Basic Life Support on Trauma

Trauma

 Defined as tissue injury due to direct effects of externally

applied energy.

 Energy may be :

mechanical, thermal, electrical, chemical

 Epidemiology

 Leading cause of death in the last 4 decades

 150,000 deaths annually in the US

 Permanent disability 3 times the mortality rate

Trimodal Death Distribution

 First peak : instantly

(brain, heart, large vessel injury)

 Second peak : minutes to hours

(Cardiac tamponade, tension pneumothorax, massive hemothorax,

esophageal injury, diaphragmatic herniation, flail chest, sucking chest
wounds)

 Third peak : days to weeks

(sepsis, MOF)

The second and third peaks should be regarded as potentially preventable

 Epidemiology
Trimodal Distribution of Trauma Deaths

 Golden Hour = 80% of trauma deaths in first

50% hour after injury
 Rapid trauma care has greatest level of
impact in these patients
30%
20%

Immediately Hours Days/Weeks

 1. Preparation

 2. Triage

 3. Primary Survey (ABCDE)

 4. Resuscitation

 5. Secondary Survey (head to toe evaluation & history)

 6. Continued post-resuscitation monitoring & re-evaluation

 7. Definite care.
 Primary Survey

Airway and Protection of Spinal Cord

Breathing and Ventilation

Circulation

Disability

Exposure and Control of the Environment

 Etiology of airway obstruction

 Unconciousness

 Trauma : Maksilofacial trauma

 Foreign bodies : blood, vomitus, food, teeth

 Classification of Obstruction

LISTEN FEEL

OBSTRUCTION Add. sound Air flow

EKSHALASI

CLEAR ⊝ ⊕

Partial ⊕ ⊕

TOTAL ⊝ ⊝
 Treatment

•Manual :
- Non trauma :
Head tilt
Chin lift
Jaw thrust “in-line manual
- Trauma : immobilization” or
Jaw thrust cervical collar

• Instrumentation
- Oropharyngeal airway
- Nasopharyngeal airway
 Trauma victim

head tilt
chin lift
JAW THRUST

recommended
OROFARINGEAL
TUBE

2
1

3 4
NASOFARINGEAL TUBE
 Definitive airway

1. Orotracheal intubation

2. Nasotracheal intubation

3. Surgical airway (cricothyroidotomy and tracheostomy)

B - Breathing and Ventilation

General Principle :

Adequate gas exchange is required to maximize patient

oxygenation and carbon dioxide elimination

17
Breathing/VentilationAssessment:

 Inspection
 Tracheal Deviation
 Accessory Muscle Use
 Retractions
 Absence of spontaneous breathing
 Paradoxical chest wall movement

 Auscultation Perkusi
 Equal Bilaterally • Dull atau Sonor
 Diminished or Absent breath sounds

 Palpation
 Deviated Trachea
 Broken ribs
 Injuries to chest wall
 Emergency breathing cases

 Tension pneumothorax
 Flail chest
PRIMARY SURVEY
 Open pneumothorax
 Massive Hematothorax

 Simple pneumothorax
 Rib fracture SECONDARY SURVEY
 Lung contusion
 Breathing supports

Manual
Mouth to mouth
Mouth to nose
Mouth to mouth and nose

Instrument
Face mask / pocket mask
Bag-valve-mask
Bag-valve-tube
Ventilator
Breathing support
 Simple MASK
FACE MASK O2 8-10 lpm with reservoir bag
FiO2 : 40-60% Flow O2 : 6-10 lpm
FiO2 : 60%- 100%

NASAL CANULE
BAG VALVE MASK (BVM)
O2 flow 1 – 6 lpm
With oxygen 8-10 lpm : 60%
FiO2 : 24 – 44 %
 C- Circulation

 Shock

 Impaired tissue perfusion

 Tissue oxygenation is inadequate to meet metabolic demand

 Prolonged shock state leads to multi-organ system failure and cell death
 Stage of Haemoragic Shock

Class 1 Class 2 Class 3 Class 4

Blood loss (ml) 750 750-1,500 1,500-2,000 > 2,000
Blood loss (% ) 15 15-30 30-40 >40

Pulse <100 >100 >120 >140

BP normal normal  
Pulse pressure    

Capillary refill normal Slow (>2s) Slow (>2s) undetectable

RR 14-20 20-30 30-40 >35

Urine >30 20-30 5-15 negligible

output(ml/hr)
Mental status slightly anxious mildly anxious anxious/confused confused/
lethargic
Fluid replacement crystalloid crystalloid crystalloid Crystalloid
plus blood plus blood
 Therapy based on response

RESPONSE
RAPID TRANSIENT NONE
VITAL SIGN Return normal Temporary improvement No improvement

BLOOD LOSS 10-20% 20-40% > 40%

ADDITIONAL FLUID seldom Yes Yes

TRANSFUSION TYPE & CROSS TYPE SPECIFIC EMERGENCY

MATCH
SURGERY maybe Very llikely Very likely

EARLY SURGICAL Yes Yes Yes

CONSULT
2000 cc RL in adult
20 CC/kgBB RL in children
 Types of Shock in Trauma
 Hemorrhagic Shock
 Results from Internal or External Bleeding

 Septic Shock

 Neurogenic Shock
 Spinal Cord injury
 General Treatment Principles

 Stop the bleeding

Apply direct pressure

 Restore circulating volume

Crystalloid Resuscitation (2L)

Administer Blood Products

 Disability
 Baseline Neurologic Exam
 Pupillary Exam
 Dilated pupil – suggests transtentorial herniation on ipsilateral side

 GCS
 Gross Neurological Exam – Extremity Movement
 Equal and symmetric
 Normal gross sensation

Maintenance of adequate cerebral perfusion is key to prevention of further brain injury

 Adequate oxygenation
 Avoid hypotension
 Glasgow Coma Scale
 Eye
 Spontaneously opens 4

 To verbal command 3

 To pain 2

 No response 1

 Motor Response
 Obeys verbal commands 6

 Localizes to pain 5

 Withdraws from pain 4

 Flexion to pain (Decorticate Posturing) 3

 Extension to pain (Decerebrate Posturing) 2

 No response 1

 Verbal Response
 Oriented/Conversant 5

 Disoriented/Confused 4

 Inappropriate words 3

 Incomprehensible words 2

 No response 1
Glasglow Coma Scale
 Exposure
 Remove all clothing
 Examine for other signs of injury

 Logroll the patient to examine patient’s back

 Maintain cervical spinal immobilization

 Palpate along thoracic and lumbar spine

 Minimum of 3 people, often more providers required

 Avoid hypothermia
 Apply warm blankets after removing clothes

 Hypothermia = Coagulopathy
 Increases risk of hemorrhage
Exposure
 Secondary Survey

 Secondary Survey is completed after primary survey

is completed and patient has been adequately
resuscitated.

 No patient with abnormal vital signs should proceed

through a secondary survey
 History

 AMPLE History

 Allergies
 Medications
 Past Medical History, Pregnancy
 Last Meal
 Events surrounding injury, Environment
 Physical Exam

 Head
 Neck
 Chest
 Abdomen
 Pelvis
 Genitourinary
 Extremities
 Neurologic
 Basic Resucitation
Synchronizing : 30 compressions - 2 breaths

30 : 2

One or two rescuers is the same

30 x compressions
2 x breaths
 Carotid Pulse

.
 .

Place the hands

on the centre
of the chest
100 x / minute

4-5 cm
Breathing support
 Breathing support

- Blow is perfomed after chest compression  30:2

- Interval between blows  1 second, after expiration

- Blow untill chest raise Volume Tidal  500-600 ml.

Early oxygen 100% supplementation 10-12L/minutes

 CIRCULATION with Bleeding control

• Place the heel of the hand in the centre of chest

• Cardiac compression 100x per minutes

• Ratio : 30 compression - 2 blows

• Press down sternum 4-5 cm

• STOP BLEEDING  include early detection and treatment

on ongoing bleeding
Thank You