Chapter 1, Initial Assessment and Management.pptx

8/20/2019 Chapter 1, Initial Assessment and Management.pptx

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ObjectivesObjectives

Apply principles of primary andApply principles of primary and

secondary surveyssecondary surveys

Identify Management prioritiesIdentify Management priorities

Institute appropriate resuscitation andInstitute appropriate resuscitation and

monitoring proceduresmonitoring procedures

Recognize value of patient’s history andRecognize value of patient’s history and

biomechanics of injurybiomechanics of injury

Anticipate pitfallsAnticipate pitfalls



Key QuestionsKey Questions

o! do I prepare for a smooth transitiono! do I prepare for a smooth transition

from the prehospital to the hospitalfrom the prehospital to the hospital

environments"environments"

#hat is a $uic%& simple !ay to assess the#hat is a $uic%& simple !ay to assess the

patient in '( seconds"patient in '( seconds"

#hat is the secondary survey and !hen#hat is the secondary survey and !hen

does it start"does it start"



More Key QuestionsMore Key Questions

o! can I minimized missed injuries"o! can I minimized missed injuries"

#hich patients do I transfer to a higher#hich patients do I transfer to a higherlevel of care"level of care"

#hen should the transfer occur"#hen should the transfer occur"



)repare for a smooth transition)repare for a smooth transition

from the prehospital environ"from the prehospital environ"

*ransport guidelines + protocols*ransport guidelines + protocols

Online medical directionOnline medical direction

Mobilization of resourcesMobilization of resources

)eriodic revie! of care)eriodic revie! of care

,losest& appropriate facility,losest& appropriate facility



)repare for a smooth transition)repare for a smooth transition

to the inhospital environ"to the inhospital environ"

)replanning is essential)replanning is essential

-$uipment& personnel& services-$uipment& personnel& services.tandard precautions.tandard precautions

)rearranged transfer agreements)rearranged transfer agreements



.tandard )recautions.tandard )recautions

,ap,ap

/o!n/o!n

/loves/loves

Mas% Mas%

.hoe ,overs.hoe ,overs

/oggles + face/oggles + face

shieldshield



Quic%& simple !ay to asses theQuic%& simple !ay to asses the

patient in '( seconds"patient in '( seconds"

Identify yourselfIdentify yourself

As% the patient his + her nameAs% the patient his + her name

As% the patient !hat happenedAs% the patient !hat happened



)rimary .urvey)rimary .urvey

*he priorities are*he priorities are

the same forthe same for allall

patients0patients0



.pecial ,onsiderations.pecial ,onsiderations

*rauma in the elderly*rauma in the elderly

)ediatric trauma)ediatric trauma*rauma in pregnant !omen*rauma in pregnant !omen




)rotect c1spine)rotect c1spine

)itfalls")itfalls"

• -$uipment failure-$uipment failure

• Inability to intubateInability to intubate• Occult air!ay injuryOccult air!ay injury

• )rogressive loss of air!ay)rogressive loss of air!ay

-stablish patent air!ay-stablish patent air!ay




Assess and ensure ade$uateAssess and ensure ade$uate

o2ygenation and ventilationo2ygenation and ventilation)itfalls")itfalls"

• Air!ay vs ventilation problem"Air!ay vs ventilation problem"

• Iatrogenic pneumothora2 or tensionIatrogenic pneumothora2 or tensionpneumothora2pneumothora2



Assess for organ perfusion"Assess for organ perfusion"

3evel of consciousness3evel of consciousness

.%in color and temperature.%in color and temperature)ulse rate and character)ulse rate and character




,ontrol,ontrolhemorrhagehemorrhage

Restore volumeRestore volume

ReassessReassessparametersparameters

)itfalls")itfalls"• -lderly-lderly

• ,hildren,hildren

•

AthletesAthletes• MedicationsMedications

,irculatory Management,irculatory Management




4aseline neurologic evaluation4aseline neurologic evaluation• /,. scoring/,. scoring

• )upillary response)upillary response

5isability5isability

Observe for neurologicObserve for neurologic

deteriorationdeterioration




,ompletely undress the patient,ompletely undress the patient

-2posure + -nvironment-2posure + -nvironment

)revent hypothermia)revent hypothermia



ResuscitationResuscitation

)rotect and secure air!ay)rotect and secure air!ay

6entilate and o2ygenate6entilate and o2ygenate

.top the bleeding.top the bleeding

6igorous shoc% therapy6igorous shoc% therapy

)rotect from hypothermia)rotect from hypothermia



Adjuncts to )rimary .urveyAdjuncts to )rimary .urvey

5)35)37A.*7A.*

5iagnostic *ools5iagnostic *ools



#hen do I start it"#hen do I start it"

)rimary survey is completed)rimary survey is completed

A4,5-s are reassessedA4,5-s are reassessed

6ital functions are returning to normal6ital functions are returning to normal

AfterAfter



#hat are the components"#hat are the components"

istoryistory

)hysical e2am8 ead1to1toe)hysical e2am8 ead1to1toe99*ubes and fingers in every orifice:*ubes and fingers in every orifice:

,omplete neurologic e2am,omplete neurologic e2am

.pecial diagnostic tests.pecial diagnostic tests

ReevaluationReevaluation



.econdary .urvey.econdary .urvey

istoryistory

AllergiesAllergies

MedicationsMedications

)ast illnesses)ast illnesses

3ast meal3ast meal

-vents + -nvironment-vents + -nvironment




/,. .core/,. .core

;eurologic e2am;eurologic e2am

,omprehensive,omprehensive

eye and ear e2ameye and ear e2am

)itfalls")itfalls"

<nconsciousness<nconsciousness

)eriorbital edema)eriorbital edema

Occluded auditoryOccluded auditorycanalcanal

eadead




4ony crepitus4ony crepitus

5eformity5eformity

MalocclusionMalocclusion

)itfalls")itfalls")otential air!ay)otential air!ay

obstructionobstruction

,ribriform plate,ribriform plate

fracturefracture

7re$uently missed7re$uently missed

Ma2illofacialMa2illofacial




*enderness*enderness

,omplete motor+,omplete motor+

sensory e2amssensory e2ams

Refle2esRefle2esImaging studiesImaging studies

)itfalls")itfalls"Altered sensoriumAltered sensorium

Inability toInability to

cooperate !ithcooperate !ithclinical e2amclinical e2am

,ervical .pine,ervical .pine




Mechanism8 4lunt vs penetratingMechanism8 4lunt vs penetrating.ymptoms8 Air!ay obstruction& hoarseness.ymptoms8 Air!ay obstruction& hoarseness

7indings8 ,repitus& hematoma& stridor&7indings8 ,repitus& hematoma& stridor&

bruitbruit

;ec% =soft tissues>;ec% =soft tissues>




5elayed5elayedsymptoms and signssymptoms and signs

)rogressive air!ay)rogressive air!ay

obstructionobstructionOccult injuriesOccult injuries

;ec% =soft tissues>8 )itfalls;ec% =soft tissues>8 )itfalls




InspectInspect

)alpate)alpate

)ercuss)ercuss

AuscultateAuscultateObtain 21raysObtain 21rays

,hest,hest




InspectInspect

AuscultateAuscultate

)alpate)alpate

)ercuss)ercussReevaluateReevaluate

.pecial studies.pecial studies

AbdomenAbdomen




ollo! viscus injuryollo! viscus injury

Retroperitoneal injuryRetroperitoneal injury

-2cessive pelvic manipulation-2cessive pelvic manipulation

Abdomen8 )itfalls"Abdomen8 )itfalls"




)erineum)erineum

RectumRectum

6agina6agina

)itfalls)itfalls

,ontusions& hematomas&,ontusions& hematomas&

lacerations& urethral bloodlacerations& urethral blood

.phincter tone & high?riding.phincter tone & high?ridingprostate& pelvic fracture&prostate& pelvic fracture&

rectal !all integrity& bloodrectal !all integrity& blood

4lood& lacerations4lood& lacerations

<rethral injury in !omen&<rethral injury in !omen&

pregnancypregnancy




,ontusion& deformity,ontusion& deformity

)ain)ain

)erfusion)erfusion

)eripheral neurovascular)eripheral neurovascular

statusstatus

@1rays as needed@1rays as needed

Musculos%eletal8 -2tremitiesMusculos%eletal8 -2tremities




)ain on palpation)ain on palpation

.ymphysis !idth.ymphysis !idth

3eg length une$ual3eg length une$ual

InstabilityInstability

@1rays as needed@1rays as needed

Musculos%eletal8 )elvisMusculos%eletal8 )elvis




)otential blood loss)otential blood loss

Missed fracturesMissed fractures

.oft1tissue or ligamentous injury.oft1tissue or ligamentous injury

,ompartment syndrome,ompartment syndrome

=especially !ith altered sensorium +=especially !ith altered sensorium +

hypotension>hypotension>

Musculos%eletal8 )itfallsMusculos%eletal8 )itfalls




/,. .core/,. .core3ateralizing signs3ateralizing signs

7re$uent reevaluation7re$uent reevaluation

)revent secondary brain injury)revent secondary brain injury

;eurologic8 4rain;eurologic8 4rain-arly-arly

neurosurgicalneurosurgicalconsultconsult




,omplete motor and sensory,omplete motor and sensory

e2amse2ams

Imaging as indicatedImaging as indicated

Refle2esRefle2es

;eurologic8 .pine and ,ord;eurologic8 .pine and ,ord

-arly neurosurgical +-arly neurosurgical +

orthopaedic consultorthopaedic consult




Incomplete immobilization.ubtle in I,) !ith manipulation

Rapid deterioration

;eurologic8 )itfalls



Adjuncts to .econdary .urveyAdjuncts to .econdary .urvey

.pecial diagnostic test as indicated.pecial diagnostic test as indicated

)itfalls")itfalls"• )atient deterioration)atient deterioration

• 5elay of transfer5elay of transfer



Minimize missed injuries"Minimize missed injuries"

igh inde2 of suspicionigh inde2 of suspicion

7re$uent reeveluation and monitoring7re$uent reeveluation and monitoring



)ain Management)ain Management

Relief of pain +an2iety as appropriateRelief of pain +an2iety as appropriate

Administer intravenouslyAdminister intravenously,areful monitoring is essential,areful monitoring is essential



#hich patients do I transfer"#hich patients do I transfer"

*hose !hose injuries e2ceed*hose !hose injuries e2ceed

institutional capabilitiesinstitutional capabilities-2amples-2amples

• Multisystem or comple2 injuriesMultisystem or comple2 injuries

• )atient !ith comorbidity or age e2tremes)atient !ith comorbidity or age e2tremes



#hen do I transfer the patient"#hen do I transfer the patient"

As soon as possible after stabilizingAs soon as possible after stabilizing

measures are completedmeasures are completed

Air!ay and ventilatory controlAir!ay and ventilatory control

emorrhage control =operation>emorrhage control =operation>

Avoid needless delayAvoid needless delay



Records& 3egal ,onsiderationsRecords& 3egal ,onsiderations

,oncise& choronologic documentation,oncise& choronologic documentation

,onsent for treatment,onsent for treatment

7orensic evidence7orensic evidence




ResuscitationResuscitation

AdjunctsAdjuncts

.econdary .urvey.econdary .urvey AdjunctsAdjuncts

5efinitive ,are5efinitive ,are

Chapter 1, Initial Assessment and Management.pptx

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