SPM 200
Skills Lab 8: Basic Trauma Life Support
& Resuscitation (Updated: 6/2007)
Review of Fundamentals
A. ABC’s
1. A = airway
2. B = Breathing
3. C = Circulation
4. Address these ABC’s and reassess them.
B. DEF
1. D = Disability
a. Glasgow coma scale (3-15)
1. get 3 points just for being there
2. at score of 8 intubate
b. Pupillary response – look for a blown pupil
c. Cranial nerve response
d. Gag reflex – if no gag reflex present, consider intubating.
e. Focal motor or sensory deficit – Glasgow coma scale does not assess this
2.
E = Exposure
a. Patient must be undresses!
b. It is very easy to miss penetrating injuries if the patient is clothed.
3.
F = Fingers and tubes – endotracheal tube, orogastric tube, nasogastric tube, IV’s, Foley catheters placement, and rectal exam.
C. Amplified History – problems-focused and hig yeild
1. Allergies, side effects, toxicities – Eg: Did they fall into pesticide?
2. Medications
a. Drugs patients are taking may affect how they present to you. Crack – tachycardic
b. Patient has a history of hypertension and unsable angina, may be on a -blocker. May never become tachycardic.
3. Past history.
4. Last meal and drink
5. Immediate events
6. Family and friends
7. Immunizations
8. EMT’s historians, old chart, person who dropped them off
9. Doctors
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SPM 200
Skills Lab 8: Basic Trauma Life Support
& Resuscitation (Updated: 6/2007)
Hemorrhagic Shock
Class
Total Blood Volume
I
Up to 15 %
(750cc of blood loss in 70 kg)
II
III
IV
Vital Signs
Treatment
Normal – No change
Oral Fluids
(Vomiting NO PO fluids)
15 –30%
(750-1500cc of blood loss)
Tachycardia
Narrow pulse pressure
Oral (PO) fluids or
IV fluids
Chest X-ray CXR – assessment
of fluid in chest
30 – 40%
(1500 – 2000cc blood loss)
Tachycardia
Hypotension
Increased Respiratory Rate (RR)
– increase in dead space
Decreased urinary output

 40%
2000cc blood loss
Tachycardia
Hypotensive
Inreased RR
Organ Hypoperfusion – decresed
urine output (< 50 years old
normal kidney– 1cc/kg/hr)
Replace with IV fluids at a rate
of 3:1- 3 parts IV for every 1
part blood loss
Consider packed RBC’s
(PRBCSs
Replace with IV, PRBCs and
“O” negative blood
(IV fluid of choice + warmed
normal saline)
Comments
VS changes result of pain,
intoxications, or patient’s own
meds
Assume fluid in chest – blood
Chest tube
Increase in Dead space ventilation
(Transfusion-profound risk to
patient, HIV, Heptitis C) (blood
transfusion – immunosuppressed)
Room temp. normal saline –
hypothermic very quickly
Ringers – cause RBCs to explode
“O” blood (universal donor)
The order of fluid resuscitation in patients with continuous blood loss:
1. Warmed normal saline – 2L bolus in an adult
2. “O” negative blood
3. Type specific blood
4. Complete type and cross match blood
2
SPM 200
Skills Lab 8: Basic Trauma Life Support
& Resuscitation (Updated: 6/2007)
Neurological Injuries
Injury
Epidural Hematomas
Subdural Hematomas
Cerebral contusions/Clossed Head
Injury (a.k.a. diffuse axonal injuries)
Skull Fractures
Cord Injuries
Classic Patient
Young and active (“Bubba” syndrome)
Older patients
Infant or Elderly
“Shaken Baby Syndrome”
Younger patient (“Bubba” syndrome)
Predominantly younger patients
Presentation
Lucid intervals
Slow progressive deterioration
Retinal hemorrhages
CT scan
CT scan
CT scan
Diagnostic Test
LOC may or may not be present
Neurological deficits
CT scan & X-ray
X-ray & CT scan
Bubba Syndrome: Males between the ages 17 and 25 who have the misconception that they are invincible are more likely to be involved in collisions, falls and
altercations.
Thoracic Trauma
Pathology
Diaphragmatic Hernia
Trauma
Blunt or penetrating abdominal trauma
Tension Pneumothorax
Hemothorax
Penetrating chest trauma or mechanical
ventilation
Penetrating chest trauma
Cardiac Tamponade
Pneumothorax
Pulmonary Contusions
Penetrating chest trauma
Penetrating chest trauma
Associated with rib fracture
Presentation
Diminished breath sounds, possible
bowel sounds
Hemodynamic instability
Diagnostic Test
Chest X-ray
Diminished breathsounds, dullness to
percusssion, and hemodynamic
instability
Hemodynamic instability
Diminished breath sounds
Progressive hypoxemia
Chest X-ray
Chest X-ray
Chest X-ray & ECHO cardiogram
Chest X-ray (Insp. & Expiratory)
Chest X-ray – hazy white
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SPM 200
Skills Lab 8: Basic Trauma Life Support
& Resuscitation (Updated: 6/2007)
Blunt Abdominal Trauma
Type
Splenic Injury
Liver Injury
Kidney
Commonality
Most common (40-55%)
2nd most common (35-45%)
3rd most common
Diagnostic Test
Kerr’s sign = left shoulder pain
Stable – CT scan, Diagnostic peritoneal
lavage (DPL)
Unstable - OR
Stable –CT, Ultra sound, and DPL
Unstable - OR
Gross Hematuria – CT abdomen
Microscopic hematuria – no further testing
unless hypotensive
Mechanism of Injury
MVC, Falls & Altercations
MVC, Falls & Altercations
MVC & Falls
Reference:
1. Advanced Trauma Life Support, (1997).
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