1. Toms basic and (hopefully)
high speed Trauma and
EMS Lecture
…or…To much for one lecture, but
here we go anyway….

3. Primary Survey - Immediate
Threats to Life (Only!)
A = Airway Obstructed?
B = Breathing Breath Sounds Present?
Bilaterally?
C = Circulation Peripheral Pulse?
Femoral? Carotid?
(Not BP Measurement.)

4. Primary Survey - Immediate
Threats to Life (Only!)
D = Disability Global (AVPU or GCS)
Gross Motor Function
(i.e. spinal cord integrity)
E = Exposure Nekkid!

5. Secondary Survey
Now find out what happened, what’s injured.
 History (AMPLE)
 Physical.
 Organized, complete head to toe exam.
 Roll, check back.
 Remember TM’s and rectal.
 Foley. NG or OG tube.

6. Things to remember…
The Ideal Trauma Resuscitation
 Roles are pre-assigned
 Clear direction & communication
 Pertinent findings verbalized in proper order
 All team members know all findings
 Rapid, Efficient
 Calm & Quiet!

7. 5places you can bleed out
 Chest
 Belly (and/or retroperitoneum)
 Thighs
 Pelvis
 Street

8. Things to remember…
Classification of Shock
Class EBL Pulse BP Mental Treatment
I <15% (<750ml) - - nl Fluids
II 15-30% (750-1.5L)  - +/-anxious Fluids
III 30-40% (1.5L-2.0L)   anxious Fluids + Blood
IV >40% (>2.0L)    confused Fluids + Blood

9. Case for head injury
 24yo fall off ladder in construction site
 Per EMS…awake, short tempered,
perseverating
 What do you want to do?
 What are you worried about?

10. Types of bleeding in the head
 Epidural
 Subdural
 Subarachnoid
 Intraparenchymal
 Intraventricular

11. Why do we care about bleeding in
the head
 Increased intracranial pressure
 Seizures
 Prognosis

12. Cerebral perfusion pressure
 Balance of forces
 Blood pressure
 Intracranial pressure
 CPP = MAP - ICP

14. Management of Severe Head
Injuries (increased ICP)
 Secure airway - role of lidocaine
 Hyperventilation
 Mannitol 1g/kg
 HOB 30o
 Seizure prophylaxis
 ICP monitors
 Craniotomy

15. Case for chest trauma
 24yo stabbed in chest
 Per EMS…fine originally, then started
complaining about short breath
 What do you want to do now?
 What are you worried about?

16. Life Threatening problems
 TensionPTX  Flail chest
 Tamponade  Massive HTX / PTX
 Esophageal disruption
 Aortic disruption
 Diaphragm hernia
 Tracheal disruption  Pulmonary contusion
 Myocardial contusion
 Simple PTX

17. Case for belly trauma
 45yo male crushed between truck and wall
 C/O dull achy pain right under ribs
 Per EMS pain getting worse, getting confused
and anxious looking…
 What do you want to do??
 What are you worried about?

18. How can you evaluate the belly?
 Serial abdominal exams
 CT
 DPL
 US
 RUG/cystogram
 Take a look (in the OR)

19. Neck Trauma
 Clear c-spine/NEXUS
 X-ray vs CT
 Zones of the neck