After receiving the call in report from EMS about a trauma patient, what are the first 3 things you will do before the patient arrives to the ED?
1) Alert the trauma team
2) Prep the trauma room for possible necessary equipment (i.e. IV fluid warmer, intubation and IV kits, pediatric or bariatric kit, etc)
3) Don PPE
The EMS is strolling into the ER with the patient, what is the first thing you do?
Across the room observation; assess for external hemorrhage that would reprioritize ABC to CAB
Define what you look for when assessing for A: Alertness and Airway
- AVPU (Alert, Verbal, Pain, Unresponsive)
- If pt not alert: While someone else is maintaining C-Spine, jaw thrust to assess for foreign objects, missing teeth, tongue, edema, any blood/vomit/secretions, bony deformity, and if pt is snoring, gurling, or has stridor.
- If pt is alert, ask the pt to open their mouth to assess their airway
What are some possible interventions if there is an airway obstruction?
- suction secretions
- remove any foreign objects or loose teeth
- insert NPA or OPA (only OPA in unconscious pts w/o gag reflex)
- indicate need for intubation
- *REASSESS any interventions applied
If you apply any interventions to correct for a problem with the airway, what are you going to do before moving on to assessingB: Breathing and Ventilation?
REASSESS your patient!
Define what you look for when assessing for B: Breathing and Ventilation?
- Inspect skin for color, spontaneous breathing, depth/pattern/RR, symmetrical chest rise and fall, increased work of breathing, open wounds or deformities, tracheal deviation, or JVD
- auscultate breath sounds: are they both present and equal?
- palpate for subQ emphysema
Name some interventions for correcting problems with breathing.
- Apply O2
- Bag-mask ventilation
- Indicate need for intubation
- Indicate need for needle decompression (tension pneumo)
- Indicate need for chest tube
- *REASSESS after any interventions applied
Immediately after intubation, what things do you need to do?
- attach a CO2 device (after 5-6 breaths, assess for evidence of exhaled CO2)
- observe for rise and fall of chest with ventilations
- auscultate over the epigastrum for gurgling, and then auscultate for bilateral breath sounds
- document where ETT is positioned at teeth, secure ETT, and attach it to the ventilator
Define what you look for when assessing for C: Circulation and Control of Hemorrhage
Mneumonic: PSH (as in the sound psshhhhhh)
- pulse (central)
- skin: color, temp, moisture
- hemorrhage
Name some interventions for correcting problems with circulation
- control uncontrolled hemorrhage
- CPR/ACLS
- assess patency of IV, obtain 2 IV sites, and initiate (warm) isotonic IVF (either rapid bolus or steady continuous
- consider blood products
- apply pelvic binder
- *REASSESS any interventions implemented
Define what you look for when assessing for D: Disability
Disability aka Neuro
- GCS
- pupils
- is CT head needed?
- assess BG
What do you assess for E: Exposure and Environment Control?
- strip patient down to assess for any uncontrolled external hemorrhage or obvious injuries
- provide warmth via blankets, warming lights, increase room temp, warmed IVF, warmed O2
What do you assess for F?
Full set of VS
Family Presence
What do you assess for G?
G: get all monitoring devices L: labs M: monitor (Cardiac/EKG) N: NG/OG O: O2 (ability to wean down O2?) and attach to capnography if still needed P: Pain assessment
Name some nonpharmacologic pain interventions
ice to swollen areas
repositioning
padding bony prominences
What do you assess for H?
History: PMH and prehospital report
Head to Toe Assessment
Briefly describe the Head to Toe assessment
- Inspect and Palpate face and head
- Inspect and Palpate neck while someone maintains C-spine
- Inspect, Auscultate, and Palpate chest, then abd and flanks
- Inspect and palpate hips, apply pressure to iliac crests medially and downward
- Inspect perineum for discharge and apply pressure to symphysis pubis; urinary catheter insertion needed or contraindicated?
- Inspects and palpates all extremities and checks for neurovascular status
- IF NO spinal or pelvic injury, log roll pt to inspect posterior and to remove back board
If spinal cord or pelvic injury is suspected in a trauma patient, how do you remove the backboard since log rolling the pt is contraindicated?
use the 6+ person lift technique
What do you assess for I?
Identify all injuries and name interventions needed (i.e. CT/xray, consults, psychosocial support, abx, pain/sedation meds, social services, law enforcement, labs, wound care, splinting, tetanus
What is J?
Just keep reevaluating VIPP V: VS I: identified injuries and effectiveness of interventions P: primary assessment P: pain
What is K?
Keep or transfer patient
