Trauma & Basic life support

Trauma & Basic life supportPaleerat Jariyakanjana, MDEmergency physicianFaculty of medicine, Naresaun university5/2/2016

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ScopeInitial assessmentFirst aidBasic life supportAdvance trauma life support

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Initial assessment

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extremely challenging environmentavailable and prepared at any time for any patient with any complaintunfamiliar

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Clinical scope of the problem

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Primary surveyAirwayBreathingCirculation

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HistoryL: LocationO: OnsetD: DurationC: CharacteristicsR: Refer(region)A: Association symptomF: Factor(+/-)T: Treatment

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Sign over: 8

Physical examinationTPRRRBPO2 satGCSPain score

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DispositionConsultationSerial evaluationAdmission/discharge

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First aid

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1669

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1669

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http://www.thaiemsinfo.com/

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EMS 1669

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EMS1669 29

Thai First Aid

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Basic life support

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Lay rescuerHealth Care ProviderB L SB a s I c L i f e S u p p o r t

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Detect 1669

No ResponseNo BreathingAgonal Gaps ???

Dispatcher

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Identify Agonal Gasps -updated

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CALL 1669

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Use as soon as possible No benefit: if CPR of 90 to 180 s. before Defib.

AEDClass IIa, LOE C-LD

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A utomated E xternal D efibrillatorP ublic A ccessD efibrillator

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Lay Rescuer Not TrainedLay Rescuer TrainedHealthcare Providerscene safetyCheck for responseActivated EMS 1669, On speaker phoneCall for help or Resuscitation teamFollow the dispatchers instructionsCheck no breathing or only gaspingCheck pulseHand only CPRCPR Rescue breathsCPR + Rescue breathsFollow and answer the dispatchers instructionsUse AED under dispatchers instructionsUse AED / Defib. as indicated

Basic Life Support Sequence

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Compression-only CPRUntrained Lay RescuerBy Dispatcher guide

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Hand position during compressions

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lower half of the sternum42

Chest Compression Depth -updated2010 > 5 cm20155 6 cm Push Hard !Class I, LOE C-LD

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Chest Compression Rate -updated2010 > 1002015100 120 Push Fast !Class IIa, LOE C-LD

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Fully Recoil !do not leaning on chestClass IIa, LOE C-LD

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Minimizing Interruptions ! updated

Achieve chest compression fraction (CCF) unprotected airway 60%0903060120

CCF = 105120= 87.5

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Summary: Chest compressionPosition: lower half of the sternumDepth: 5-6 cmRate: 100-120Fully Recoil: do not leaning on chestMinimizing Interruptions in Chest Compressions

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Respiratory Rate (No advanced airway)

Avoid Hyperventilation !30 : 2Class IIa, LOE C-LD

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Application Enhance Resuscitation

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CPR tempo

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EMS1669Emer+I lert U

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OK

EMERGENCY VOLUNTEER now

slide to viewLay responders arrived first in 44.6%Time to first shock was improved

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Advance trauma life support

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Initial assessmentPreparationTriagePrimary survey (ABCDEs)ResuscitationAdjuncts to primary survey and resuscitationConsideration of the need for patient transferSecondary survey (head-to-toe evaluation and patient history)Adjuncts to the secondary surveyContinued postresuscitation monitoring and reevaluationDefinitive care

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Primary surveyAirway maintenance with cervical spine protectionBreathing and ventilationCirculation with hemorrhage controlDisabilityExposure/Environmental control

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Airway maintenance with cervical spine protectionable to communicate verbally patentsigns of airway obstructionSecretion or blood per mouth/noseStridorinspection for foreign bodiesfacial, mandibular, or tracheal/laryngeal fracturessevere head injuries definitive airway

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Airway maintenance with cervical spine protectiontraumatic incidentloss of stability of the cervical spine should be assumedprotection of the patients spinal cord with appropriate immobilization devicesEvaluation and diagnosis of specific spinal injury, including imaging, should be done later.

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Resuscitation

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Resuscitation

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Resuscitation

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Breathing and ventilationneck and chestjugular venous distention, position of the trachea, and chest wall excursionAuscultation, visual inspection, palpation, and percussion

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Excursion: 61

Breathing and ventilationInjuriestension pneumothoraxflail chest with pulmonary contusionmassive hemothoraxopen pneumothorax

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Excursion: 62

Breathing and ventilationTension Pneumothoraxhyperresonant note on percussiondeviated tracheaabsent breath sounds over the affected hemithorax

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63

Breathing and ventilationOpen Pneumothorax (Sucking Chest Wound)2/3 of the diameter of the trachea

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The human trachea has an inner diameter of about 25 millimetres (1 in)

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Breathing and ventilationFlail Chest and Pulmonary Contusion2 adjacent ribs fractured in 2 placesparadoxical motion

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Breathing and ventilationMassive Hemothorax>1500 mL of blood200 mL/hr for 2-4 hours

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Resuscitationsupplemental oxygenmask-reservoir device 11 L/min

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ResuscitationTension pneumothoraxImmediate decompression ICD

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ResuscitationOpen pneumothoraxocclusive dressingICD

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ResuscitationMassive hemothorax

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intercostal drain70

ResuscitationFlail Chest and Pulmonary Contusionadequate oxygenationadminister fluids judiciouslyprovide analgesia

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Judicious: 71

Circulation with hemorrhage controllevel of consciousnessskin colorpulse

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Circulation with hemorrhage controlBleedingExternal/internalExternal hemorrhagedirect manual pressure Tourniquetsmassive exsanguinationrisk of ischemic injury only be used when direct pressure is not effectiveHemostats: damage to nerves and veins

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Circulation with hemorrhage controlBleedingmajor areas of internal hemorrhagechest, abdomen, retroperitoneum, pelvis, and long bonesidentified by physical examination and imagingManagement: as cause

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Resuscitation2 large-caliber (minimum of 16G in an adult) IV catheters, upper-extremity peripheral IV accessWarmed crystalloids, bolus of 1-2 L of isotonic solutionunresponsive to initial crystalloid therapy: blood transfusion

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Resuscitationbaseline hematologic studies + G/MUPTBlood gases a/o lactate level: assess shock

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Disability (neurologic evaluation)level of consciousnesspupillary size and reaction

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best motor response77

Exposure and environmental controlcompletely undressedKeep warmWarm blankets or an external warming deviceWarm intravenous fluids and a warm environment

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Cervical collarsmaintains cervical immobilizationmeasures the pt for proper size selection bottom of mandible - top of clavicleMeasure the same distance on the premarked cervical collarSelect the appropriate size or adjust the collarApply the cervical collar

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Assemble = 79

Cervical collars

http://www.rch.org.au/clinicalguide/guideline_index/Cervical_Spine_Injury/

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Principles of Spine Immobilization and Logrolling4 people1 person to maintain manual, inline immobilization of the patients head and neck1 for the torso (including the pelvis and hips)1 for the pelvis and legs1 to direct the procedure and move the spine board

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Principles of Spine Immobilization and Logrolling

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1st: maintaining alignment of the patients head and neck2nd: grasps the patient at the shoulder and wrist3rd: grasps the patients hip just distal to the wrist with one hand, and with the other hand firmly grasps the roller bandage or cravat that is securing the ankles together82

Principles of Spine Immobilization and LogrollingApply gentle, inline manual immobilization to the patients head and apply a semirigid cervical collar.cautiously logroll the patient as a unit toward the two assistants at the patients side, but only to the least degree necessary to position the board under the patientPlace the spine board beneath the patient

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Principles of Spine Immobilization and LogrollingPadding and tape the patients head and neckstraps across the patients thoraxjust above the iliac crestsacross the thighsjust above the ankles

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Thank you

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