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Questions and Answers
What is the primary purpose of the PHTLS approach in trauma management?
What is the primary purpose of the PHTLS approach in trauma management?
Which statement accurately describes the PHTLS Primary Survey?
Which statement accurately describes the PHTLS Primary Survey?
What differentiates the PHTLS Secondary Survey from the Primary Survey?
What differentiates the PHTLS Secondary Survey from the Primary Survey?
Which organization formalized the PHTLS approach?
Which organization formalized the PHTLS approach?
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What is NOT included in the PHTLS Primary Survey?
What is NOT included in the PHTLS Primary Survey?
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What does the Glasgow Coma Scale primarily assess in a patient?
What does the Glasgow Coma Scale primarily assess in a patient?
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What is the primary focus during the 'Expose & Examine' phase?
What is the primary focus during the 'Expose & Examine' phase?
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Which of the following is NOT part of the assessment for the chest during the secondary survey?
Which of the following is NOT part of the assessment for the chest during the secondary survey?
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What does the acronym DCAPBTLS stand for in the secondary survey?
What does the acronym DCAPBTLS stand for in the secondary survey?
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In the scenario of suspected traumatic brain injury, which of the following is a likely cause?
In the scenario of suspected traumatic brain injury, which of the following is a likely cause?
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What assessment technique should be utilized for evaluating the neck during a secondary survey?
What assessment technique should be utilized for evaluating the neck during a secondary survey?
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What should be checked for when performing the pelvic examination?
What should be checked for when performing the pelvic examination?
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What is a common sign of a flail chest segment during respiration?
What is a common sign of a flail chest segment during respiration?
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Which assessment is included in the vital signs observation during the secondary survey?
Which assessment is included in the vital signs observation during the secondary survey?
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Blunt force trauma can be classified into which of the following categories?
Blunt force trauma can be classified into which of the following categories?
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Which of the following is NOT typically a symptom of blunt force trauma?
Which of the following is NOT typically a symptom of blunt force trauma?
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What type of trauma is characterized by an object piercing the skin and causing an open wound?
What type of trauma is characterized by an object piercing the skin and causing an open wound?
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Which of the following factors does NOT contribute to blunt trauma?
Which of the following factors does NOT contribute to blunt trauma?
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Which condition is characterized by the tearing of the skin, leading to an irregular wound?
Which condition is characterized by the tearing of the skin, leading to an irregular wound?
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Which mechanism is NOT associated with blunt force trauma?
Which mechanism is NOT associated with blunt force trauma?
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In cases of blunt force trauma, which symptom indicates potential respiratory distress?
In cases of blunt force trauma, which symptom indicates potential respiratory distress?
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What is a potential consequence of a ruptured spleen?
What is a potential consequence of a ruptured spleen?
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Which of the following symptoms is associated with pelvic fractures?
Which of the following symptoms is associated with pelvic fractures?
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What defines a severe pelvic fracture?
What defines a severe pelvic fracture?
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What percentage of severe internal bleeding can occur in a femoral shaft fracture?
What percentage of severe internal bleeding can occur in a femoral shaft fracture?
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Which of the following is NOT a sign of a mid shaft femur fracture?
Which of the following is NOT a sign of a mid shaft femur fracture?
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What is a common symptom experienced in pelvic injuries?
What is a common symptom experienced in pelvic injuries?
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Which of the following treatments should be followed for major pelvic trauma?
Which of the following treatments should be followed for major pelvic trauma?
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What primary effect can a crush injury have on the body?
What primary effect can a crush injury have on the body?
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Which locations are most commonly affected by compartment syndrome?
Which locations are most commonly affected by compartment syndrome?
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What role does the spleen play in the body?
What role does the spleen play in the body?
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What three conditions make up the trauma triad of death?
What three conditions make up the trauma triad of death?
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How does severe bleeding in trauma affect the body's oxygen delivery?
How does severe bleeding in trauma affect the body's oxygen delivery?
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What initiates the positive feedback loop in the trauma triad?
What initiates the positive feedback loop in the trauma triad?
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What is the consequence of metabolic acidosis in trauma?
What is the consequence of metabolic acidosis in trauma?
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What physical process does drowning involve?
What physical process does drowning involve?
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What is a major treatment guideline to follow for limb trauma?
What is a major treatment guideline to follow for limb trauma?
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What is a potential complication of untreated heat stress?
What is a potential complication of untreated heat stress?
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Which of the following symptoms is NOT associated with hypothermia?
Which of the following symptoms is NOT associated with hypothermia?
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In cases of acid attack, what is the first step in the management process according to NHS guidance?
In cases of acid attack, what is the first step in the management process according to NHS guidance?
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What is a key characteristic of heat exhaustion?
What is a key characteristic of heat exhaustion?
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What distinguishes traumatic amputation from other types of limb injuries?
What distinguishes traumatic amputation from other types of limb injuries?
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Which of the following treatments should be followed for managing burns in acid attack victims?
Which of the following treatments should be followed for managing burns in acid attack victims?
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Which statement about heat stroke is true?
Which statement about heat stroke is true?
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What is the recommended action for managing heat-related illness?
What is the recommended action for managing heat-related illness?
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Study Notes
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.
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Description
Test your knowledge on the PHTLS (Prehospital Trauma Life Support) approach in trauma management. This quiz covers the fundamentals including the Primary and Secondary Surveys, their purposes, and the organizations involved in PHTLS. Challenge yourself to see how well you understand these critical concepts in emergency medical care.
