SPM 200 Clinical Skills Lab 8

Basic Trauma Life Support and Trauma

Resuscitation

Daryl P. Lofaso, M.Ed, RRT

Trauma

Trauma remains the leading cause of death in the first four decades of life (ages 1 - 44)

150,000 deaths annually in the US Disabilities dwarfs mortality by 3

to 1 Trauma related cost: $400 billion

annually

Trimodal Death Distribution

First Peak death occurs in seconds to minutes of injury

(lacerations: brain, brain stem, high cord , heart, aorta, &b large blood vessels)

Second Peak death occurs within minutes to several

hours of injury (subdural/epidural hematomas, pneumothorax, spleen, liver, pelvic fx & blood loss)

Third Peak death occurs several day to weeks after

initial injury (sepsis and multiple organ system failure)

Mechanism of Injury Motor Vehicle Collision (MVC)

T-bone, Roll-over

Falls > 12 ft. Lethal Dose (LD50) > 48 ft.

Penetrating Gunshot wound (GSW) & Stab

Altercation Fist, stick, pipe

Classification of Head Injury

Blunt High velocity (MVC) Low velocity (fall, assault)

Penetrating Gunshot wound (GSW) Other penetrating injuries (stab)

Severity of Head Injury

Mild GCS Score: 14 - 15

Moderate GCS Score: 9 - 13

Severe GCS Score: 3 - 8

T-Bone Collision

T-Bone Collision Injuries

Impact to Driver: Closed Head injury (CHI) C-spine Pelvic fx & Extremity fx (Long Bone) Spleen Blunt chest trauma

Pulmonary contusion Rib fx Cardiac contusion

T-Bone Collision Injuries Impact to Passenger:

Closed Head injury (CHI) C-spine Pelvic fx & Extremity fx (Long Bone) Solid organ injury

Liver, spleen Blunt chest trauma

Pulmonary contusion Rib fx Cardiac contusion Pneumo/Hemothorax

Pedestrian vs. Car

Most likely injury types: Adults – tibia / fibula or knee fx Teenagers – femur Small kids (ages 5-7) head on the

bumper

Pathophysiology of Shock

Shock is an acute state in which tissue perfusion is inadequate to maintain the supply of oxygen and nutrient necessary for normal cell function. (Alexander et al 1994), which results in widespread hypoxia. Inability to maintain homeostasis.

Shock: Inadequate Tissue Perfusion

↓ Circulating blood volume Failure of the heart to

pump effectively Massive increase in

peripheral vasodilation

Classification of Shock

Hypovolaemic: ↓ Blood volume Cardiogenic: Left vent. failure Anaphylatic: severe allergic reaction

(vasodilation) Septic: over-whelming bacterial toxins

(vasodilation); (Most common: Gram -)

Neurogenic: loss of sympathetic nerve activity (vasodilation); Drug or Trauma injury

Stages of Shock Initial Stage: cells are deprived of

oxygen; no energy (ATP); cells become damaged

Compensatory Stage: anaerobic metabolism and hyperventilation

Progressive Stage: compensatory mechanisms fail

Refractory Stage: vital organs have failed and shock can no longer be reversed

Fluid Replacement Crystalloids Fluid

Peds. – Normal Saline (NS) (20cc/kg) Adults – NS / Lactated Ringers (LR)

(2L) If unresponsive to fluid bolus,

repeat & consider blood. “O” neg. (1st available – 1 min.)

Type specific (2nd available – 10-15 min.)

Fully type and matched (3rd available – 15-30 min.)

PE Exam Signs of Trauma

Raccoon Eyes Battle Sign Flail chest Indicate Retroperitoneal Injury

Periumbilical Ecchymosis Cullen’s sign

Flank Ecchymosis Gray – Turner’s sign

Seat Belt Sign ↑ Probability of Intra-Abdominal Injury

Injuries

Hip Fx. - leg shortened & externally rotated

Posterior Hip Dislocation – injury leg internally rotated & flexed

Anterior Shoulder Dislocation – arm positioning – adduction and flexion at elbow