refresher course c
TRANSCRIPT
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Prehospital Trauma Life Support
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Trauma
Mega-Trends
4thEdition
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PHTLS Refresher Course
Trauma Today & Tomorrow
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PHTLS Trauma Update
Objectives.Current ATLS guidelines.
Controversial topics (PASG, IV, etc.).Possible changes based on availableresearch.
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PHTLS Refresher Course
Trends
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PHTLS Refresher Course
Injury Prevention
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Motor Vehicle Injury PreventionRequires stricter:
Safety belt use.Helmet use.Child safety seat use.Enforcement of impaired driving laws.Guidelines for improved vehicle safetydevices and designs.
Opposition to increased speed limits.Reduces availability and consumptionof drugs and alcohol.
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Prevention of Violence &
Violent InjuriesDevelop violence prevention andintervention programs (Safe Kids, etc.).Improve recognition, referral, treatment, andtracking of victims of violence.Improve recognition, referral, treatment, andtracking of violent people.Increase awareness of, and education about,firearm safety.
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Reduce use of drugs and alcohol byviolent and potentially violent persons.
Provide early childhood interventionprograms.
Educate and protect potential victims of violent injury.
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cont’d. Prevention of Violence &
Violent Injuries
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Home & Leisure Injury
PreventionEducate public about potential
hazards in the home.Enforce design standards to makehome equipment safer.
Support community efforts in first aidand basic life support (BLS).
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Occupational Injury Prevention
Maintain federal safety standards.
Reward injury prevention programs.
Establish injury surveillance systems.
Expand coverage of workers underfederal programs.
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Injury prevention should be
everyone’s goal!
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Intraosseous Infusion
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Has become widely acceptedstandard for pediatric care.
Quick technique.
Relatively safe and easy to perform.
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Pulse Oximetry
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Measures:Estimation of pulmonary oxygenation.RBC oxygen saturation.
Does not measure:Tissue oxygenation.Oxygen delivery.Aerobic versus anaerobic metabolism.
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Ventilation Evaluation
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Hospital care: PaCO 2.
Prehospital: Respiratory rate. 12 - 20 per minute = Good.Greater than 20 = Questionable.
Less than 10 = Bad.
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Bloodborne Infections
Hepatitis is still more hazardousto EMS than the HIV/AIDS virus.
Less contamination required.One contact may cause infection.
Hepatitis B vaccines are available.
Death rate among health carepersonnel annually is much higherthan for HIV/AIDS.
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Prevention of Bloodborne Infections
Prior immunization.
Body surface isolation (BSI) skin
protection.Wash carefully after contact.
Consult physician after significantcontact.
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Patient Movement
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Log roll only when necessary.
Roll only as high as required.
Use scoop when possible.
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PHTLS Refresher Course
Controversies
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Pneumatic Anti-Shock Garment (PASG)
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Increases systemic vascular resistance.
Performs auto-transfusion.
Tamponades bleeding.
Stabilizes fractures.
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PASG Limitations
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Prolong scene time.
Cause metabolic acidosis and/orcompartment syndrome.
Limit physical examination.
Worsen thoracic injury outcomes.
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Hypertonic Saline
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Replenishes intravascular space andcirculating volume.
Causes rapid fluid shift from intracellularand interstitial compartments intointravascular space.
Current evidence does not support routineuse of hypertonic solutions.
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May prove useful in post-traumatichypotension and head injury.
Hypertonic solutions may have somepotential benefit.
Hypertonic Saline cont’d.
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PHTLS Refresher Course
Intubation/Airway Management
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Double-Lumen Airway Devices
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EsophagealTracheal
Combitube(ETC)
Pharyngeal
Tracheal
Lumen Airway
(PTL)
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Ease of use.
Placement done by blind technique.
Provides a more definitive airway than basictechniques.
May be placed in the esophagus or trachea.
High success, and low complication rates.
Can be placed without C-spine manipulation.
Advantages of the ETC/PTL
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Limited studies on prehospital use.
Cannot be used in children or adults under4 feet in height.
Not nearly as definitive as ET intubation.
Contraindications:
Presence of a gag reflex.Conscious or unconscious and breathing patients.Obstructed airway.Caustic ingestion or esophageal disease.
Disadvantages of the ETC/PTL
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Endotracheal Intubation
ET intubation remains the airwayof choice.
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Summary
Trauma prevention.Intraosseous Infusion.Pulse oximetry.Bloodborne infections.Spine fractures.
Pneumatic Anti-Shock Garment.Hypertonic saline.Double-lumen airway devices.
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