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EXAM
- Preparation and Triage
- Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
- Reevaluation (consideration of transfer)
- Secondary Survey (HI) with reevaluation adjuncts
- Reevaluation and post resuscitation care
- Definitive care of transfer to an appropriate trauma nurse: Initial Assessment
- A- airway and Alertness with simultaneous cervical spinal stabilization
- B- breathing and Ventilation
- circulation and control of hemorrhage
- D - disability (neurologic status)
- F - full set of vitals and Family presence
- G - Get resuscitation adjuncts
L- Lab results (arterial gases, blood type and crossmatch)
M- monitor for continuous cardiac rhythm and rate assessment
N- naso or orogastric tube consideration
O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal
caron dioxide (ETC02) monitoring and capnopgraphy
H- History and head to toe assessment
I- Inspect posterior surfaces: ABCDEFGHI
- Before the arrival of the pt: When should PPE be placed:
- Pt is at hospital in the right amount of time, right care, right trauma facility,
right resources: Safe Care:
- Uncontrolled Hemorrhage: Major cause of preventable death:
- reorganize care to C-ABC: If uncontrolled hemorrhage ..
- Used at the beginning of the initial assessment
- A Alert. If the pt is alert he or she will be able to maintain his or her airway
once it is clear.
- V responds to verbal stimuli responds to pain. If the patient needs verbal
stimulation to respond, an airway adjunct may be needed to keep the tongue
from obstructing the airway.
- P responds to pain. If the pt. responds only to pain, he or she may not be
able to maintain his or her airway adjunct may need to be placed while further
assessment is made to determine the need for intubation.
- U Unresponsive. If the pt. is unresponsive, announce it loudly to the team
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and direct someone to chk in the pt is pulseless while assessing if the cause
of the problem is the airway.: Airway and AVPU:
- ask pt to pen his or her mouth: While assessing airway the patient is alert and
responds to verbal stimuli you should..
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b. symmetrical rise and fall
c. depth, pattern, and rate of respiration
d. signs of difficulty breathing such as accessory muscle use
e. skin color (normal, pale, flushed, cyanotic)
f. contusions, abrasions, deformities (flail chest)
g. open pneumothoraces (sucking chest wounds)
h. JVD
i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum): B
- tracheal deviation and jvd: Late signs of tension pneumo:
- equal breath sounds bilaterally at the second intercostal space midclav-
icular line and the bases for fifth intercostal space at the axillary line: Auscul-
tate the chest for:
- bony fractures and possible rib fractures, which may impact ventilation
- palpate for crepitus
- subcutaneous emphysema which may be a sign for a pneumothorax
- soft tissue injury: Palpate the chest for
- open the airway, use jaw thrust
- insert an oral airway
- assist ventilations with a bag mask
- prepare for definitive airway: If breathing is absent..
- trauma its need early supplemental oxygen, start with 15 mL O2 and titrate
oxygen delivery.: Oxygen on trauma patients
- Circulation and Control of Hemorrhage
Inspect first for any uncontrolled bleeding
Skin color
palpate for central pulses - carotid and femoral - rate, rhythm, and strength
Skin temp: cool, diaphoretic, or warm and dry: C
- apply direct pressure to bleeding
elevate extremity
apply pressure over arterial sites
Consider a pelvic binder for pelvic fractures
consider a tourniquet
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cannulate two veins with large caliber IV - if unable to gain assess consider
IO
a. obtain labs, type and cross
b. infuse warm isotonic fluids
c. consider balanced resuscitation
d. use rapid infusion device: C Interventions:
- Disability - Neurologic Status
- Assess pupils for equality, shape, and reactivity (PERRL)
- Assess GCS (eye opening, verbal response, and motor response): D
- Get a CT
- Consider ABG 's if decreased LOC
- Consider glucose check: D Interventions
- Exposure and Environmental Control
Remove all clothes and assess for any obvious injuries and uncontrolled
bleeding: E
- IF clothing is needed for evidence preserve in paper bag.
Maintain body temp - cover the pt, turn up heat in room, administer warm
fluids: E Interventions:
- Full set of vitals and family presence: F
- Get Resuscitation Adjuncts
L - Labs (maybe a lactic acid), a b g 's, blood type
M - monitors
N - naso or oro gastric tubes
O Oxygen and ETC02 monitors
P - pain assessment and management: G
- Reevaluation and Consider the need to Transfer: Final step in primary survey
- H,I: Secondary Survery
- History and Head to toe
MIST - prehospital report
MOI
Injuries sustained
S s/s in the field
T treatment in the field
if patients family present get a better hx on them: H
- Sample is part of history
S symptoms associated with injury
7 g/g
- inspect posterior surfaces
blogroll with at least 3 people. maintain c spine take out backboard Rectal tone per MD: I
- labs, wound care, tetanus, administer meds, prepare for transfer: Sec-
ondary Reval Adjuncts
- Vital signs
Interventions Primary survey Pain: Post resuscitation care parameters that are continuously evaluated:
- Capnography monitors numeric value, as well as continuous waveform,
indicating real-time measurement and trending over time.: Quantitative:
- Colorimetric CO2 detectors provide info about the presence or absence of
CO2. A chemically treated indicator strip changes color revealing the pres- ence or absence of exhaled CO2: Qualitative
- D displaced tube
O obstructed or kinked P pneumothorax E equipment failure , such as becoming detached from the equipment or loss of capnopgrahy: DOPE
- Preparation
- Preoxygenation
- Pretreatment
- Paralysis and Induction
- Protecting and positioning - v
- Placement of proof - secure the tube
- Post intubation - secure ETT Tube, get X-ray for placement: Steps of Rapid
Sequence Intubation
- from hemorrhage is leading cause. Hypovolemia is caused by decrease
in the amount of circulating volume. Goal is to replace volume.: Hypovolemic Shock results from hypo perfusion to the tissue due to an obstruction in either vasculature or heart. Goal is to
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ogaregunstablegorglikelygtogdeteriorategagchestgtubegisgplaced.:gSimplegpneu
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surgicalgrepair.:gOpengPneumo:
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lghavegsevergrespgdistress,ghypotension,gJVD.:gTensiongpneumo
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- gmusculargbundlegthatgrunsgundergthegrib.
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egorgspleengcombinedgwithginjurygtogthegdiaphragm.
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lgevaluation.
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- AorticgDissection:gUnequalgextremitygpulsegstrengthgpossibilitygof..
11
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