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Trauma Primary Survey for Rural and Austere Environments

Trauma Primary Survey for Rural and Austere Environments. William A. Liston MD FACS Capt, MC, USN July 2011. Acute Trauma. Leading Cause of Death all over the world in ages younger than 44 Prevention is the key to improving survival Safe driving, removing land mines or IEDs

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Trauma Primary Survey for Rural and Austere Environments

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  1. Trauma Primary Survey forRural and Austere Environments William A. Liston MD FACS Capt, MC, USN July 2011

  2. Acute Trauma • Leading Cause of Death all over the world in ages younger than 44 • Prevention is the key to improving survival • Safe driving, removing land mines or IEDs • Preventing burns from open flame heat/ cooking • Safe handling of firearms • Safe electrical power/ wiring

  3. Primary Survey • Organized approach prevents missing injuries that may cause death • May be done with little or no resources such as X-ray machines, lab tests, sonograph (Ultrasound )machine • Same approach may be useful to triage large numbers of injured patients that require care

  4. Primary Survey • Easy to remember method of ABCDE • A = Airway/ the opening from the mouth to the lungs • B = Breathing/ moving air from the mouth to the lungs • C = Circulation/ assess for blood loss • D = Disability/ Is there a head injury and/ or paralysis of any arms or legs • E = Expose or examine the entire patient to not miss any injuries including the back and then cover patient to prevent heat loss

  5. Airway • Chin Lift/ Jaw thrust may be enough to allow patient to breath on their own • Rescue breathing position may allow patient to breath that has bleeding from the mouth or is not completely awake • Bag Valve Mask ventilation with oxygen or just room air may be adequate to allow the patient to breathe • Nasal trumpet may assist breathing

  6. Breathing • Breathing cannot occur without an open airway • If a patient can talk or moan then they have an open airway and can breathe • Bag Valve Mask can assist with breathing • Endotracheal intubation is not always necessary or available • CPR techniques can include mouth to mouth breathing but the person doing it wears out within 30 minutes at best

  7. Circulation 1 • Many injured patients die from hemorrhage/ bleeding • Bleeding can be seen externally from lacerations to the body/ it is hard to guess blood loss from looking at blood on a patient or beside them • Bleeding may going on in the chest, abdomen, pelvis, or in the thigh and not be seen • Pallor, rapid pulse, patient complaining of thirst may be clues they are bleeding internally

  8. Circulation 2 • Bleeding may be treated for external wounds by pressure dressing and or tourniquets • Oral fluids with some salt and sugar mixed in may be given to patients that are awake enough to swallow instead of intravenous saline or blood • Patients may survive for long periods of time with severe wounds internally because some times the body will shut down blood flow to non-vital organs to preserve life

  9. Circulation 3 • Patients with blood loss that is significant are best treated with blood and intravenous fluids • Tourniquets should not be left on for more than 6 hours if possible to preserve the extremity • Tourniquets may be left on for longer trading an arm or leg for life • Keeping the patient warm with blankets may prolong life while waiting for transportation to a hospital that can treat their injuries

  10. Disability 1 • Patients that are struck in the head or have a penetrating head injury from bullets, fragments, IEDs, explosions may have a brain injury that requires CAT scan and neurosurgery • Some patients will survive a brain injury without surgery • Oxygen, when available, may help prevent further brain damage • Unequal pupil size or pupils that do not contract with a light may indicate a brain injury

  11. Disability 2 • It is important to exam a patient for paralysis and note the level it is at • Patients that have been paralyzed by the trauma usually have a spinal cord injury • It is important to pad the back with a blanket to prevent sores from developing on the patient’s back, head, neck, or buttocks • It is important to fix the patient to a firm surface/ backboard to stabilize the spine and prevent further injury

  12. Exposure/ Environment • It is important to remove all clothing to look for injuries including the back • It is important to cover the patient back up after exam to prevent hypothermia even in a warm climate • Patients lose body heat faster after blood loss • Patients may be completely examined modestly with an attendant/ family member present • It should be stresses to the patient and family how important this exam is so as to not miss an injury

  13. Transport • Patients that are severely injured are best cared for at a hospital that treats trauma patients • Patients that are severely injured may survive several hours to days with minimal care so continue to provide care if possible or care not futile • Open skull fracture at top of mountain with no help • Simple splinting and/ or backboard may reduce further injuries during transport

  14. Summary • Good care can be provided with little to no resources • Systematic approach can discover most injuries and prevent worse injuries from treatment or lack of good treatment • Remember ABCDE • Patients with severe injuries are best treated at a hospital that cares for trauma patients

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