BASIC TRAUMA LIFE SUPPORT

Initial Assessment
and Management
of Trauma

Purwoko Sugeng H
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Introduction
Trauma is the fourth leading cause of
death for all ages trauma is the
leading cause of death for children &
adult under the age of 45 years
Golden Hour
Time to reach operating room
(or other definitive treatment)
EMS does NOT have a Golden Hour
EMS has a Platinum Ten Minutes

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Introduction
Patients in their Golden Hour must:
Be recognized quickly
Have only immediate life threats managed
Be transported to an APPROPRIATE facility
Survival depends on assessment skills
Good assessment results from
An organized approach
Clearly defined priorities
Understanding available resources

Trauma Assessment
Scene Size Up
Detailed Assessment Ongoing Assessment
Focus
Assessment
Rapid
Trauma
Survey
Initial Assessment
Load and Go
Situation ?
Load and Go
Situation ?
HOSP
Safety
Body Surface Isolation (BSI)
Number of Patients
Additional Resources
Mechanism of Injury(MOI)

Safety

Traffic
Smoke
Electricity
Haz-Mat
Hostile
Persons
Weapons
Drugs
Silence
BODY SURFACE ISOLATION

Gloves for minimal
fluids
Goggles for eye
protection if theres
any chance of
splatter
Mask and Gown for
gross contamination

Number of Patients



Call for additional resources
ASAP
Additional resources


Extrication
Traffic control
Utilities
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Significant Mechanism
of Injury
Ejection from vehicle
Death in same
passenger
compartment
Fall of greater than
15 feet or
3 times the patients
height
Rollover of vehicle
High-speed vehicle
collision
Vehicle-pedestrian
collision
Motorcycle crash
Unresponsive or altered
mental status
Penetrating injury of head,
chest, or abdomen

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Bent Steering Wheel
Broken Mirror
Distorted Pedals
Deformed
Dashboard
Spider-Webbed
Windshield
Initial Assessment
General Impression
Mental Status
Airway
Breathing
Circulation

General Impression
Age, Weight, Gender
Position (relative to posture and
surroundings)
Activity
Obvious Injuries/Bleeding
Assess Mental Status
Take C-Spine control
A Alert and immediately
responsive
V Responsive to verbal stimuli
P Responsive to painful stimuli
U Unresponsive
Assess Airway
Open if necessary using jaw-thrust
maneuver
Consider oro- or naso-pharyngeal
airway
Note unusual sounds and correct
cause
Snoring oro-/naso-pharyngeal airway
Gurgling suction
Stridor consider intubation
Silence
Correcting silence
Attempt ventilation
Reposition
Heimlich
Visualize and remove
Intubate
Trans-laryngeal jet insuflation
Assess Breathing
Look, Listen, Feel
Rate, Rhythm, Depth (tidal volume)
Use of accessory muscles/retractions
Treat
Absent ventilate x2, check pulse
< 12/min assist ventilation
Decreased tidal volume assist ventilation
Labored oxygen 10 liters NRB
Normal or rapid consider oxygen
Assess Circulation -
Pulses
Compare radial
and corotid
Rate
Normal
Fast
Slow
Rhythm
Regular
Irregular
Quality
Weak
Thready
Bounding
Assess Circulation -
Skin
Color
Temperature
Moisture
Assess Circulation -
Bleeding
Direct pressure
Pressure dressing

Determine priority
Poor general impression
Mental status changes
Difficulty breathing
Shock
Chest pain
Severe bleeding
Severe pain
Load and Go Situation ?
Rapid Trauma Survey
Head to toe
Rapid sweep to identify major
injuries which could prove life
threatening
DCAP-BTLS
Inspect and Palpate for
DCAP-BTLS
=
=
=
=
D
C
A
P
Deformities
Contusions
Abrasions
Punctures/
Penetrations
=
=
=
=
B
T
L
S
Burns
Tenderness
Lacerations
Swelling
Rapid Trauma Survey
Deformities Contusions
Abrasions Punctures/Penetrations
Burns
Tenderness
Lacerations Swelling
Rapid Trauma Survey
Head
Neck
Chest
Abdomen
Pelvis
Extremities
Posterior
Head: DCAP-BTLS + Crepitation
Neck: DCAP-BTLS + Jugular Vein Distention and
Crepitation
Chest: DCAP-BTLS + Crepitation and
Breath Sounds (Presence and Equality)
Mid-clavicular
Mid-axillary
Listen to both sides of the chest. Is air entry present?
Absent? Equal on both sides? Compare left side to
right side.
Abdomen: DCAP-BTLS + Firmness and Distention
Pelvis: DCAP-BTLS (Compress gently)
Extremities: DCAP-BTLS + Distal Pulse,
Sensation, Motor Function
Posterior: DCAP-BTLS
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Procedure that are done at
the scene & can be delegated
Initial airway management
Assist ventilation
Administer oxygen
Begin CPR
Control of major external bleeding
Seal sucking chest wounds
Stabilize flail chest
Stabilize impaled objects
Complete packaging of the patient
Package and begin transport
Immediate immobilize, load, go
Delayed immobilize, treat as
necessary, transport
If No Significant Mechanism
of Injury
Reconsider mechanism of injury
Determine chief complaint
Perform focused physical exam based on:
Chief complaint
Mechanism of injury
Use DCAP-BTLS on focused area of
assessment
Assess baseline vital signs
Obtain SAMPLE history
Focused History and Physical
Baseline vital signs
SAMPLE History
Focus on and treat injuries found
during initial assessment and rapid
trauma assessment as appropriate
considering priority
SAMPLE History
S = Signs and symptoms
A = Allergies
M = Medications
P = Pertinent past history
L = Last oral intake
E = Events leading to injury
or illness
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Vital Signs
Respirations
Pulse
Skin color, temperature,
condition
Pupils
Blood Pressure


















Detailed Physical Exam
As appropriate, considering
priority
History and vital signs,
neurological
Repeat initial assessment
Complete critical interventions
Careful head to toe survey
(DCAP/BTLS)
Detailed Physical Exam
Head to Toe
Head DCAP/BTLS and creptiation
Ears DCAP/BTLS and blood/fluid
Face DCAP/BTLS and blood/fluid
Eyes DCAP/BTLS and discoloration,
pupils, foreign bodies, blood
Nose DCAP/BTLS and blood/fluid
Mouth DCAP/BTLS and teeth, foreign
bodies, swelling, lacerations, odor
Head to Toe
Detailed Physical Exam
Head to Toe
Neck DCAP/BTLS and JVD, crepitation
Chest DCAP/BTLS and palpate for paradoxical
motion, symmetry, crepitation, and auscultate
breath sounds
Abdomen DCAP/BTLS and tenderness,
rigidity, distention
Pelvis DCAP/BTLS and pain, tenderness,
motion, crepitation
Upper extremities DCAP/BTLS and PMS
Lower extremities DCAP/BTLS and PMS
Posterior DCAP/BTLS

Subjective changes
Reassess vital signs:neurological,ABC
Reassess injuries
Reassess interventions
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