Professional Documents
Culture Documents
1. Preparation
2. Triage
3. Primary Survey
4. Resuscitation
5. Secondary Survey
6. Continued postresuscitation
monitoring and re-evaluation
7. Definitive care
Preparation
Prehospital
Notify receiving hospital
Closest appropriate facility
Report pertinent information
Inhospital
Warmed IV solutions
Ancillary departments notified
Equipment made readily available
Hospital personnel protection
Primary Survey
Airway
Breathing
Circulation
Disability: Neurologic
Evaluation
Exposure/Environmental Control
Primary Survey
Airway
Patency
Foreign bodies
Facial Fractures
Protect C-spine
Primary Survey
Breathing
Patency does not equal adequate ventilation
Expose chest
Auscultate
Conditions that may acutely impair
ventilation
Tension pneumothorax
Massive hemothorax
Flail chest
Rib fractures
Open pneumo
Pulmonary contusion
Primary Survey
Circulation
Hemorrhage control
Two Key Elements
1. Level of Consciousness
-AVPU
-Glasgow Coma Score
2. Pulse
Bleeding
Control
No hemostats
Consider occult sources
Primary Survey
Disability
AVPU
Glasgow Coma
Verbal Response Motor response
Oriented 5 Obeys
6
Confused 4 Localizes 5
Inappropriate words 3 Withdraws 4
Incomprehensible sounds 2 Decortication 3
None 1 Decerebration 2
None
1
Eye Opening
Spontaneous 4
To speech 3
To pain 2
None 1
Primary Survey
Exposure
Remove all clothes
Cover to prevent hypothermia
Resuscitation
Airway
Oral
Nasal- do not put in someone with
facial trauma
Endotracheal
Surgical
Breathing
Supply O2
Ventilate alveoli
Resuscitation
Circulation
Establish 2 large bore IVs
Draw blood
Vigorous IV therapy
ECG monitoring
Avoid hypothermia
Evaluate PEA
Other dysrhythmias
Hemorrhage classification
Class % blood Heart rate Blood Pulse Resp rate Capillary Urine Other Mortality
loss pressure pressure refill output
I 10 19 Normal
(750 cc)
II 20 29 >100 Slightly Delayed
(1250)
Catheters
Urinary
Rectal first
Check for other signs of urethral
injury
Gastric
Oral v.s. nasal placement
NGT Intracranial
Resuscitation
Monitoring
ABGs
Pulse oximetery
Blood pressure
ECG
Roentgenograms
FAST scan
Focused Assessment Sonography in Trauma
Ultrasound
1. Pericardial sac (epigastric area)
2. Hepatorenal fossa
3. Splenorenal fossa
4. Pelvis or Pouch of Douglas (bladder)
Secondary Survey
PITFALLS
Increased intracranial pressure
Subdural hematoma
Epidural hematoma
Depressed skull fracture
Spine injury
Beware of unconscious patient
Subdural Hematoma
Epidural Hematoma
Aftercare
Continuous reevaluation
Definitive care