terminal learning objective - jsomtcslides.jsomtc.org/somtrl0a/somtrl0a.pdfresearch shows that basic...

9/1/2017

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Slide 1JSOMTC, SWMG(A)

Trauma Patient AssessmentPFN: SOMTRL0A

Hours: 1.0

Instructor:


Terminal Learning Objective

Action: Communicate knowledge of the trauma patient assessment

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


References

Emergency Care and Transportation of the Sick and Injured, 10th edition

Tactical Trauma Protocols 31 Jan 2017

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Reason

The SOCM must be able to perform both a military and civilian trauma patient

assessment IOT operate in a battlefield environment or in a civilian setting.


Agenda

Differentiate civilian versus military trauma patient assessments

Identify the components of a civilian trauma patient assessment

Identify the components of a military trauma patient assessment


Differentiate Civilian versus Military Trauma Patient Assessments

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Trauma Patient Assessments

Civilian Trauma Patient AssessmentA.B.C.D.E.

Primary Survey

Secondary Survey

Military Trauma Patient AssessmentM.A.R.C.H.

Initial

Rapid

Detailed


Identify the Components of a Civilian Trauma Patient Assessment


Civilian Trauma Patient Assessment

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Introduction to Civilian TPA

Trauma is the leading cause of Death in Patients under the age of 45

In 1966 Lyndon B. Johnson and President's Commission on Highway Safety/National Academy of Sciences declares motor vehicle trauma "the neglected disease of modern society"

Research shows that basic pre‐hospital interventions can work just as effectively as Advanced pre‐hospital Trauma Care


Civilian Trauma Patient Assessment

Airway

Breathing

Circulation

Disability

Expose


Civilian TPA (Airway)

Consider C‐spine injuries due to MOI

Inspect

Secure airway

NPA

OPA

Intubation

Cricothyroidotomy

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Civilian TPA (Breathing) Assess rate and quality of respirations

BVM if respirations are inadequate (>20 or <12) with high flow O2 (15 L/min)

IAPP

Inspect, auscultate, palpate and percuss

Needle decompression

Chest tube PRN


Civilian TPA (Circulation)

Control bleeding

Assess distal pulses

Auscultate heart

Gain IV access

Administer colloids/crystalloids

Administer blood/plasma

Perform FAST exam

Treat for hypovolemia or shock


Civilian TPA (Disability)

Determine patient’s blood glucose level

Rule out drugs and ETOH

Determine a patient’s Glascow Coma Scale score

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Civilian TPA (Expose)

Remove patients clothing

Inspect head to toe for untreated injuries

Log roll

Treat for hypothermia


Civilian TPA (Primary Survey)

Scene size up

Patient history/MOI

Assess patient

Airway

Breathing

Circulation

Disability

Expose


Civilian TPA (Secondary Survey)

Detailed examination head to toe

Identify and treat all injuries

Reassess vitals

NG tube

Foley

Neurological exam

Labs, CT and FAST used as indicated

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Identify the Components of a Military Trauma Patient Assessment


Military Trauma Patient Assessment


Introduction to Military TPA

Surgeon Dominique Jean Larrey employed the use of the first ambulance during the Napoleonic Wars

Major Jonathan Letterman instituted the first evacuation and treatment system during the civil war.

Spanish American War: Introduction of the First Aid Kit

WWI: First employment of combat medics at the front lines

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Military Trauma Patient Assessment

Massive hemorrhage

Airway

Respiration

Circulation

Head Injury / Hypothermia


Military TPA (Massive Hemorrhage)

Identify sources of bleeding

Control bleeding

Tourniquets

Hemostatic agents

Pressure dressings


Military TPA (Airway) Establish and maintain a patent airway

Conscious causalities

Allow patient to position self

NPA

Cricothyroidotomy

Unconscious causalities

NPA

OPA

ET tube

Cricothyroidotomy

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Military TPA (Respiration)

Seal open chest wounds

Assess respiratory effort

Decompress tension pneumothorax

Support ventilation and oxygenation


Military TPA (Circulation)

Establish IV/IO access

Administer fluids to treat for hemorrhagic shock


Military TPA (Head Injury)

Prevention of hypoxia and hypotension

Controlled hyperventilation if ICP suspected

Hypertonic saline for ICP management

Seizure prophylaxis and management

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Military TPA (Hypothermia)

Decreases casualty’s clotting abilities

Wrap casualty in hypothermia blankets, sleeping bags, etc

Use fluid warming devices for resuscitation


Military TPA (Initial Trauma Assessment)


Military TPA (Initial Trauma Assessment)

Life Threats

LOC

Airway

Patent

NPA/OPA/ET/CRIC PRN

Breathing

Assess for chest injuries

BVM if respirations are inadequate and <12 or >20

Breathing continued:

Needle Decompress PRN

Circulation

Assess pulses rate and quality

Detect signs of shock

Spinal Precautions

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Military TPA (Rapid Trauma Assessment)


Military TPA (Rapid Trauma Assessment)

Reassess LOC, ABCs and treatments

All bleeding needs to be controlled

Order Head

Neck

Chest (IAPP)

Abdomen

Pelvis

Extremities

Order continued: Tourniquet conversion

Immobilization when indicated• Back (log roll unless contraindicated by pelvic fracture) with reassessment after logroll

Establish IV access & take vitals

Fluid challenge PRN (systolic BP less than 90mm Hg)

Pain meds and WWT


Military TPA (Detailed Trauma Assessment)

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Military TPA (Detailed Trauma Assessment)

Reassess LOC, ABCs and treatments

Head to toe assessment

Neuro exam

Procedures Chest tube PRN

Drug administration

DRE

NG/OG tube

Foley catheter

2nd large bore IV

Vitals

Oxygen



Questions?

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Agenda

Differentiate civilian versus military trauma patient assessments

Identify the components of a civilian trauma patient assessment

Identify the components of a military trauma patient assessment


Reason

The SOCM must be able to perform both a military and civilian trauma patient

assessment IOT operate in a battlefield environment or in a civilian setting.


References

Emergency Care and Transportation of the Sick and Injured, 10th edition

Tactical Trauma Protocols 31 Jan 2017

9/1/2017

14


Terminal Learning Objective

Action: Communicate knowledge of the trauma patient assessment

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


Trauma Patient AssessmentPFN: SOMTRL0A

Hours: 1.0

Instructor:

terminal learning objective - jsomtcslides.jsomtc.org/somtrl0a/somtrl0a.pdfresearch shows that basic...

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