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Life Support
for Prehospital Care Providers
Sixth Edition
Chapter 2
Assessment and Initial Management of the Trauma Patient
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Assessment
and Initial Management
of the Trauma Patient Courtesy of ITLS Ontario
Patient Assessment - 3
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Patient Assessment
ITLS Primary Survey
Scene Size-up
Initial Assessment
Rapid Trauma Survey
or Focused Exam
Patient Assessment - 4
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
ITLS Primary Survey
Scene Size-up
Initial Assessment
Rapid Trauma Survey
or Focused Exam
Patient Assessment - 5
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Scene Size-up
Patient Assessment - 6
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Scene Size-up
Patient Assessment - 7
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Initial Assessment
Patient Assessment - 8
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
Initial Assessment
General impression
Initial level of consciousness
Manual stabilization of cervical spine
ABCs
Prioritizes patient
Determines existence of immediately
life-threatening conditions
Patient Assessment - 9
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
Less than 2 minutes
Initial Assessment and Rapid Trauma Survey
Delegate any intervention.
Interrupt survey only for:
Scene danger
Airway obstruction
Cardiac arrest
Patient Assessment - 10
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
General impression
Approximate age, sex, weight
General appearance
Position of patient body and surroundings
Patient activity
Obvious major injuries or bleeding
Patient Assessment - 11
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
Patient Assessment - 12
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
Airway: look, listen, feel
Direct: simple positioning and suctioning
Patient Assessment - 13
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
Breathing: look, listen, feel
Direct: high-flow oxygen
If not adequate
Direct: assisted ventilation
Patient Assessment - 14
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Breathing Rates
Normal Abnormal
Adult 1020 <10 and >24
Patient Assessment - 15
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Primary Survey
Circulation: peripheral pulse
No peripheral, check carotid
Too fast, too slow, quality
Interrupt: cardiac arrest
Skin
Color, temperature, condition
Patient Assessment - 16
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
MOI Decision
Dangerous generalized
or unconscious
Rapid Trauma Survey
Dangerous focused
Focused Exam
Not significant
Initial Assessment normal
Focused Exam
Patient Assessment - 17
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Priority Patient
Dangerous MOI High-risk group
Altered mental status
History Difficulty breathing
Loss of consciousness
Abnormal perfusion
Difficulty breathing
Abnormal Initial Assessment
Severe pain
in head, neck, torso
Patient Assessment - 18
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Rapid Trauma Survey
Patient Assessment - 19
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Rapid Trauma Survey
Patient Assessment - 20
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Rapid Trauma Survey
Inspect Chest
Asymmetry, Contusion, Penetrations,
Paradoxical Motion, Instability, Crepitation
Breath Sounds
Present? Equal?
(If unequal: Percussion)
Heart Tones
Patient Assessment - 21
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Rapid Trauma Survey
Abdomen
Bruising, Penetration/Evisceration, Tenderness,
Rigidity, Distention
Pelvis
Tenderness, Instability, Crepitation
Patient Assessment - 22
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Rapid Trauma Survey
Lower/Upper Extremities
Swelling, Deformity, Instability, Motor, Sensory
Place Patient on Backboard
Posterior
Penetrations, Deformity, Presacral Edema
Patient Assessment - 23
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Rapid Trauma Survey
If critical situation,
transfer to ambulance to complete exam.
Patient Assessment - 24
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Rapid Trauma Survey
Patient Assessment - 25
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Glasgow Coma Scale
Patient Assessment - 26
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Brief Targeted History
S Symptoms
A Allergies
M Medications
P Past medical history
L Last oral intake
E Events preceding incident
Patient Assessment - 27
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Load-and-Go Situations
Initial Assessment Shock potential
Altered mental status Abnormal chest exam
Abnormal respiration Tender, distended
Abnormal circulation abdomen
Pelvic instability
Bilateral femur fractures
Patient Assessment - 28
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
When in doubttransport early!
Patient Assessment - 29
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Critical Interventions
On-scene procedures
Manage airway Seal sucking chest
Assist ventilation Stabilize flail chest
Administer oxygen Decompress tension
pneumothorax
Begin CPR
Stabilize impaled
Control major
external bleeding Complete packaging
Patient Assessment - 30
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Initiate Transport
Procedures not on scene, not life-saving
Splinting, bandaging, IV line insertion
Endotracheal intubation, often
Patient Assessment - 31
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Secondary Survey
Patient Assessment - 32
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Secondary Survey
More comprehensive exam
Evaluation for all injuries, not just life-threatening
Establishes baseline for treatment decisions
Performed
Critical patientsdone during transport
Short transportmay not have time
Non-critical patientsdone on scene
Patient Assessment - 33
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Secondary Survey
Initial Assessment
Repeat routinely
Vital signs
Repeat routinely
Monitoring
Detailed Exam
Head-to-toe
DCAP-BTLS
Patient Assessment - 34
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Secondary Survey
INITIAL ASSESSMENT
LOC
AVPU
Airway
Control Cervical Spine
Snoring, Gurgling, Stridor, Silence
Breathing
Present? Rate, Depth, Effort
Carotid/Radial Pulses
Present? Rate, Rhythm, Quality
Skin Color, Temperature, Moisture; Capillary Refill
Uncontrolled External Hemorrhage?
Patient Assessment - 35
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Detailed Exam: DCAP-BTLS
Deformities Burns
Contusions Tenderness
Abrasions Lacerations
Penetrations Swelling
Patient Assessment - 36
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Secondary Survey
DETAILED EXAM
Patient History
Complete SAMPLE History
Vital Signs
Measured Pulse, Respirations, Blood Pressure
SpO2, ECG, Blood Sugar, EtCO2
Glasgow Coma Scale Score
Eyes, Voice, Movement; Emotional State
Head
Pupils, Battles Sign, Raccoon Eyes, Drainage;
DCAP-BTLS
Patient Assessment - 37
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Secondary Survey
Neck
DCAP-BTLS; Neck Vein Distention? Tracheal Deviation?
Chest
Asymmetry; Paradoxical Motion; DCAP-BTLS;
Tenderness, Instability, Crepitation [TIC]
Breath Sounds
Present? Equal?
(If unequal: Percussion)
Heart Tones
Patient Assessment - 38
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Secondary Survey
Abdomen
DCAP-BTLS; Rigidity, Distention
Pelvis
DCAP-BTLS
Lower/Upper Extremities
DCAP-BTLS; TIC; PMS
Posterior
Examine only if not done in ITLS Primary Survey
DCAP-BTLS
Patient Assessment - 39
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Ongoing Exam
Change in condition
Patient
Interventions
Remain calm
Optimum speed by organization and teamwork
Patient Assessment - 42
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ
Discussion
Patient Assessment - 43
Campbell, International Trauma Life Support, 6th Ed.
2008 Pearson Education, Inc., Upper Saddle River, NJ