Lesson 02
- 1. Lesson 2 Lessons Learned in Trauma Management
- 2. Objectives As a result of active participation in this lesson you should be able to: Discuss core principles of trauma management Recognize pitfalls in prehospital trauma care
- 3. PHTLS Philosophy EMS evolved from the need to reduce trauma morbidity and mortality PHTLS has been instrumental in helping EMS systems toward this goal for over 20 years Through research, we have learned a number of lessons that help us provide the best prehospital trauma care possible
- 4. Goal of Trauma Care Getting the patient to: The right facility By the right mode In the right time With the right things done
- 5. Lessons Learned How has the approach to prehospital trauma care evolved over time?
- 6. Life-Long Learning Health care providers must be life-long learners Science is always evolving and helps us verify or disprove our approach to trauma care We must critically examine everything we do Practices change as we learn!
- 7. Lessons Learned: Overview Provider and patient safety Primary survey Approaches to extrication Spinal immobilization Assessment and treatment priorities Transportation Documentation
- 8. Provider Safety Click to play video
- 9. Primary Survey Consider kinematics Look for and correct immediate threats to life Use basic airway maneuvers Include breath sounds in the primary survey Provide oxygen early Control significant hemorrhage Maintain the patient’s body temperature Provide manual stabilization of the cervical spine
- 10. Airway Basic adjuncts first Suction as needed Oxygenate and ventilate between suction attempts Time intubation attempts Check endotracheal tube placement
- 11. Breathing Select the correct device for oxygenation and ventilation Continuously monitor changes in ventilatory status Ventilate at the correct rate Proper use of BVM
- 12. Circulation Control significant hemorrhage Every red blood cell counts! Shock in trauma is hypovolemic until proven otherwise Use PASG if indicated IVs are started en route after other interventions Overaggressive fluid administration is undesirable
- 13. Disability Identify patients with indications for cervical spinal immobilization Maintain manual stabilization until patient is fully immobilized Use padding, secure torso first, then head Check pupils for indications of traumatic brain injury
- 14. Extrication Identify indications for rapid extrication Avoid rapid extrication when it is not indicated Recognize the limitations of cervical collars Maintain cervical spine stabilization during extrication Use a team approach
- 15. Assessment and Management Potential pitfalls: Scene times Missing signs of deterioration in an initially noncritical patient Missing life threats by not exposing the patient Forgetting that maintenance of body temperature is critical Performing a secondary survey prior to stabilizing life threats Not performing a secondary survey when possible
- 16. Transportation Transport to definitive care without delay is an important intervention What is the right destination for a given patient? Rough handling is detrimental Choose the right mode of transportation
- 17. Communication and Documentation Clear, concise, accurate, and complete communication with the receiving facility facilitates trauma care Good documentation is required to justify trauma system spending and for trauma research, as well as for medical-legal reasons and continuity of care
- 18. Summary “ Our patients did not choose us. We have chosen to treat them.” – Dr. Norman McSwain
- 19. Summary We must accept this responsibility and give our patients the very best care possible, even in the worst conditions. We must be ready to treat our patients by learning from our experiences, as well as the experiences of those before us.
- 20. QUESTIONS?
Editor's Notes
- #6: Instructor Notes: Ask students to describe some ways in which trauma care has changed over the past several years? What things do we now think differently about than we did before?
- #8: Instructor Notes: Ask students how EMS has changed its approach to each of these items over the years.
- #9: Instructor Notes: The number one priority is the safety of EMS providers. Ask, “What are some specific hazards to EMS providers?” Ensure responses include violence, traffic, spills, electricity, unstable vehicles or structures, etc.
- #10: Instructor Notes: These are the priorities of the primary survey. Ask, “What are things that can cause us to lose sight of these priorities?”
- #11: Instructor Notes: Generate discussion using the questions below: What could lead us to overlook critical steps in airway management? How can airway management go wrong? How can we keep our focus on the patient’s airway?
- #12: Instructor Notes: Ask, “What do we need to know to choose the correct device for oxygenation and/or ventilation?”
- #13: Instructor Notes: This is an area of trauma care where thinking has evolved dramatically over the years.
- #15: Instructor Notes: Generate discussion using the questions below: How and why can the wrong decisions be made about extrication? How can we ensure good decision-making?
- #16: Instructor Notes: Generate discussion using the questions below: What are some things we can do, as providers, to make sure we are detecting changes in patient condition? How can we continue to improve in providing prehospital trauma care?
- #17: Instructor Notes: Generate discussion using the questions below: What are causes of unnecessary scene delays? What needs to be done prior to transport?
- #19: Instructor Notes: Slide 1 of 2 summary slides