INITIAL ASSESSMENT AND MANAGEMENT

Question 1

pRepARAtioN: aims of Prehospital Phase

Answer 1

1. Expedite treatment in the FIELD
2. Notify the receiving hospital before personnel transport the patient from the scene.
3. Mobilization of the hospital’s trauma team members.

Question 2

pRepARAtioN: prehospital phase care objectives.

Answer 2

1. airway maintenance, 2. control of external bleeding and shock,
2. immobilization of the patient, and
3. immediate transport to the closest appropriate facility, preferably a verified trauma center

Question 3

How can you minimize prehospital scene time?

Answer 3

Using the Field Triage Decision Scheme

Answer 4

airway maintenance, control of external bleeding and shock, immobilization of the patient, and immediate transport to the closest appropriate facility, preferably a verified trauma center

Question 5

Hospital phase: what are the critical aspects of hospital preparation

Answer 5

• A resuscitation area is available for trauma patients. • Properly functioning airway equipment (e.g., laryngoscopes and endotracheal tubes) is organized, tested, and strategically placed to be easily accessible. • Warmed intravenous crystalloid solutions are immediately available for infusion, as are appropriate monitoring devices. • A protocol to summon additional medical assistance is in place, as well as a means to ensure prompt responses by laboratory and radiology personnel. • Transfer agreements with verified trauma centers are established and operational. (See ACS COT’s Resources for Optimal Care of the Injured Patient, 2014).

Question 6

Hospital care: what is the minimum precautions and protection requirements?

Answer 6

face mask, eye protection, water-impervious gown, and gloves)

Question 7

Hospital care: What is triage

Answer 7

Triage involves the sorting of patients based on the resources required for treatment and the resources that are actually available. The order of treatment is based on the ABC priorities

Question 8

Hospital care : what factors dertimine triage and treatment priority

Answer 8

The order of treatment is based on the ABC priorities

severity of injury, ability to survive, and available resources.

Question 9

Hospital phase: what prehospital measre can assist or facilitate triage

Answer 9

Trauma score

Question 10

Trauma score

Question 11

How are triage situations categorized

Answer 11

Multiple casualties are those in which the number of patients and the severity of their injuries do not exceed the capability of the facility to render care.
Mass casualties the number of patients and the severity of their injuries does exceed the capability of the facility and staff.

Question 12

Disaster management and emergency preparedness

Question 13

What are the components of the primary Survey

Answer 13

• Airway maintenance with restriction of cervical spine motion • Breathing and ventilation • Circulation with hemorrhage control • Disability(assessment of neurologic status) • Exposure/Environmental control

Question 14

Primary Survey: airway MaintenanCe witH restriCtion oF CerViCaL spine Motion

Answer 14

Patency
Inspection: foreign bodies, faidentifying facial, mandibular, and/or tracheal/laryngeal fractures and other injuries that can result in airway obstruction; and suctioning to clear accumulated blood or secretions that may lead to or be causing airway obstruction.
Begin measures to establish a patent airway while restricting cervical spine motion.

Question 15

Indications for definitive airway

Answer 15

Glasgow Coma Scale (GCS) score of 8 or lower

Establish a definitive airway if there is any doubt about the patient’s ability to maintain airway integrity.

Question 16

Maneuvers to open airway

Answer 16

jaw-thrust or chin-lift maneuver

oropharyngeal airway if no gag reflex

Question 17

Precautions to take

Answer 17

While assessing and managing a patient’s airway, take great care to prevent excessive movement of the cervical spine. Based on the mechanism of trauma, assume that a spinal injury exists

Question 18

How is cervical spine proteced

Answer 18

cervical collar

team member manually restricts motion of the cervical spine

Question 19

When is surgical airway indicated

Answer 19

intubation is contraindicated or cannot be accomplished.

Question 20

Breathing and ventilating assessment

Answer 20

assess jugular venous distention, position of the trachea, and chest wall excursion, expose the patient’s neck and chest. Perform auscultation to ensure gas flow in the lungs. Visual inspection and palpation can detect injuries to the chest wall that may be compromising ventilation. Percussion of the thorax can also identify abnormalities, but during a noisy resuscitation this evaluation may be inaccurate.

Question 21

Airway and ventilation management

Answer 21

supplemental oxygen. If the patient is not intubated, oxygen should be delivered by a mask-reservoir device to achieve optimal oxygenation.
Use a pulse oximeter to monitor adequacy of hemoglobin oxygen saturation.
Simple pneumothorax, simple hemothorax, fractured ribs, flail chest, and pulmonary contusion can compromise ventilation to a lesser degree and are usually identified during the secondary survey

Question 22

CirCULation witH HeMorrHage ControL

Answer 22

Blood volume, cardiac output, and bleeding are major circulatory issues to consider.

Answer 23

Obtain AMPLE history from patient, family, or prehospital personnel. •A—allergies •M—medications •P—past history, illnesses, and pregnancies •L—last meal •E—environment and exposure

Question 24

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Answer 24

Obtain history of injury-producing event and identify injury mechanisms

Answer 25

Assess the head and maxillofacial area. A. Inspect and palpate entire head and face for lacerations, contusions, fractures, and thermal injury. B. Reevaluate pupils. C. Reevaluate level of consciousness and Glasgow Coma Scale (GCS) score. D. Assess eyes for hemorrhage, penetrating injury, visual acuity, dislocation of lens, and presence of contact lenses. E. Evaluate cranial nerve function. F. Inspect ears and nose for cerebrospinal fluid leakage.G. Inspect mouth for evidence of bleeding and cerebrospinal fluid, soft-tissue lacerations, and loose teeth.

Answer 26

A. Inspect for signs of blunt and penetrating injury, tracheal deviation, and use of accessory respiratory muscles. B. Palpate for tenderness, deformity, swelling, subcutaneous emphysema, tracheal devia- tion, and symmetry of pulses. C. Auscultate the carotid arteries for bruits. D. Restrict cervical spinal motion when injury is possible.

Answer 27

A. Inspect the anterior, lateral, and posterior chest wall for signs of blunt and penetrating injury, use of accessory breathing muscles, and bilateral respiratory excursions. B. Auscultate the anterior chest wall and pos- terior bases for bilateral breath sounds and heart sounds. C. Palpate the entire chest wall for evidence of blunt and penetrating injury, subcutaneous emphysema, tenderness, and crepitation. D. Percuss for evidence of hyperresonance or dullness.

Answer 28

A. Inspect the anterior and posterior abdomen for signs of blunt and penetrating injury and internal bleeding. B. Auscultate for the presence of bowel sounds. C. Percuss the abdomen to elicit subtle rebound tenderness
D. Palpate the abdomen for tenderness, involun- tary muscle guarding, unequivocal rebound tenderness, and a gravid uterus.

Answer 29

7. Assess the perineum. Look for • Contusions and hematomas • Lacerations • Urethral bleeding

Answer 30

Perform a rectal assessment in selected patients to identify the presence of rectal blood. This includes checking for: • Anal sphincter tone • Bowel wall integrity • Bony fragments

Answer 31

Perform a vaginal assessment in selected patients. Look for • Presence of blood in vaginal vault • Vaginal lacerations

Answer 32

Perform a musculoskeletal assessment. • Inspect the upper and lower extremities for evidence of blunt and penetrating injury, including contusions, lacerations, and deformity. • Palpate the upper and lower extremities for tenderness, crepitation, abnormal movement, and sensation. • Palpate all peripheral pulses for presence, absence, and equality. • Assess the pelvis for evidence of fracture and associated hemorrhage. • Inspect and palpate the thoracic and lumbar spines for evidence of blunt and penetrating injury, including contusions,lacerations, tenderness, deformity, and sensation (while restricting spinal motion in patients with possible spinal injury).

Answer 33

Perform a neurological assessment. • Reevaluate the pupils and level of consciousness. • Determine the GCS score. • Evaluate the upper and lower extremities for motor and sensory functions. • Observe for lateralizing signs.