international trauma life support for emergency care providers chapter seventh edition scene size-up...

International Trauma Life Supportfor Emergency Care Providers

CHAPTER

seventh edition

Scene Size-up

1

International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians

Scene Size-up

© Jack Degley Photography


Overview

• Steps of Scene Size-up• Two basic mechanisms of motion injury• Three collisions associated with MVCs• Common forms of MVCs• Potential injuries associated with restraint

systems


Overview

• Assessment criteria and anticipated injuries from falls

• Two most common forms of penetrating injury

• Blast injury factors related to assessment


Trauma Care

• Teamwork is important! • You must know:

– What you can handle and what you can't– What you should handle and what you

shouldn't– When to stay and when to leave– Fastest route there and fastest route away– What to do, what not to do, and when to wait


Scene Size-up

• A critical part of trauma assessment • Anticipate what you will find at scene• Anticipate equipment and resource needs• Form a plan of approach• Be prepared to modify that plan• Failure to size-up can jeopardize lives


Scene Size-up

• First step in ITLS Primary Survey


Scene Size-up

1. Standard precautions

2. Scene safety

3. Initial triage (total number of patients)

4. Need for more help or equipment

5. Mechanism of injury


Standard Precautions

• Exposure to blood or OPIM very likely at a trauma scene

• Appropriate PPE must be worn– Covered in more detail in Chapter 22


Scene Safety

• Ambulance positioning– Safe place to park– Facing away from scene

• Windshield survey– Threats to you– Threats to/from patient– Threats to/from bystanders

Courtesy of Bonnie Meneely, EMT-P


Initial Triage

• Total number of patients– Call for backup– Medical command– Initiate MCI protocols– Any more patients?



Need for More

• Essential equipment– Carry to scene for time efficiency– Change gloves between patients

• Additional resources – Call early– Relay where to respond and any dangers


Mechanism of Injury

• Energy follows physics laws.– Injuries present in predictable patterns

• High-energy at risk of severe injury.– Consider injured until proven otherwise

• Type of MOI– Generalized– Focused


Basic Motion Mechanisms

• Blunt injuries– Rapid forward

deceleration– Rapid vertical

deceleration– Blunt instrument

energy transfer

• Penetrating injuries– Projectiles– Knives– Falls upon objects


Motor-Vehicle Collisions

Each collision is three collisions:

Machine Collision1 Body

Collision2 Organ Collision3


Other Collisions

• Secondary collisions– Objects are missiles – Additional impacts– Vehicle collides with

another object– Other vehicles collide

with original vehicle


Clues to Injury

• Deformity of vehicle– What forces were involved in collision?

• Deformity of interior structures– What did patient hit?

• Deformity or injury patterns on patient– What anatomic areas were hit?


Common Collisions

• Common types– Frontal-impact– Lateral-impact– Rear-impact– Rollover– Rotational

(© Jack Dagley Photography)


Frontal-Impact Collision

• Windshield injuries– Brain, soft-tissue injury,

cervical spine

• Steering wheel injuries– Traumatic tattooing of skin

• Dashboard injuries– Face, brain, cervical spine,

pelvis, hip, knee

(Courtesy of Maria Dryfhout, Shutterstock )


Lateral-Impact Collision

• Similar to frontal-impactwith lateral energy – Not easily predicted– Consider organ damage

• Check impact side– Head, neck, upper arm,

shoulder, thorax, abdomen, pelvis, legs

(Photo courtesy of Anthony Cellitti, NREMT-P)


Rear-Impact Collision

• Posterior displacement– Rapid forward

deceleration also possible

• Headrest position– Hyperextension injuries

• Damage back and front– Deceleration injuries

(Courtesy of Bonnie Meneely, EMT-P)


Rollover Collision

• Multiple impacts– Multiple directions– Multiple injuries

• Axial-loading injuries– Spine injury

• Ejection– Chance of death

increases 25 times


(Courtesy of Bonnie Meneely, EMT-P)


Rotational Collision

• Head-on, lateral-impact combination– Converts forward motion

to spinning motion

• Windshield, dashboard, steering wheel, side– Same possible injuries

of both mechanisms

© Dedyukhin Dmitry / Shutterstock.com


Occupant Restraint

• Lap belt– Clasp knife effect– Abdomen– Lumbar spine

• Three-point restraint– Cervical spine– Clavicular fracture

• Air bags– First impact only– Always “lift and look”– Lumbar spine

(Courtesy of Olivier Le Queinec, Shutterstock.com)


Tractor Accidents

• 50% of farm fatalities– Side overturns 85%

Likely to throw clear

– Rear overturns 15% Likely to entrap or crush

• Common injuries– Crush injuries– Thermal or chemical burns

Courtesy of Roy Alson, MD


Small-Vehicle Crashes

• Small vehicles– Motorcycles– All-terrain vehicles– Personal watercraft– Snowmobiles

• Factors– Protective gear– Additional impacts

© Orientaly / Shutterstock.com


Pedestrian Injuries

• Mechanism– Primary collision– Additional impacts

• Common injuries– Internal injuries and

fractures Adult: bilateral leg, knee Children: pelvis, torso Courtesy of Bonnie Meneely, EMT-P


Penetrating Injuries

• Knife-wound severity– Anatomic area penetrated

Fourth intercostal space may be chest and abdomen

– Length of blade– Angle of penetration

• Stabilize impaled object– Minimize external

movement


Penetrating Injuries

• Firearms– Type of weapon

Low-velocity High-velocity

– Caliber Missile size Bullet construction Tumbling/yaw

– Distance traveled

Courtesy of Roy Alson, MD


Penetrating Wounds

• Entry wound– Smaller– May be darkened, burned

• Exit wound– One, none, or many– Larger– May be ragged (©Edward T. Dickinson, MD)


Wound Ballistics

• Factors– Missile velocity– Missile size– Missile deformity– Missile design– Tumbling and yaw

(Courtesy of Roy Alson, MD)


Wound Ballistics

• Internal wound– Tissue contact damage– High-velocity transfer of energy

Shock waves Temporary cavity Pulsation of temporary cavity

• Damage proportional to tissue density– Highly dense tissue sustains more damage


Blast Injuries

• Primary– Initial air blast

• Secondary– Material propelled

• Tertiary– Impact on object

• Quaternary– Dispersed hazardous material


Caution

Do not approach until

Scene Size-up is complete!


Summary

• Time is critical; teamwork is essential• Scene size-up can be lifesaving• Mechanism of injury:

– An aid to predict injury– Part of overall management of trauma patient

• Record scene and mechanism findings

international trauma life support for emergency care providers chapter seventh edition scene size-up...

Documents

edition scene size

trauma assessment

assessment slide

focused slide

mechanism of injury

trauma scene appropriate

original vehicle slide

emtp slide