BASIC TRAUMA LIFE SUPPORT
Initial Assessment
and Management
of Trauma
Purwoko Sugeng H
Introduction
• Golden Hour
– Time to reach operating room
(or other definitive treatment)
– NOT time for transport to ED
– NOT time in Emergency Department
• 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
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Trauma Assessment
Scene Size Up
Initial Assessment
Load and Go
Situation ?
Rapid
Focus
Trauma
Assessment
Survey
Load and Go
Situation ? HOSP
Detailed Assessment Ongoing Assessment
Scene Size-Up
• Safety
• Body Substance 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 there’s
any chance of
splatter
• Mask and Gown for
gross contamination
Number of Patients
Call for additional resources
ASAP
Additional resources
• Extrication
• Traffic control
• Utilities
Significant Mechanism
of Injury
Ejection from vehicle High-speed vehicle
collision
Death in same
passenger Vehicle-pedestrian
compartment collision
Fall of greater than Motorcycle crash
15 feet or
Unresponsive or altered
3 times the patient’s
mental status
height
Penetrating injury of head,
Rollover of vehicle
chest, or abdomen
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Bent Steering Wheel Broken Mirror
Spider-Webbed
Windshield
Deformed
Distorted Pedals Dashboard
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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 • Rhythm
and corotid – Regular
• Rate – Irregular
– Normal • Quality
– Fast – Weak
– Slow – Thready
– Bounding
Assess Circulation -
Skin
• Color
• Temperature
• Moisture
Assess Circulation -
Bleeding
• Direct pressure
• Pressure dressing
Determine priority
Load and Go Situation ?
– Poor general impression
– Mental status changes
– Difficulty breathing
– Shock
– Chest pain
– Severe bleeding
– Severe pain
Rapid Trauma Survey
• Head to toe
• Rapid sweep to identify major
injuries which could prove life
threatening
• DCAP-BTLS
Rapid Trauma Survey
Inspect and Palpate for
DCAP-BTLS
D = Deformities B = Burns
C = Contusions T = Tenderness
A = Abrasions L = Lacerations
P = Punctures/ S = Swelling
Penetrations
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)
Listen to both sides of the chest. Is air entry present?
Absent? Equal on both sides? Compare left side to
right side.
Mid-clavicular Mid-axillary
Abdomen: DCAP-BTLS + Firmness and Distention
Pelvis: DCAP-BTLS (Compress gently)
Extremities: DCAP-BTLS + Distal Pulse,
Sensation, Motor Function
Posterior: DCAP-BTLS
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
•
Vital Signs
Respirations
Pulse
Skin color, temperature,
condition
Pupils
Blood Pressure
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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
On-Going Assessment
• Subjective changes
• Reassess vital signs:neurological,ABC
• Reassess injuries
• Reassess interventions
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