Chapter 18 Golden Principle of Prehospital Trauma Care 2023 updated

Chapter 18 Golden Principle of Prehospital Trauma Care 2023 updatedThe Golden Principles of PHTC: 1. ensure the safety of Prehospital Care Providers and the Patient Main points: - correct answer - Anticipated risk and ensure safety of all emergency responders. - In violent crime, law enforcement personnel must partner with EMS. - PPE against body fluid eg. HIV and hepatitis B The Golden Principles of PHTC: 2. Assess the scene situation to determine the need for additional resources Main points - correct answer The Golden Principles of PHTC: 3. Recognise the Kinematics that produced the Injuries Main points - correct answer Mechanism of Injury Criteria for Triage to Trauma Centers - correct answer The Golden Principles of PHTC: 4. use the primary assessment to identify Life-threatening conditions - correct answer 1. ABCED: airway, breathing, circulation, disability and exposure/environment 2. input from several senses (sight, hearing, smell, touch 3. during transport, the primary assessment should be reassessed at reasonable intervals what should you considered if the victims are children, pregnant patients and elderly person? - correct answer 1. to be more serious than their outward appearance 2. to have a more profound systemic influence 3. to have a greater potential for producing rapid decompensation. The Golden Principles of PHTC: 5. Provide Appropriate airway management while maintaining cervical spine stabilisation as indicated - correct answer 1. maintaining airway + maintaining head and neck in a neutral in-line position - manual clearing of the airway - Trauma jaw thrust and trauma chin life: manual maneuvers to open the airway - suctioning - use of oropharyngeal and nasopharyngeal airways. 2. Ventilation - bag-mask ventilation/ endotracheal intubation - cricothyroidotomy if ventilation cannot be accomplished 3. continuous capnometry - can used to reconfirm endotracheal tube placement what patients should be considered endotracheal intubation? - correct answer 1. A Glasgow Coma score (GCS) score of 8 or less 2. Requirement for high concentrations of O2 to maintain oxygen saturation (SpO2) greater than 95% 3. requirement for assisted ventilations because of a decreased ventilatory rate of decreased minute volume. 4. An expanding hematoma in the neck 5. airway or pulmonary burns 6. altered mental status that affects positioning of the tongue. The Golden Principles of PHTC: 6. support ventilation and deliver oxygen to maintain an SpO2 greater than 95% - correct answer 1. maintain normal ventilation - if patients are bradypnea --> assisted or total ventilatory support with a bag-mask device connected to supplemental oxygen (fraction of inspired oxygen [FiO2] greater than 0.85) - If patients are tachypneic --> estimate their minute ventilation (tidal volume x ventilation rate) --> if significant decrease in minute volume --> bag-mask device connected to FiO2 greater than 0.85 2. end-tidal carbondioxide monitoring (ETCO2) --> ensure ventilatory support - sudden decrease in ETCO2 --> indicate dislodgement of the endotracheal tube or sudden decrease in perfusion. 3. supplementary oxygen should be administered to any trauma pateint with obvious or suspected life-threathening conditions 4. pulse oximetry used to maintain the SpO2 greater than 95% 5. avoid hyperventilation when asisted ventilation. what is the normal ventilation rate? - correct answer - 12 to 20 ventilations per minute The Golden Principles of PHTC: 7. control any significant external hemorrhage - correct answer 1. controlling blood loss on extremities a. Direct pressure at the bleeding site, or use of a pressure dressing created with gauze 4x4 pads and an elastic bandage - the gauze must be packed tightly into the wound. b. if a not work --> use tourniquet (single or double that is proximal to the first one) 2. blood loss not on the extremities a. hemostatic agent: gauze-impregnated agent must be inserted and packed into the wound and pressure applied for a minimum of 3 mins *attempted resuscitation will never be successful in the presence of ongoing external hemorrhage The Golden Principles of PHTC: 8. Provide Basic Shock Therapy including appropriately splinting musculoskeletal injuries and restoring and maintaining normal body temperature. - correct answer 1. expose the body to look for life-threatening injuries. 2. cover the patient to avoid hypothermia* - hypothermia impairs the ability of the body's clotting system to achieve hemostasis --> leading to formation of a fibrin matrix that traps RBCs and stems bleeding (3 enzymes very narrow temp range --> coagulopathy