BASIC TRAUMA LIFE

SUPPORT

Initial
Assessment and
Management of
Trauma
Purwoko Sugeng
H

Introduction
Golden Hour
Time to reach operating room
(or other definitive treatment)
NOT time for transport to ED
NOT time in Emergency Department

EMS does NOT have a Golden

Hour
EMS has a Platinum Ten
Minutes
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Introduction
Patients in their Golden Hour must:
Be recognized quickly
Have only immediate life threats managed
Be transported to an APPROPRIATE facility

Survival depends on assessment skills

Good assessment results from
An organized approach
Clearly defined priorities
Understanding available resources

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Trauma Assessment

Load and Go
Situation ?

Load and Go
Situation ?

HOSP

Scene SizeUp

Safety
Body Surface Isolation (BSI)
Number of Patients
Additional Resources
Mechanism of Injury(MOI)

Safety

Traffic
Smoke
Electricity
Haz-Mat
Hostile
Persons
Weapons
Drugs
Silence

BODY SURFACE
ISOLATION
Gloves for minimal
fluids
Goggles for eye
protection if theres
any chance of
splatter
Mask and Gown for
gross contamination

Number of Patients

Call for additional resources

ASAP

Additional resources

Extrication
Traffic control
Utilities

Significant Mechanism
of Injury
Ejection from vehicle
Death in same
passenger
compartment
Fall of greater than
15 feet or
3 times the patients
height
Rollover of vehicle

High-speed vehicle
collision
Vehicle-pedestrian
collision
Motorcycle crash
Unresponsive or altered
mental status
Penetrating injury of head,
chest, or abdomen
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Bent Steering Wheel

Broken Mirror

Spider-Webbed
Windshield

Distorted Pedals

Deformed
Dashboard

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Initial Assessment
General Impression
Mental Status
Airway
Breathing
Circulation

General Impression
Age, Weight, Gender
Position (relative to posture and
surroundings)
Activity
Obvious Injuries/Bleeding

Assess Mental Status

Take C-Spine control
A Alert and immediately
responsive
V Responsive to verbal
stimuli
P Responsive to painful
stimuli
U Unresponsive

Assess Airway
Open if necessary using jaw-thrust
maneuver
Consider oro- or naso-pharyngeal
airway
Note unusual sounds and correct
cause

Snoring oro-/naso-pharyngeal airway

Gurgling suction
Stridor consider intubation
Silence

Correcting silence
Attempt ventilation
Reposition
Heimlich
Visualize and remove
Intubate
Trans-laryngeal jet insuflation

Assess Breathing

Look, Listen, Feel

Rate, Rhythm, Depth (tidal volume)
Use of accessory
muscles/retractions
Treat

Absent ventilate x2, check pulse

< 12/min assist ventilation
Decreased tidal volume assist ventilation
Labored oxygen 10 liters NRB
Normal or rapid consider oxygen

Assess Circulation Pulses

Compare radial Rhythm

and corotid
Regular
Irregular
Rate
Normal
Quality
Fast
Slow

Weak
Thready
Bounding

Assess Circulation Skin

Color
Temperature
Moisture

Assess Circulation Bleeding

Direct pressure
Pressure dressing

Determine priority
Load and Go
Situation ?

Poor general impression

Mental status changes
Difficulty breathing
Shock
Chest pain
Severe bleeding
Severe pain

Rapid Trauma Survey

Head to toe
Rapid sweep to identify major
injuries which could prove life
threatening
DCAP-BTLS

Rapid Trauma Survey

Inspect and Palpate for
DCAP-BTLS
D =
C =

Deformities

Contusions

A =
P =

Abrasions

Punctures/
Penetrations

= Burns
= Tenderness
= Lacerations
= Swelling

Deformities

Abrasions

Contusions

Punctures/Penetrations

Burns

Lacerations

Tenderness

Swelling

Rapid Trauma Survey

Head
Neck
Chest
Abdomen
Pelvis
Extremities
Posterior

Head: DCAP-BTLS + Crepitation

Neck: DCAP-BTLS + Jugular Vein Distention and

Crepitation

Chest: DCAP-BTLS + Crepitation and

Breath Sounds (Presence and Equality)

Listen to both sides of the chest. Is air entry present?

Absent? Equal on both sides? Compare left side to
right side.

Mid-clavicular

Mid-axillary

Abdomen: DCAP-BTLS + Firmness and Distention

Pelvis: DCAP-BTLS (Compress

gently)
(

Extremities: DCAP-BTLS + Distal Pulse,

Sensation, Motor Function

Posterior: DCAP-BTLS

Package and begin transport

Immediate immobilize, load, go
Delayed immobilize, treat as
necessary, transport

If No Significant Mechanism
of Injury
Reconsider mechanism of injury
Determine chief complaint
Perform focused physical exam based on:
Chief complaint
Mechanism of injury
Use DCAP-BTLS on focused area of
assessment
Assess baseline vital signs
Obtain SAMPLE history

Focused History and

Physical

Baseline vital signs

SAMPLE History
Focus on and treat injuries found
during initial assessment and rapid
trauma assessment as appropriate
considering priority

SAMPLE History
S

= Signs and symptoms

= Allergies

M = Medications
P
L

= Pertinent past history

= Last oral intake

= Events leading to injury

or illness

Vital Signs
Respirations
Pulse
Skin color, temperature,
condition
Pupils
Blood Pressure

Home

Detailed Physical
Exam
As appropriate, considering
priority
History and vital signs,
neurological
Repeat initial assessment
Complete critical interventions
Careful head to toe survey
(DCAP/BTLS)

Detailed Physical Exam

Head to Toe

Head DCAP/BTLS and creptiation

Ears DCAP/BTLS and blood/fluid
Face DCAP/BTLS and blood/fluid
Eyes DCAP/BTLS and discoloration,

Nose DCAP/BTLS and blood/fluid

Mouth DCAP/BTLS and teeth, foreign

pupils, foreign bodies, blood

bodies, swelling, lacerations, odor

Head to Toe

Detailed Physical
Exam
Head to Toe

Neck DCAP/BTLS and JVD, crepitation

Chest DCAP/BTLS and palpate for paradoxical
motion, symmetry, crepitation, and auscultate
breath sounds

Abdomen DCAP/BTLS and tenderness,

rigidity, distention

Pelvis DCAP/BTLS and pain, tenderness,

motion, crepitation

Upper extremities DCAP/BTLS and PMS

Lower extremities DCAP/BTLS and PMS
Posterior DCAP/BTLS

On-Going
Assessment
Subjective changes

Reassess vital signs:neurological,ABC

Reassess injuries
Reassess interventions

Home