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DR FARZAD PANAHI

DR FARZAD PANAHI. ASSOCIATE PROFESSOR OF GENERAL SURGERY HEAD OF TRAUMA AND DISASTER RESEARCH CENTER (BMSU) BAQUITOLLAH MEDICAL SCHOOL UNIVERSITY. ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT. OVERVIEW. SCENE SIZE-UP BTLS PRIMARY SURVEY TRANSPORT DECISION AND CRITICAL INTERVENTIONS

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DR FARZAD PANAHI

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  1. DR FARZAD PANAHI ASSOCIATE PROFESSOR OF GENERAL SURGERY HEAD OF TRAUMA AND DISASTER RESEARCH CENTER (BMSU) BAQUITOLLAH MEDICAL SCHOOL UNIVERSITY

  2. ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT

  3. OVERVIEW • SCENE SIZE-UP • BTLS PRIMARY SURVEY • TRANSPORT DECISION AND CRITICAL INTERVENTIONS • DETAILED EXAM • ONGOING EXAM

  4. SCENE SIZE-UP • SCENE SAFETY • TOTAL NUMBER OF PATIENTS • ESSENTIAL EQUIPMENT • ARE ADDITIONAL RESOURCES NEEDED • MECHANISM OF INJURY

  5. ESSENTIAL EQUPMENT • PERSONAL PROTECTIVE EQUIPMENT • BACKBOARD, STRAPS, AND HEAD IMMOBILIZER • C-COLLAR • OXYGEN & AIRWAY EQUIPMENT • TRAUMA BOX

  6. BTLS PRIMARY SURVEY • INITIAL ASSESSMENT • RAPID TRAUMA SURVEY OR FOCUSED EXAM

  7. INITIAL ASSESSMENT • GENERAL IMPRESSION OF PATIENT ON APPROACH • CONTROL C-SPINE AND ASSESS LEVEL OF CONSCIOUSNESS • AIRWAY • BREATHING • CIRCULATION

  8. DO NOT INTERRUPT THE INITIAL ASSESSMENT EXCEPT FOR • Airway Obstruction • Cardiac Arrest

  9. LEVELS OF MENTAL STATUS • A – ALERT • V – RESPONDS TO VERBAL STIMULI • P – RESPONDS TO PAIN • U – UNRESPONSIVE

  10. PRIORITY PATIENTS • Dangerous mechanism of injury • History reveals: • Loss of consciousness • Difficulty breathing • Abnormal Initial Assessment • Poor general impression

  11. RAPID TRAUMA SURVEY OR FOCUSED EXAM? • Dangerous generalizedmechanism or altered mental status = Rapid Trauma Survey • Dangerous focused mechanism suggesting isolated injury or no significant life threat = Focused Exam

  12. RAPID TRAUMA SURVEY • Brief assessment of head, neck, chest, abdomen, pelvis, and extremities to identify immediate life threats • SAMPLE history • Baseline vital signs • If altered LOC do brief neurological exam

  13. SAMPLE HISTORY • S – SYMPTOMS • A – ALLERGIES • M – MEDICATIONS • P – PAST MEDICAL HISTORY • L – LAST MEAL • E – EVENTS PRIOR TO INJURY

  14. IF ALTERED LOC • DO BRIEF NEURO EXAM TO RULE OUT INCREASED INTRACRANIAL PRESSURE • LOC • PUPILS • GCS • SIGNS OF CUSHINGS REFLEX • MEDICAL IDENTIFICATION DEVICES?

  15. FINISHING THE BTLS PRIMARY SURVEY • Check the patient’s back • Transfer the patient to the backboard • Load-and-Go situation = immediate transport

  16. LOAD-AND-GO SITUATIONS • Significant mechanism of injury or poor general impression • Initial Assessment reveals • Altered mental status • Abnormal airway or respiration • Abnormal circulation (shock or uncontrolled bleeding)

  17. LOAD-AND-GO SITUATIONS continued • Signs discovered during Rapid Trauma Survey suggesting impending shock • Abnormal chest exam • Tender, distended abdomen • Unstable pelvis • Bilateral femur fractures

  18. INTERVENTIONS THAT MAY BE DONE ON-SCENE • Initial airway management • Oxygen/ventilatory assistance • CPR • Control major bleeding • Seal sucking chest wounds

  19. INTERVENTIONS THAT MAY BE DONE ON-SCENE • Stabilize flail chest • Decompress tension pneumothorax • Stabilize impaled objects • Immobilize spine

  20. DETAILED EXAM • Detailed exam to find injuries other than life-threats • Provides baseline for future decisions • Performed en route on critical patients • Record your findings

  21. DETAILED EXAM • Record vital signs • Neurological exam • Consider monitors • Do head-to-toe exam • Further bandaging and splinting • Continually observe

  22. DETAILED NEUROLOGICAL EXAM • LOC • Pupils • Motor function • Sensation • If altered mental status, perform Glasgow Coma Score

  23. ONGOING EXAM • Ask patient about changes in symptoms • Reassess mental status • Reassess ABCs • Reassess abdomen • Reassess identified injuries • Reassess interventions

  24. COMMUNICATIONS WITH MEDICAL DIRECTION • Contact early if patient is critical • Be concise and to the point • Give your destination and ETA • Identify any special preparations that should be done before your arrival

  25. PITFALLS • Approaching the patient before performing a Scene Size-Up • Trying to do too much on-scene • Attempting to “stabilize” the patient in the field

  26. SUMMARY • Scene Size-Up • BTLS Primary Survey • Initial Assessment • Rapid Trauma Survey or Focused Exam • Critical interventions and transport decision • Detailed Exam • Ongoing Exam

  27. QUESTIONS?

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