Scheme

Question 1

PHTLS-Introduction (3)

Answer 1

Fundamental points:

• Golden Time (10 minutes from arrival to departure (try not to stop on way to hospital))
• What kills first is treated first
• We can’t treat in field, we can only preserve the current situation until arrival at trauma theatre.

Question 2

PHTLS-Step 1 (SSS)

Safety (2)
Scene (1)

Answer 2

Safety x2 (Person, Team):

• Use common sense (secure area, ambulance- placement and exit, secure team-gear)
• Call 101 for reinforcement and report if necessary

Scene:
-Kinematics (speed, height, seatbelt marks, damage to car and gear)

Question 3

PHTLS-Step 2 (ABCDE)

Initial impression (3)

Answer 3

Initial impression:

• State of consciousness (AVPU)
• In case of clinical death, call 101 and ask for permission to begin CPR.
• Erupting haemorrhages
• Exposed internal organs

Question 4

PHTLS-Airway (5)

Answer 4

Airway:

• Head fixation/Feel back of head for damage
• Place neck brace/Remove helmet

If unconscious;

• Jaw thrust
• Remove excrements (suction)
• Insert airway (straight)

Question 5

PHTLS-Breathing (4)

Answer 5

Breathing:
-Expose chest area and analyse: 
  1)Check breathing
     (speed, depth, symmetry, cyanosis,                    
     assisted breathing)
  2)Check for wounds
     (Pneumothorax, Jugular vein        
     distension)
-Treatment
  1)Oxygen mask/AMBO
  2)Asherman, bandages

Question 6

PHTLS-Circulation (4)

Answer 6

Circulation 
1.Check perfusion:
  -Pulse (impression not      
    measurement- speed, strength)
  -Pallor (skin colour and temperature)
  -Capillary filling time (if cold don't 
    check)

2. Suspect:
   - Circulatory Shock (all types)

Question 7

PHTLS-Disability (3)

Answer 7

Disability:

1) Re-evaluate level of consciousness
2) Check motor ability (fingers and feet)
3) Check pupils:
- dilated (lack of oxygen to brain)
- unequal (basial skull fracture)
- unresponsive (neurological damage)

Question 8

PHTLS-Exposure (2)

Answer 8

Exposure:

• Undress patient (if necessary!)
• Feel body for any other injuries (adrenaline can distract pain)
• Cover patient

Question 9

PHTLS-Step 3

Fixture to back splint-Scenarios (4)
Conditions (4)

Answer 9

Fixture to back splint:

Severe kinematics with

1) Suspected spinal damage
2) Loss of consciousness
3) Loss of motor ability
4) Doubt

Additional scenarios

1) Severe back pains (muscle related)
2) Suspected broken hip (abnormal leg length/positioning)
3) Stomach trauma

Question 10

PHTLS-Step 4 (T&T) (3)

Answer 10

Treat and Transport:
1)Emergency/Regular evacuation 
2)Consider calling ICU:
  Severe kinematics and:
  -Decline in consciousness
  -Abnormal ABCD
3)Prepare trauma theatre

Question 11

PHTLS-Step 4

ABCD
Anamnesis (2)

Answer 11

Second Evaluation x2:(beginning and end)

A-Secure airway
B-Count breathing
C-Pulse, BP, I.V (long transport-20 minutes, monitor BP-80 systole, Fill ratio-1/3)
Dressing-Complete dressings (burns, wounds, fractures/splints)

Anamnesis:

1) Blood thinners (primary question)
2) Try and present a complete package to hospital:
- Cause of trauma (perhaps disease related)
- Broaden case file (AMPL)