EMR LECTURE NOTES
Chapter 2 - Trauma Assessment and
Management
OUTCOME 8 – ITLS
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
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Objectives
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Outline the steps in trauma assessment and
management
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Describe the ITLS Primary Survey
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Explain the initial assessment and how it
relates to the rapid trauma survey and the
focused exam
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Describe when the initial assessment can be
interrupted
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Describe when critical interventions should
be made and where to make them
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Identify which patients have critical
conditions and how they should be managed
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Describe the ITLS Ongoing Exam
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Describe the ITLS Secondary Survey
ITLS Patient Assessment
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Delegate immediate interventions to partners
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Do not stop your assessment unless:
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Scene becomes unsafe
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Exsanguinating hemorrhage
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Airway obstruction
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Cardiac arrest
Teamwork
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
SCENE SIZE-UP
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Hazards
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Power lines, gas, animals, people
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PPE
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Number of patients
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Establish command
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Additional resources
MOI
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Anticipate type and severity of injuries
ITLS PRIMARY SURVEY
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Initial Assessment
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General impression
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evel of consciousness
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Manual stabilization of cervical spine
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ABCs
Prioritize patient
»
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Identify immediate life-threatening
conditions
Less than 2 minutes
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Initial Assessment and Rapid Trauma Survey
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
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Delegate any intervention
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Interrupt survey only for:
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Unsafe scene
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Airway obstruction
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Cardiac arrest
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Life-threatening bleeding
General impression
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Obvious major injuries or bleeding
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Immediately control life-threatening
bleeding
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Approximate age, sex, weight
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General appearance
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Position of patient body and surroundings
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Patient activity
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Triage multiple patients
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Initial Level of Consciousness
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Airway: look, listen, feel
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Direct: simple positioning and suctioning
Breathing: look, listen, feel
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Cervical-spine stabilization if indicated
Direct: high-flow oxygen
Is major bleeding controlled?
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
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Circulation: peripheral pulse
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No peripheral, check carotid
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Too fast, too slow, quality
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Interrupt: cardiac arrest
Skin
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Color, temperature, condition
MOI Decision
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Dangerous generalized or unconscious
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Dangerous focused
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Rapid Trauma Survey
Focused Exam
No significant MOI and Initial Assessment
normal
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Focused Exam
Rapid Trauma Survey
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Assess:
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Head and neck
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Chest
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Abdomen
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Pelvis
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Lower and upper extremities
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Back
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
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Transfer to backboard if necessary
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Obtain baseline vital signs
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If altered mental status
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Brief neurological exam
Pupils, GCS, and signs of cerebral herniation
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Look for medic alert tags
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Consider other causes
Priority Patient:
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Dangerous MOI
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History
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Loss of consciousness
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High-risk groups
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Abnormal Initial Assessment
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Altered mental status
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Difficulty breathing
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Abnormal perfusion
Brief Targeted History:
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S
Symptoms
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A
Allergies
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M
Medications
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P
Past medical history
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L
Last oral intake
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E
Events preceding incident
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
Load-and-Go Situations
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Initial Assessment
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Altered mental status
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Abnormal respiration
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Abnormal circulation
Shock potential
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Abnormal chest exam
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Tender, distended abdomen
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Pelvic instability
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Bilateral femur fractures
Critical Interventions
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Manage airway
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Assist ventilation
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Administer oxygen
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Begin CPR
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Control major external bleeding
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Seal sucking chest
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Stabilize flail chest
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Pneumothorax
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Stabilize impaled object
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Complete packaging
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
Initiate Transport
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Procedures not on scene, not lifesaving:
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Splinting, bandaging,
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stimated time of arrival (ETA)
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Condition of patient
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Special needs on arrival
ITLS ONGOING EXAM
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Change in condition
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Patient
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Interventions
Perform and record
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Critical: every 5 minutes
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Stable: every 15 minutes
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Each time patient moved
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With each intervention
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If condition changes
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Subjective changes
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Mental status (LOC and pupils)
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ABCs
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Neck, chest, abdomen
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Previously identified injuries
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Interventions
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
ITLS SECONDARY SURVEY
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More comprehensive exam
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Evaluation for all injuries, not just lifethreatening
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Establishes baseline for treatment decisions
Performed
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Critical patients—done during transport
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Short transport—may not have time
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Noncritical patients—can do on scene
Initial Assessment
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Repeat routinely
Vital signs
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Repeat routinely
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Monitoring
Detailed Exam
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Head-to-toe
DCAP-BLS-TIC
Detailed Exam: DCAP-BLS-TIC
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Deformities
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Contusions
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Abrasions
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Penetrations
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EMR LECTURE NOTES ITLS CHAPTER 2
EMERGENCY MEDICAL RESPONDER
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Burns
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Lacerations
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Swelling
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Tenderness
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Instability
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Crepitus
Adjuncts for Patient Assessment
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Pulse oximetry
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Wave form capnography
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Portable ultrasound
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F.A.S.T.
SUMMARY
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ITLS Patient Assessment
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Key to trauma care
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Not difficult, but time-critical
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Rapid, orderly, thorough
Remain calm
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Maximize speed through organization and
teamwork
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