Prehospital Trauma Life Support

Lesson

13

Golden Principles of Prehospital Trauma Care

PROVIDER COURSE
Copyright 2003, Elsevier Science (USA). All rights reserved.

You are dispatched to the scene of a pedestrian struck by a vehicle. Law enforcement and the fire department are en route. It is an overcast spring day with a temperature of 50 F (10 C).

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What are your initial concerns as you arrive on scene?

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Ensure the safety of the prehospital care providers and the patient.
What are the safety concerns with this scene?

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Assess the scene situation to determine the need for additional resources.
What additional resources may be needed?

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Recognize the kinematics that produced the injuries.

What are the factors relating to kinematics implied here?
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Use the primary survey approach to identify lifethreatening conditions.

Kinematics Expose/ Environment Airway

Disability

Breathing

Circulation

What are the key concepts of the primary survey?

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Provide appropriate management while maintaining cervical spine stabilization. The patient has noisy ventilations and blood is draining from the oropharynx.
What should be considered when managing this airway?
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The patients ventilatory rate is 6 and is shallow. Cyanosis is visible on the patients face and fingers. There is bruising across the chest and decreased breath sounds are on the left. GCS score is 7 (E-2, V-1, M-4).

Support ventilation and deliver oxygen to maintain SpO2 95%.

How can this be accomplished?

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Control any significant external hemorrhage.

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Direct pressure controls the external hemorrhage from the right arm. The radial pulse is weak and rapid at about 140 beats/min. The patient is pale, cold, and clammy. There is crepitus and tenderness on palpation of the pelvis and a left thigh deformity consistent with a left midshaft femur fracture.

How would you manage these findings?

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Provide basic shock therapy, including restoring and maintaining normal body temperature and appropriately splinting musculoskeletal injuries.

Consider the use of the PASG for patients with decompensated shock (SBP < 90 mm Hg) and suspected pelvic, intraperitoneal, or retroperitoneal hemorrhage; and in patients with profound hypotension (SBP < 60 mm Hg).
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Maintain manual spinal stabilization until the patient is immobilized onto a long backboard.

When is spinal immobilization indicated?

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Golden Period

Platinum 10 minutes

10

For critically injured patients, initiate transport to the closest appropriate facility within 10 minutes of arrival on scene.

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Initiate warmed intravenous fluid replacement en route to the receiving facility.

What are the considerations with prehospital fluid therapy?

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Ascertain the patients medical history and perform a secondary survey when life-threatening problems have been satisfactorily managed or have been ruled out.

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Decision Making
Trauma-related incident Scene assessment Primary Survey Life threatening or multisystem injuries

Yes
Initiate rapid transport Reassess Secondary survey

No
Secondary survey Reassess Manage injuries as appropriate Initiate transport
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Above all, do no further harm.

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Fundamental Principles
Rapid assessment Key field interventions Rapid transport to the closest appropriate facility

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PHTLS works!
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Prehospital Trauma Life Support

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