Apidays New York 2024 - The Good, the Bad and the Governed by David O'Neill, ...
Toms Basic And (Hopefully) High Speed
1. Toms basic and (hopefully)
high speed Trauma and
EMS Lecture
…or…To much for one lecture, but
here we go anyway….
2.
3. Primary Survey - Immediate
Threats to Life (Only!)
A = Airway Obstructed?
B = Breathing Breath Sounds Present?
Bilaterally?
C = Circulation Peripheral Pulse?
Femoral? Carotid?
(Not BP Measurement.)
4. Primary Survey - Immediate
Threats to Life (Only!)
D = Disability Global (AVPU or GCS)
Gross Motor Function
(i.e. spinal cord integrity)
E = Exposure Nekkid!
5. Secondary Survey
Now find out what happened, what’s injured.
History (AMPLE)
Physical.
Organized, complete head to toe exam.
Roll, check back.
Remember TM’s and rectal.
Foley. NG or OG tube.
6. Things to remember…
The Ideal Trauma Resuscitation
Roles are pre-assigned
Clear direction & communication
Pertinent findings verbalized in proper order
All team members know all findings
Rapid, Efficient
Calm & Quiet!
7. 5places you can bleed out
Chest
Belly (and/or retroperitoneum)
Thighs
Pelvis
Street
8. Things to remember…
Classification of Shock
Class EBL Pulse BP Mental Treatment
I <15% (<750ml) - - nl Fluids
II 15-30% (750-1.5L) - +/-anxious Fluids
III 30-40% (1.5L-2.0L) anxious Fluids + Blood
IV >40% (>2.0L) confused Fluids + Blood
9. Case for head injury
24yo fall off ladder in construction site
Per EMS…awake, short tempered,
perseverating
What do you want to do?
What are you worried about?
10. Types of bleeding in the head
Epidural
Subdural
Subarachnoid
Intraparenchymal
Intraventricular
11. Why do we care about bleeding in
the head
Increased intracranial pressure
Seizures
Prognosis
14. Management of Severe Head
Injuries (increased ICP)
Secure airway - role of lidocaine
Hyperventilation
Mannitol 1g/kg
HOB 30o
Seizure prophylaxis
ICP monitors
Craniotomy
15. Case for chest trauma
24yo stabbed in chest
Per EMS…fine originally, then started
complaining about short breath
What do you want to do now?
What are you worried about?
17. Case for belly trauma
45yo male crushed between truck and wall
C/O dull achy pain right under ribs
Per EMS pain getting worse, getting confused
and anxious looking…
What do you want to do??
What are you worried about?
18. How can you evaluate the belly?
Serial abdominal exams
CT
DPL
US
RUG/cystogram
Take a look (in the OR)
19. Neck Trauma
Clear c-spine/NEXUS
X-ray vs CT
Zones of the neck