Primary/Secondary Survey of the Combat Casualty
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Primary/Secondary Survey of the Combat Casualty CPT Allen Proulx, MPAS, CPT Allen Proulx, MPAS, PA-C PA-C Tactical Combat Medical Tactical Combat Medical Care Care (TCMC) (TCMC)
description
Primary/Secondary Survey of the Combat Casualty. CPT Allen Proulx, MPAS, PA-C Tactical Combat Medical Care (TCMC). Objectives. Discuss the importance of the primary/secondary survey Outline how ATLS applies to the combat casualty. Time of death. Primary/Secondary Survey. - PowerPoint PPT Presentation
Transcript of Primary/Secondary Survey of the Combat Casualty
Primary/Secondary Survey of the Combat Casualty
CPT Allen Proulx, MPAS, PA-CCPT Allen Proulx, MPAS, PA-C
Tactical Combat Medical CareTactical Combat Medical Care
(TCMC)(TCMC)
ObjectivesObjectives
Discuss the importance of the Discuss the importance of the primary/secondary surveyprimary/secondary survey
Outline how ATLS applies to the combat Outline how ATLS applies to the combat casualtycasualty
Time of deathTime of death
33355
3
12
20
25
44
Immediate 5-30Mins 2Hrs-6Hrs
1D-1W
Killed in Action
Died of Wounds
Primary/Secondary SurveyPrimary/Secondary Survey
Why is it important?Why is it important?– What and where are the wounds?What and where are the wounds?
What resuscitation is required?What resuscitation is required?– Mode of CASEVAC?Mode of CASEVAC?
What is the Approach?What is the Approach?ATLSATLS– Created by surgeons for the non-surgeonCreated by surgeons for the non-surgeon– Designed in the urban environmentDesigned in the urban environment– Performed in the hospital settingPerformed in the hospital setting– Requires a lot of high tech resourcesRequires a lot of high tech resources
–This is our classical training platformThis is our classical training platform
Will this approach work in combat?Will this approach work in combat?
How Do We Develop Our How Do We Develop Our Approach?Approach?
What are we going to see?What are we going to see?– Injury patternsInjury patterns
Civilian trauma?Civilian trauma?
Combat trauma?Combat trauma?
How Do We Develop Our How Do We Develop Our Approach?Approach?
Civilian traumaCivilian trauma– Trimodal death distributionTrimodal death distribution
First peakFirst peak– Death results in the pre-hospital setting from massive head injury Death results in the pre-hospital setting from massive head injury
and massive vascular injury.and massive vascular injury.
Second peakSecond peak– Death in the first few minute of arrival to the hospital and due to Death in the first few minute of arrival to the hospital and due to
massive head, chest and abdominal injurymassive head, chest and abdominal injury
Third peakThird peak– Post resuscitation/operative complicationsPost resuscitation/operative complications
• Combat TraumaCombat Trauma– We don’t know the death distributionWe don’t know the death distribution
• It is believed that if the casualty can arrive alive and relatively stable It is believed that if the casualty can arrive alive and relatively stable to the FST/CSH…they will live.to the FST/CSH…they will live.
How Do We Develop Our How Do We Develop Our Approach?Approach?
ATLSATLS– Based on urban injury patternsBased on urban injury patterns
Primary SurveyPrimary Survey– A-Airway/c-spine controlA-Airway/c-spine control– B-BreathingB-Breathing– C-CirculationC-Circulation– D-DisabilityD-Disability– E-ExposureE-Exposure
Detailed secondary surveyDetailed secondary survey– Head-to-toe examHead-to-toe exam
How Do We Develop Our How Do We Develop Our Approach?Approach?
The Combat CasualtyThe Combat Casualty– Slightly different injury pattern-in this order!Slightly different injury pattern-in this order!
Penetrating extremity traumaPenetrating extremity trauma
Tension pneumothoraxTension pneumothorax
Loss of airwayLoss of airway
– Instead of ABCs……think CBAsInstead of ABCs……think CBAs
The Combat Casualty Primary The Combat Casualty Primary SurveySurvey
Assess for hemorrhage firstAssess for hemorrhage first– Intervene for life threatening bleed only!Intervene for life threatening bleed only!
Then, assess for tension Then, assess for tension pneumothoraxpneumothorax– Perform needle decompression as neededPerform needle decompression as needed
Then, assess for an airwayThen, assess for an airway– Utilize a Combitube or surgical airwayUtilize a Combitube or surgical airway– Rarely a need for c-spine controlRarely a need for c-spine control
The Combat Casualty Primary The Combat Casualty Primary SurveySurvey
D-disability- decision to evacuateD-disability- decision to evacuate– GCS scoring is appropriateGCS scoring is appropriate AVPU also appropriateAVPU also appropriate
E-exposureE-exposure– Explore ideas on how to expose your casualty while Explore ideas on how to expose your casualty while
protecting them from the environmentprotecting them from the environmentHypothermia is BADHypothermia is BAD
– Remember, they may need that kevlar!!!Remember, they may need that kevlar!!!
F-foleyF-foley– Situational need for urinary catheterSituational need for urinary catheter
G-gastric tubeG-gastric tube– Situational need to decompress the stomachSituational need to decompress the stomach
Hypothermia is Bad!Hypothermia is Bad!
Rewarming in the trenches of WWIRewarming in the trenches of WWI
Heat loss during transportHeat loss during transport
HypothermiaHypothermia
HypothermiaHypothermia
The Combat Casualty Secondary The Combat Casualty Secondary SurveySurvey
Occurs after you have performed your Occurs after you have performed your primary survey and appropriate primary survey and appropriate interventionsinterventions
Head-to-toe exam along ATLS Head-to-toe exam along ATLS guidelines.guidelines.– Be very thorough-Be very thorough-many injuries are many injuries are
subtle!subtle!
Commonly used acronymsCommonly used acronyms
DCAP-BTLS- deformities, contusions, abrasions, DCAP-BTLS- deformities, contusions, abrasions, penetrations, burns, tears, lacerations, swelling.penetrations, burns, tears, lacerations, swelling.
TIC- tenderness, instabilities, crepitus.TIC- tenderness, instabilities, crepitus.
TRD- tenderness, rigidity, distensionTRD- tenderness, rigidity, distension
PMS- pulse, motor, sensory PMS- pulse, motor, sensory
Head examHead exam
DCAP-BTLSDCAP-BTLS
PupilsPupils
Otorrhea/Rhinorrhea/HemotympanumOtorrhea/Rhinorrhea/Hemotympanum
Raccoon/Battle signs Raccoon/Battle signs
Mid-face instabilityMid-face instability
Neck examNeck exam
Step-offStep-off
Tracheal deviationTracheal deviation
Jugular vein distentionJugular vein distention
Chest examChest exam
DCAP-BTLSDCAP-BTLS
TICTIC
AuscultationAuscultation
Percussion Percussion
Abdominal/Pelvic examAbdominal/Pelvic exam
DCAP-BTLSDCAP-BTLS
TRD-PTRD-P
Pelvic instabilityPelvic instability
PriapismPriapism
Scrotal/labial hematoma/blood at the Scrotal/labial hematoma/blood at the meatusmeatus
Extremity exam Extremity exam
DCAP-BTLSDCAP-BTLS
TICTIC
PMSPMS
Posterior ThoraxPosterior Thorax
Log roll casualtyLog roll casualty– SpineSpine
DCAP-BTLSDCAP-BTLS
Tenderness/step-offTenderness/step-off
– DREDREGross blood onlyGross blood only
Questions?Questions?
