lesson 02
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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
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3
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
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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
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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?
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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!
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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
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Provider SafetyProvider Safety
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20
QUESTIONS?QUESTIONS?