Prehospital Trauma Life Support

4th
Edition

Trauma Mega-Trends

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PHTLS Refresher Course

Trauma Today & Tomorrow

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PHTLS Trauma Update

Objectives.

Current ATLS guidelines. Controversial topics (PASG, IV, etc.).

Possible changes based on available research.

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PHTLS Refresher Course

Trends

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PHTLS Refresher Course

Injury Prevention

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Motor Vehicle Injury Prevention

Requires stricter:

Safety belt use. Helmet use. Child safety seat use. Enforcement of impaired driving laws. Guidelines for improved vehicle safety devices and designs.

Opposition to increased speed limits.

Reduces availability and consumption of drugs and alcohol.
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Prevention of Violence & Violent Injuries

continued...

Develop violence prevention and intervention programs (Safe Kids, etc.). Improve recognition, referral, treatment, and tracking of victims of violence. Improve recognition, referral, treatment, and tracking of violent people. Increase awareness of, and education about, firearm safety.
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Prevention of Violence & Violent Injuries

Reduce use of drugs and alcohol by violent and potentially violent persons.
Provide early childhood intervention programs.

contd.

Educate and protect potential victims of violent injury.

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Home & Leisure Injury Prevention

Educate public about potential hazards in the home.
Enforce design standards to make home equipment safer. Support community efforts in first aid and basic life support (BLS).
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Occupational Injury Prevention

Maintain federal safety standards.

Reward injury prevention programs.

Establish injury surveillance systems. Expand coverage of workers under federal programs.
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Injury prevention should be everyones goal!

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Intraosseous Infusion
Has become widely accepted standard for pediatric care.

Quick technique.
Relatively safe and easy to perform.

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Pulse Oximetry
Measures:

Estimation of pulmonary oxygenation. RBC oxygen saturation.

Does not measure:

Tissue oxygenation. Oxygen delivery. Aerobic versus anaerobic metabolism.

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Ventilation Evaluation
Hospital care: PaCO2.
Prehospital: Respiratory rate.

12 - 20 per minute = Good. Greater than 20 = Questionable.

Less than 10 = Bad.

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Bloodborne Infections
Hepatitis is still more hazardous to EMS than the HIV/AIDS virus.

Less contamination required.

One contact may cause infection.

Hepatitis B vaccines are available. Death rate among health care personnel annually is much higher than for HIV/AIDS.
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Prevention of Bloodborne Infections

Prior immunization. Body surface isolation (BSI) skin protection. Wash carefully after contact.

Consult physician after significant contact.

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Patient Movement
Log roll only when necessary. Roll only as high as required. Use scoop when possible.

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PHTLS Refresher Course

Controversies

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Pneumatic Anti-Shock Garment (PASG)

Increases systemic vascular resistance.

Performs auto-transfusion.
Tamponades bleeding. Stabilizes fractures.

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PASG Limitations
Prolong scene time. Cause metabolic acidosis and/or compartment syndrome. Limit physical examination. Worsen thoracic injury outcomes.
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Hypertonic Saline

continued...

Replenishes intravascular space and circulating volume.

Causes rapid fluid shift from intracellular and interstitial compartments into intravascular space. Current evidence does not support routine use of hypertonic solutions.
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Hypertonic Saline

contd.

May prove useful in post-traumatic hypotension and head injury.

Hypertonic solutions may have some potential benefit.

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PHTLS Refresher Course

Intubation/Airway Management

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Double-Lumen Airway Devices

Esophageal Tracheal

Combitube
(ETC)

Pharyngeal Tracheal Lumen Airway (PTL)

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Advantages of the ETC/PTL

Ease of use.

Placement done by blind technique.

Provides a more definitive airway than basic techniques. May be placed in the esophagus or trachea. High success, and low complication rates. Can be placed without C-spine manipulation.
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Disadvantages of the ETC/PTL

Limited studies on prehospital use.

Cannot be used in children or adults under 4 feet in height.

Not nearly as definitive as ET intubation. Contraindications:

Presence of a gag reflex. Conscious or unconscious and breathing patients. Obstructed airway. Caustic ingestion or esophageal disease.
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Endotracheal Intubation
ET intubation remains the airway of choice.

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Summary

Trauma prevention. Intraosseous Infusion. Pulse oximetry. Bloodborne infections. Spine fractures. Pneumatic Anti-Shock Garment. Hypertonic saline. Double-lumen airway devices.
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