legs due to pain; GCS score 12 (E-3, V-4, M-5)(E-3, V-4, M-5)

E:E: No obvious external traumaNo obvious external trauma

How are you going to manage thisHow are you going to manage thispatient?patient?


Special Considerations Special Considerations in the Elderlyin the Elderly

Preexisting disease may increase with agePreexisting disease may increase with age Age and general physical condition greatly Age and general physical condition greatly

influence response to injuryinfluence response to injury Medical historyMedical history

Prescription medicationsPrescription medications

Trauma may be the result of a medical emergencyTrauma may be the result of a medical emergency


You are dispatched to the scene of a pedestrian You are dispatched to the scene of a pedestrian struck by a vehicle. Law enforcement and the struck by a vehicle. Law enforcement and the fire department are en route. It is an overcast fire department are en route. It is an overcast spring day with a temperature of 50° F (10° C). spring day with a temperature of 50° F (10° C).

ScenarioScenario


What are your initial concerns What are your initial concerns as you arrive on the scene?as you arrive on the scene?


Ensure the safety of the prehospital Ensure the safety of the prehospital care providers and the patient.care providers and the patient.

What are the safety concerns What are the safety concerns with this scene?with this scene?

OverviewOverview


Assess the scene situation to determine Assess the scene situation to determine the need for additional resources.the need for additional resources.

What additional resources may be needed?What additional resources may be needed?

OverviewOverview


Recognize the kinematics that Recognize the kinematics that produced the injuries.produced the injuries.

What are the factors relating What are the factors relating to kinematics implied here?to kinematics implied here?

OverviewOverview


Use the primary survey approach to identify Use the primary survey approach to identify life-threatening conditions.life-threatening conditions.

What are the key concepts of theWhat are the key concepts of theprimary survey?primary survey?

Breathing

Airway

Kinematics

Circulation

Disability

Expose/Environment

OverviewOverview


Provide appropriate management while Provide appropriate management while maintaining cervical spine stabilization.maintaining cervical spine stabilization.

The patient has noisy ventilations and blood is The patient has noisy ventilations and blood is draining from the oropharynx.draining from the oropharynx.

What should be considered when What should be considered when managing this airway?managing this airway?

OverviewOverview


The patient’s ventilatory rate is 6 and is shallow. The patient’s ventilatory rate is 6 and is shallow. Cyanosis is visible on the patient’s face and Cyanosis is visible on the patient’s face and fingers. There is bruising across the chest and fingers. There is bruising across the chest and decreased breath sounds are heard on the left. decreased breath sounds are heard on the left. GCS score is 7 (E-2, V-1, M-4).GCS score is 7 (E-2, V-1, M-4).

Support ventilation and deliver oxygen to Support ventilation and deliver oxygen to maintain SpOmaintain SpO22 at 95% or more. at 95% or more.

How can this be accomplished?How can this be accomplished?

OverviewOverview


Control any Control any significant significant external external hemorrhage.hemorrhage.

OverviewOverview


Direct pressure controls the external Direct pressure controls the external hemorrhage from the right arm. The radial pulse hemorrhage from the right arm. The radial pulse is weak and rapid at about 140 beats/min. The is weak and rapid at about 140 beats/min. The patient is pale, cold, and clammy. There is patient is pale, cold, and clammy. There is crepitus and tenderness on palpation of the crepitus and tenderness on palpation of the pelvis and a left thigh deformity consistent with pelvis and a left thigh deformity consistent with a left midshaft femur fracture.a left midshaft femur fracture.

How would you manage these findings?How would you manage these findings?

OverviewOverview


Provide basic shock therapy, including restoring Provide basic shock therapy, including restoring and maintaining normal body temperature and and maintaining normal body temperature and appropriately splinting musculoskeletal injuries.appropriately splinting musculoskeletal injuries. Consider the use of the PASG for patients with Consider the use of the PASG for patients with decompensated shock (SBP less than 90 mm decompensated shock (SBP less than 90 mm Hg) and suspected pelvic, intraperitoneal, or Hg) and suspected pelvic, intraperitoneal, or retroperitoneal hemorrhage; and in patients with retroperitoneal hemorrhage; and in patients with profound hypotension (SBP less than 60 mm profound hypotension (SBP less than 60 mm Hg).Hg).

OverviewOverview


Maintain manual spinal stabilization until the Maintain manual spinal stabilization until the patient is immobilized onto a long backboardpatient is immobilized onto a long backboard..

When is spinal immobilization indicated?When is spinal immobilization indicated?

OverviewOverview


For critically injured patients, initiate transport For critically injured patients, initiate transport to the closest appropriate facility within 10 to the closest appropriate facility within 10 minutes of arrival on scene.minutes of arrival on scene.

10

PlatinumPlatinum10 minutes10 minutes

Golden Golden PeriodPeriod

OverviewOverview


Initiate warmed Initiate warmed intravenous fluid intravenous fluid replacement en route replacement en route to the receiving facility.to the receiving facility.

What are the considerations with prehospital fluid therapy?

OverviewOverview


Ascertain the patient’s medical history and perform Ascertain the patient’s medical history and perform a secondary survey when life-threatening problems a secondary survey when life-threatening problems have been satisfactorily managed or have been have been satisfactorily managed or have been ruled out.ruled out.

OverviewOverview


Above all, Above all,

do no further harm.do no further harm.


Fundamental PrinciplesFundamental Principles

Rapid assessmentRapid assessment Key field interventionsKey field interventions Rapid transport to the closest appropriate Rapid transport to the closest appropriate

facilityfacility


PHTLS Works!PHTLS Works!


QUESTIONS?

refresher program

Education