AAP Trauma Craig Aug24 v3.pdf

Support the management of trauma in the emergency and urgent care setting Component 8 Trauma Overview  Trauma - Component 8 Session Outline Major Trauma – the...

Support the management of trauma in the emergency and urgent care setting Component 8 Trauma Overview  Trauma - Component 8 Session Outline Major Trauma – the risk of serious injury DR CAcBCDE Approach Supporting the EAC/paramedic & keeping things moving! Designed to complement existing knowledge on the management of simple wounds and minor injuries Transfer existing skills into the context of major trauma ©Department of Clinical Education & Standards  Trauma - Component 8 Key messages before we start! Scene safety Minimal on scene times! Pre-empt what paramedic is going to do! Have kit ready Expedite packaging and removal Prevent paramedic from performing unnecessary interventions and assist them where needed Tell paramedic about any of your findings ©Department of Clinical Education & Standards  Trauma - Component 8 Trauma Deaths Immediate fatal injury Early deaths: A, B, C and D Late deaths Infection, ARDS Acute Respiratory Distress Syndome What can be done to reduce deaths in each phase? ©Department of Clinical Education & Standards  The Major Cause of Death in Trauma is Blood Loss ©Department of Clinical Education & Standards  Trauma - Component 8 Compensation for Blood Loss Most trauma victims are young and healthy They compensate very well for blood loss Vasoconstriction Increased heart rate Increased respiratory rate Vital signs can be misleading ©Department of Clinical Education & Standards  In young, healthy adults these changes are often subtle and may only be seen late! ©Department of Clinical Education & Standards  Trauma - Component 8 Changes in Vital Signs “Text-Book” normal heart rate: 60 – 80 / minute A heart rate of 100 is only slightly outside this range… yet may be almost double the patient’s resting rate ©Department of Clinical Education & Standards  Trauma - Component 8 Changes in Vital Signs “Text-Book” normal breathing rate 12 - 20 / minute A breathing rate of 24 is only slightly outside this range… yet may be double the patient’s resting rate ©Department of Clinical Education & Standards  A young persons ability to compensate for major trauma + The fact that we do not always witness and appreciate the forces involved = Serious injuries may be missed ©Department of Clinical Education & Standards  Trauma - Component 8 Who is at risk of serious injury? – Young, healthy adults Alcohol & Drugs – Older people Less resilient Multiple medical problems and medications – Children No concept of danger ©Department of Clinical Education & Standards  Trauma - Component 8 Affects older patients Increased rate of significant injuries from falls from standing Elderly and fall downstairs is bad Anti-coagulant medication can complicate the injury 12 CSR 2016.3  Trauma - Component 8 Major trauma following low-mechanism injury is common in older patients – Careful neurological assessment – Immobilisation in a neutral position for the patient – Not applying a collar is not ‘clearing the spine’ 13 Clinical Education & Standards  Trauma - Component 8 Why do we miss seriously injured patients? ©Department of Clinical Education & Standards  Trauma - Component 8 Sometimes it is obvious ©Department of Clinical Education & Standards  Trauma - Component 8 But… – Time to scene ? – Experience ? – Mechanism ? – Compensation ? ©Department of Clinical Education & Standards  GO NOW! ©Department of Clinical Education & Standards  Minimise on-scene time for Major Trauma “minutes” for penetrating trauma ≤ 20 minutes for blunt trauma ©Department of Clinical Education & Standards  Secondary survey - Component 3 Mechanism of Injury Understanding how traumatic injury occurs 19 © Department of Clinical Education & Standards  Penetrating injury cannot be fixed on scene or in the ambulance Keep on-scene time to the absolute minimum ©Department of Clinical Education & Standards  Trauma - Component 8 … when you can’t go now ©Department of Clinical Education & Standards  Trauma - Component 8 Get Everything Ready Kit out Trolley out Ambulance pointing in the right direction Heating on Exit route planned and clear Family and police briefed ©Department of Clinical Education & Standards  Trauma - Component 8 Scene Management Involve everyone Match the skill level to the task Who is holding the head? Have an overview Anticipate & multi-task Communicate ©Department of Clinical Education & Standards  Trauma – Component 8 Good Trauma Care is a Team Sport ©Department of Clinical Education & Standards ©Department of Clinical Education & Standards ©Department of Clinical Education & Standards  Trauma - Component 8 The approach to the seriously injured patient ©Department of Clinical Education & Standards  Trauma - Component 8 The first 10 minutes are vital – Consistent approach – Rapid identification of life-threatening injuries – Assessment and management are simultaneous – Assume the worst and exclude or treat it ©Department of Clinical Education & Standards  The approach to major trauma Scene Assessment Primary Survey Fail at any stage Pass / Stable Lifesaving Interventions Secondary Survey Pain Control Initiate Transport Manage as Needed Default This Way ©Department of Clinical Education & Standards The approach to major trauma Scene Assessment Primary Survey Fail at any stage Pass / Stable Initiate Transport Secondary Survey Pain Control Lifesaving Interventions Manage as Needed Default This Way ©Department of Clinical Education & Standards  Trauma - Component 8 The Primary Survey D D – Danger R R – Response < c C- > Catastrophic haemorrhage A – AAirway C – C – spine consideration B – BBreathing C – CCirculation (Blood on the Floor PLUS Four More) D – DDisability E – EExpose and evaluate ©Department of Clinical Education & Standards  All seriously injured patients must get 100% Oxygen as soon as their airway is clear ©Department of Clinical Education & Standards  Any patient with a serious head injury or loss of consciousness has a spinal injury until proven otherwise ©Department of Clinical Education & Standards  Trauma - Component 8 Your role: In addition…. Anticipate Monitor Prepare Plan Keep things moving ! ©Department of Clinical Education & Standards  Trauma - Component 8 Trauma Priority Call: PD 09 C Call sign A Age T Time of injury M Mechanism of injury I Injuries found and suspected S Signs (vital) T Treatment given or required ©Department of Clinical Education & Standards  Trauma - Component 8 Key Messages Be thorough and effective with airway management Don’t get distracted Expose the patient – if you don’t look you won’t find (keep them warm afterwards) Hypoxia and/or hypotension will kill the brain injured patient The first clot is the best one Minimal movement of the seriously injured (don’t let this slow you down though!) ©Department of Clinical Education & Standards  Trauma - Component 8 Key Messages Get the patient to the – right hospital – in the right time – first time If you are tasked to significant trauma – think about your options for support early Pre-empt what the paramedic will do and ensure kit ready and assist where possible Tell the paramedic of your findings ©Department of Clinical Education & Standards  There are not many things that can be fixed on scene or in the ambulance Keep on-scene time to the absolute minimum ©Department of Clinical Education & Standards  Trauma - Component 8 Questions? ©Department of Clinical Education & Standards  Trauma - Component 8 Summary – Good trauma care requires: Rapid assessment Immediate interventions –Airway, Breathing, Circulation Attention to detail Continual reassessment Teamwork ©Department of Clinical Education & Standards