Major Trauma A standard approach

1. Major TraumaA standard approach Ballarat Health Services Emergency Medicine Training Hub

2. Trauma workshop Objectives • C-Spine assessment and collar application • Primary Survey • Log Roll

3. C-Spine Assessment • History • Observe patient • Head Holding • Posturing • Failure to tolerate collar • Palpate • Midline • Paracervical structures • Neurological Examination • Move/collar as indicated

5. C-Spine Assessment • History • Observe patient • Head Holding • Posturing • Failure to tolerate collar • Palpate • Midline • Paracervical structures • Neurological Examination • Move/collar asindicated

6. Sizing a collar Use fingers, horizontally placed to assess distance from apex of trapezius to line of mandible.

7. Primary Survey A • Talk to the patient! • Look, listen, feel, monitor • Intervene as required • Oro/naso-pharyngeal • BMV • RSI and ETT

8. Primary Survey B • Spring chest and examine for injury • Auscultate for air and blood Air Blood

9. Primary Survey C • Examine • Heart Rate • Blood pressure • CRT • JVP • Heart Sounds • Abdomen • Long bone injury Chest, Abdomen, Pelvis, Limbs and one more – the floor

10. Primary Survey D • GCS • Obvious neurological injury • Limb • Spinal

11. Log Roll • 5 people (4 in children) • Four to roll, one to examine • Keep your hands across your chest. • You will not fall but will feel like you might. • I will press down your spine on each bone (demonstrate on an unbroken clavicle) like this. • Say yes if it hurts, no if it doesn’t. • I will then examine your back passage/anus to check for sensation and tone#@!**. • Turn to the head person – on your call.

12. To say to the patient • Keep your hands across your chest. • You will not fall but will feel like you might. • I will press down your spine on each bone (demonstrate on an unbroken clavicle) like this. • Say yes if it hurts, no if it doesn’t. • I will then examine your back passage/anus to check for sensation and tone#@!**. • Turn to the head person – on your call.

13. Log Roll Is everybody ready? We will roll on three. . . 1, 2, 3

14. Log Roll • Palpate down the spine, each vertebra • Do not forget to • PR (if indicated) • examine the back of the head, c-spine, torso

15. Log Roll Is everybody ready? We will roll back on on three. . . 1, 2, 3

16. Summary • C-Spine assessment with Canadian C-spine rules • Primary Survey – intervene and start again at ‘A’ • Log roll – team and procedure

17. Questions?

18. Thankyou