Lesson 02

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

LessonLesson 2 2

Lessons Learned in Lessons Learned in Trauma ManagementTrauma Management

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

ObjectivesObjectives

As a result of active participation in this As a result of active participation in this lesson you should be able to:lesson you should be able to: Discuss core principles of trauma managementDiscuss core principles of trauma management Recognize pitfalls in prehospital trauma careRecognize pitfalls in prehospital trauma care


PHTLS PhilosophyPHTLS Philosophy

EMS evolved from the need to reduce trauma EMS evolved from the need to reduce trauma morbidity and mortalitymorbidity and mortality

PHTLS has been instrumental in helping EMS PHTLS has been instrumental in helping EMS systems toward this goal for over 20 yearssystems toward this goal for over 20 years

Through research, we have learned a number Through research, we have learned a number of lessons that help us provide the best of lessons that help us provide the best prehospital trauma care possibleprehospital trauma care possible


Goal of Trauma CareGoal of Trauma Care

Getting the patient Getting the patient to:to: The right facilityThe right facility By the right modeBy the right mode In the right timeIn the right time With the right things With the right things

donedone


Lessons LearnedLessons Learned

How has the approach to prehospital How has the approach to prehospital trauma care evolved over time?trauma care evolved over time?


Life-Long LearningLife-Long Learning

Health care providers must be life-long Health care providers must be life-long learnerslearners

Science is always evolving and helps us Science is always evolving and helps us verify or disprove our approach to trauma verify or disprove our approach to trauma carecare

We must critically examine everything we do We must critically examine everything we do

Practices change as we learn!


Lessons Learned: OverviewLessons Learned: Overview

Provider and patient safetyProvider and patient safety Primary surveyPrimary survey Approaches to extricationApproaches to extrication Spinal immobilizationSpinal immobilization Assessment and treatment prioritiesAssessment and treatment priorities TransportationTransportation DocumentationDocumentation


Provider SafetyProvider Safety

QuickTime™ and aYUV420 codec decompressor

are needed to see this picture.

Click to play video


Primary SurveyPrimary Survey Consider kinematicsConsider kinematics Look for and correct immediate Look for and correct immediate

threats to lifethreats to life Use basic airway maneuversUse basic airway maneuvers Include breath sounds in the Include breath sounds in the

primary surveyprimary survey Provide oxygen earlyProvide oxygen early Control significant hemorrhageControl significant hemorrhage Maintain the patient’s body Maintain the patient’s body

temperaturetemperature Provide manual stabilization of Provide manual stabilization of

the cervical spinethe cervical spine


AirwayAirway

Basic adjuncts firstBasic adjuncts firstSuction as neededSuction as neededOxygenate and Oxygenate and

ventilate between ventilate between suction attemptssuction attempts

Time intubation Time intubation attemptsattempts

Check endotracheal Check endotracheal tube placementtube placement


BreathingBreathing

Select the correct device Select the correct device for oxygenation and for oxygenation and ventilationventilation

Continuously monitor Continuously monitor changes in ventilatory changes in ventilatory statusstatus

Ventilate at the correct Ventilate at the correct raterate

Proper use of BVMProper use of BVM


CirculationCirculationControl significant Control significant

hemorrhagehemorrhageEvery red blood cell counts!Every red blood cell counts!

Shock in trauma is Shock in trauma is hypovolemic until proven hypovolemic until proven otherwiseotherwise

Use PASG if indicatedUse PASG if indicated IVs are started en route after IVs are started en route after

other interventionsother interventionsOveraggressive fluid Overaggressive fluid

administration is undesirableadministration is undesirable


DisabilityDisability

Identify patients with Identify patients with indications for cervical indications for cervical spinal immobilizationspinal immobilization

Maintain manual Maintain manual stabilization until patient is stabilization until patient is fully immobilizedfully immobilized

Use padding, secure torso Use padding, secure torso first, then headfirst, then head

Check pupils for indications Check pupils for indications of traumatic brain injuryof traumatic brain injury


ExtricationExtrication

Identify indications for Identify indications for rapid extricationrapid extrication

Avoid rapid extrication Avoid rapid extrication when it is not indicatedwhen it is not indicated

Recognize the limitations Recognize the limitations of cervical collarsof cervical collars

Maintain cervical spine Maintain cervical spine stabilization during stabilization during extricationextrication

Use a team approachUse a team approach


Assessment and ManagementAssessment and Management

Potential pitfalls:Potential pitfalls: Scene timesScene times Missing signs of deterioration in an initially noncritical patientMissing signs of deterioration in an initially noncritical patient Missing life threats by not exposing the patientMissing life threats by not exposing the patient Forgetting that maintenance of body temperature is criticalForgetting that maintenance of body temperature is critical Performing a secondary survey prior to stabilizing life threatsPerforming a secondary survey prior to stabilizing life threats Not performing a secondary survey when possibleNot performing a secondary survey when possible


TransportationTransportation Transport to definitive Transport to definitive

care without delay is an care without delay is an important interventionimportant intervention

What is the right What is the right destination for a given destination for a given patient?patient?

Rough handling is Rough handling is detrimentaldetrimental

Choose the right mode Choose the right mode of transportationof transportation


Communication and DocumentationCommunication and Documentation

Clear, concise, accurate, and complete Clear, concise, accurate, and complete communication with the receiving facility communication with the receiving facility facilitates trauma carefacilitates trauma care

Good documentation is required to justify Good documentation is required to justify trauma system spending and for trauma trauma system spending and for trauma research, as well as for medical-legal research, as well as for medical-legal reasons and continuity of carereasons and continuity of care


SummarySummary

““Our patients did not choose us. Our patients did not choose us. We have chosen to treat them.”We have chosen to treat them.”

– – Dr. Dr. Norman McSwainNorman McSwain


SummarySummary

We must accept this responsibility and give We must accept this responsibility and give our patients the very best care possible, even our patients the very best care possible, even in the worst conditions. in the worst conditions.

We must be ready to treat our patients by We must be ready to treat our patients by learning from our experiences, as well as the learning from our experiences, as well as the experiences of those before us.experiences of those before us.


QUESTIONS?QUESTIONS?

Lesson 02

Education

Transcript of Lesson 02