PHTLS Trauma Management Quiz

Paramedic Science - Health & Human Development 2 - Trauma

• This presentation contains disturbing content, including slides, images and videos.

Definition

• Trauma is defined as an extrinsic force acting upon the body.

A PHTLS Approach

• Prehospital Trauma Life Support (PHTLS) is an assessment and management tool for trauma patients.
• It's similar to an A-E or ALS assessment.
• Worldwide, it's the most used tool for assessing trauma patients.
• Initiated by the National Association of Emergency Medical Technicians (NAEMT).
• Recognized by the College of Paramedics and the Health & Care Professions Council as the preferred assessment tool for trauma patients.

PHTLS Primary Survey

• A PHTLS Primary Survey isn't the same as a standard A-E assessment.
• It's a rapid assessment, taking no longer than a few minutes.
• Designed to identify and manage acutely life-threatening problems.
• No observations are gathered during this phase.

PHTLS Secondary Survey

• More detailed analytical assessment of the patient, similar to a head-to-toe assessment.
• Any injuries are managed in order of priority.
• Baseline observations are taken and managed in this part of the assessment.

PHTLS Primary Survey - Scene Safety

• Dynamic risk assessment
• Standard infection control procedures (consider double gloves)
• Mechanism of injury
• Number of patients
• Additional resources

PHTLS Primary Survey - Scene Size Up/Global Overview

• Visual Head-to-Toe assessment
• Colour appearance and position of the patient
• Catastrophic hemorrhage (apply tourniquet 6cm proximal to injury)
• Adopt/consider C-spine control
• Identify/manage time critical problems

PHTLS Primary Survey - Response

• Checks ACVPU (Alert, Conscious, Verbal, Pain, Unresponsive)
• If unconscious, check for pulse and breathing to exclude trauma (TCA)
• Visual airway inspection
• Identify/Manage time critical problems

PHTLS Primary Survey - Breathing

• Estimate respiratory rate
• Apply high-flow oxygen
• Visual inspection
• Palpation
• Auscultation
• Percussion
• Identify/Manage time-critical problems

PHTLS Primary Survey - Circulation

• Estimate pulse, rhythm and strength
• Skin color, temperature and texture
• Peripheral/Central capillary refill

PHTLS Primary Survey — Blood on the Floor & 5 More

• External sweep, checking natural hollows then internal sweep
• Head
• Thorax
• Abdomen
• Pelvis
• Femurs
• Identify/manage time critical problems.

PHTLS Primary Survey - Disability

• Pupillary assessment
• Glasgow Coma Scale
• Abnormal behaviour/agitation
• Hypoxia/drugs/alcohol
• Pre-existing condition
• Identify/manage time critical problems

PHTLS Primary Survey - Expose & Examine

• Remove clothing to assess extremities
• Upper limb PMS
• Lower limb PMS
• Maintain dignity and temperature
• Identify/manage time critical problems

PHTLS Secondary Survey

• Head-to-toe examination
• Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAPBTLS)
• Head
• Face
• Pupillary assessment (PERRLA)

PHTLS Secondary Survey - Airway

• Visual inspection
• Neck: deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAPBTLS).
• Palpate C-spine and apply a collar if necessary.
• Check for jugular vein distension/tracheal deviation/surgical emphysema.

PHTLS Secondary Survey - Chest

• Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAPBTLS).
• Gain full respiratory rate, depth, and rhythm.
• Gain SPO2
• Visual inspection
• Palpation
• Auscultation
• Percussion

PHTLS Secondary Survey - Abdomen

• Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAPBTLS).
• Palpate the abdomen.

PHTLS Secondary Survey - Pelvis

• Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAPBTLS).
• If immobilised, no further handling.
• Visual inspection for incontinence
• Check for priapism.

PHTLS Secondary Survey - Back

• Only log roll if necessary.
• Upper limb assessment including PMS
• Lower limb assessment including PMS
• Immobilised/Treated Appropriately

PHTLS Secondary Survey - Gain Observations

• Pulse rate
• Blood pressure
• Cap refill
• ECG
• Glasgow Coma Scale (GCS) score
• Blood glucose
• Temperature

PHTLS Secondary Survey - History Taking

• Gain SAMPLE (Signs, Symptoms, Allergies, Medications, Pertinent Past History, Events leading up to injury).
• Conduct SOCRATES (Specific location, Onset, Character, Radiation, Associated signs and Symptoms, Time, Exacerbating and relieving factors)
• Social history
• Family history
• Identify appropriate trauma pathway

Traumatic Brain Injury (TBI)

• Disruption in the brain's normal function.
• Caused by a blow, bump, jolt to the head, or object piercing the skull and entering brain tissue.
• Signs include: loss of/decreased consciousness, amnesia, focal neurological deficits, mental state changes (disorientation, slow thinking, difficulty concentrating).
• Severity varies (mild, moderate, severe), impacting mental state, consciousness, and potentially leading to death.

Intracranial Pressure (ICP)

• Increased pressure within the brain.
• Cushing's triad: bradycardia, irregular respirations, widened pulse pressure.
• Loose C-collar slightly to reduce ICP risk.

Skull Fractures

• Types:
  • Linear: break in the bone without movement. Usually no intervention needed.
  • Depressed: part of the skull is sunken in, often requiring surgical intervention.
  • Diastatic: fractures along the suture lines (areas between skull bones). Common in newborns and infants.
  • Basilar: fractures at the base of the skull, can cause clear fluid drainage from nose or ears. Requires close monitoring
• Le Fort classifications (I, II, III) are types of facial fractures.

Brain Injury

• Primary Impact (Coup): Brain strikes skull on impact side.
• Secondary Impact (Contrecoup): Brain strikes the opposite side of the skull, as a result of the initial impact.

Concussion

• Mild traumatic brain injury.
• Often caused by falls, crashes, assaults, or sports.
• Characterised by loss of consciousness (<30minutes) or post-traumatic amnesia (<24 hours).

Pathophysiology of Trauma

• Many slides describing various trauma types, pathophysiology, signs and symptoms and treatment.
• Important data for each trauma type mentioned relating to injuries

Open Pneumothorax

• Air enters/accumulates between the chest wall and lung due to a physical defect/wound.
• A special type called a sucking chest wound where air is sucked into the thoracic cavity, not the lung.
• Need to ensure a closed system for effective treatment

Hemothorax

• Collection of blood in the pleural cavity.

Cardiac Tamponade

• Fluid build-up around the heart, putting pressure on it and reducing heart function.
• Beck's triad: low blood pressure, distended jugular veins, muffled heart sounds.

Flail Chest

• Two or more contiguous rib fractures resulting in a portion of the chest wall being destabilised.

Blunt Force Trauma

• Trauma from blunt object.
• Types include contusion (bruise), abrasion (scrape), laceration, and fracture.
• Various causes including car accidents, falls, or assaults.

Penetrating Trauma

• Injury caused by a foreign object penetrating the body.
• Most common causes include gunshot and stab wounds.

Abdominal Injuries & Pelvic Injuries:

• Description of the various aspects of abdominal and pelvic injuries, causes, symptoms and treatment.
• Include diagrams to support the discussion of these injuries

Mid-Shaft Femur Fractures

• Features of the femur fracture, associated injuries, symptoms and treatment.
• Relevant anatomical features about the femur.

Compartment Syndrome

• Rising pressure in a muscle compartment, impacting blood flow.
• Usually in the lower leg, but other parts of the body can be affected
• Significant risk of damage, so treatment needs to be timely.

Trauma Triad of Death

• Combination of hypothermia, acidosis, and coagulopathy, often seen in severe trauma.
• A vicious cycle. Each complicates the others and if not treated timely can lead to death.

Drowning

• The process of experiencing respiratory impairment from submersion or immersion.
• Important data describing the process and resulting treatments.

Burns

• Three classifications: superficial (first degree), partial thickness (second degree), and full thickness (third degree).
• Describes features of the burn injuries, and the differing degrees of burns.

Hypothermia

• Low body temperature (below 35°C)
• Can be life-threatening, with potentially fatal outcomes if not treated effectively

Heat Stress, Heat Exhaustion, Heat Stroke

• Describes the differing stages of heat-related illnesses. Each has different symptoms and treatments.

Acid Attack

• Use of corrosive substances (acids, alkaline/caustic chemicals) in assault.
• Commonly causing chemical burns to the skin and eyes.
• Includes First Aid guidance on how to act appropriately when dealing with acid attacks.

Traumatic Amputation

• Separation of a limb from the body.
• Usually due to accident.
• May be partial or complete.
• Treatment involves reattachment if possible.

Tooth Avulsion

• Permanent teeth only.
• Prompt replantation crucial for successful outcome.
• Treatment guidelines given, including storage in milk, rather than water.

Shock in Trauma

• Decreased oxygen delivery and/or increased oxygen consumption, leading to cellular and tissue hypoxia.
• A dangerous condition of circulatory failure.
• 7 types of shock described in the associated slides, with specific features and origins for each.

Spinal Structure

• Spinal structure: vertebrae, facet joints, intervertebral disks, spinal cord & nerves, soft tissue, and the types of spinal curves.

Spinal Cord Injuries

• Includes the severity of injury classifications based on complete and incomplete spinal cord injuries.

Emergency Signs & Symptoms of spinal cord injury

• Detailed signs and symptoms of spinal cord injury that are crucial for prompt identification and treatment.

Spinal Fractures

• Causes, categories, and types of spinal fractures

Spinal Immobilisation

• Urgent immobilisation of potentially injured spines.
• Important factors to consider when providing the necessary immobilisation techniques
• Includes an algorithm.

Contact Information

• Provides contact information for the module lead and the programme.