SPM 200
Clinical Skills Lab 8
Basic Trauma Life Support
and Trauma Resuscitation
Daryl P. Lofaso, M.Ed, RRT
Trauma
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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
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First Peak
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Second Peak
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death occurs in seconds to minutes of injury
(lacerations: brain, brain stem, high cord , heart, aorta,
&b large blood vessels)
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
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Motor Vehicle Collision (MVC)
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T-bone, Roll-over
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> 12 ft.
Lethal Dose (LD50) > 48 ft.
Falls
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Penetrating
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Gunshot wound (GSW) & Stab
Altercation
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Fist, stick, pipe
Classification of
Head Injury
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Blunt
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High velocity (MVC)
Low velocity (fall, assault)
Penetrating
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Gunshot wound (GSW)
Other penetrating injuries (stab)
Severity of Head Injury
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Mild
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Moderate
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GCS Score: 14 - 15
GCS Score: 9 - 13
Severe
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GCS Score: 3 - 8
T-Bone Collision
T-Bone Collision Injuries
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Impact to Driver:
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Closed Head injury (CHI)
C-spine
Pelvic fx & Extremity fx (Long Bone)
Spleen
Blunt chest trauma
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Pulmonary contusion
Rib fx
Cardiac contusion
T-Bone Collision Injuries
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Impact to Passenger:
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Closed Head injury (CHI)
C-spine
Pelvic fx & Extremity fx (Long Bone)
Solid organ injury
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Liver, spleen
Blunt chest trauma
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Pulmonary contusion
Rib fx
Cardiac contusion
Pneumo/Hemothorax
Pedestrian vs. Car
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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
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↓ Circulating blood volume
Failure of the heart to pump
effectively
Massive increase in peripheral
vasodilation
Classification of Shock
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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
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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
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Crystalloids Fluid
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Peds. – Normal Saline (NS) (20cc/kg)
Adults – NS / Lactated Ringers (LR) (2L)
If unresponsive to fluid bolus, repeat &
consider blood.
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“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
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Raccoon Eyes
Battle Sign
Flail chest
Indicate Retroperitoneal Injury
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Periumbilical Ecchymosis
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Flank Ecchymosis
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Cullen’s sign
Gray – Turner’s sign
Seat Belt Sign
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↑ Probability of Intra-Abdominal Injury
Injuries
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Hip Fx. - leg shortened & externally
rotated
Posterior Hip Dislocation – injury leg
internally rotated & flexed
Anterior Shoulder Dislocation – arm
positioning – adduction and flexion at
elbow