WPC +#!jUD % 0(4 w@(h mj 0J 0T 0^ 0h} 0r 0|W 0 0Y 1u 0d^ 0( 0(U6 H AI oW @Z b U>F o @   v~vOkidata ML 3210<6X9`+,Courier 10cpiLegalX($]$3|xX  OPDQRUSTUVDWDXe U2 0Indent123  2" 0Indent20 23  2, 0Indent30 0 23  26 0Indent40 0 0 23  2@ 0Indent50 0 0 0 23  2J 0Indent60 0 0 0 0 23  2T 0Indent70 0 0 0 0 0 23  2^ 0Indent80 0 0 0 0 0 0 23    ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P 8Mac DefaultMac Default ` X("$("$<  9p`(Courier New 1 2 3 4 5 C << GWPC'YX6"YX6"  *  !5!.&(2 4,4UU ?cc" !  )   ` p'C!#4$ ` \! `!CQ Page    www.mfri.org<  9p`(&Times New RomanWPC'B!NB!N  *  !5!.&(2 4,4UU]---&  !  '  ` X XInstructionalGuide     InstructorsNotesC!'4$ ` \! `!CPtPtHH(FG(HH(d'`Styl{WP}01  HH  2$HH  Geneva  <Px443!#4$*$$*$ KK  Geneva  Geneva .,6 Geneva   D2:De Geneva  D2:De Geneva ! .   $   X %ԛ DrillOfTheMonthMay1998 DrillTopic: RapidTraumaAssessment,andPrioritizingFractures% %XLevelofInstruction: 2̀TimeRequired:TwoHoursMaterialsNeeded:` XN X0  DrillTransparencies/Blackboard0  OverheadProjector0  Screen0  LiveVictims0  BSI ` XReferences:EMTBBridgeStudentGuide,Lesson1,BradyEmergencyCare,SeventhEdition,Chapter27̄ Preparation: Motivation:0 Uponarrivalonthescene,EMTB'ssometimesmistakedramaticfracturesforlifethreateninginjuries.Theintentofthisdrillistoremindrescuersthatextremitytraumararelycausesalifethreateningsituation.IncaseswheresignificantMOIexits,ABC'sandRapidTraumaAssessmentisyourfirstactionObjective(SPO):11Thestudentwilldemonstrateabasicunderstandingofrapidtraumaassessment,andprioritizingfractures.Overview: Rapidtraumaassessment,andassessingandfractures ` XN X0  Introduction0  RapidPA0  Prioritizingfractures0  Principlesoftreatingfractures ` XSession1RapidPA/AssessmentAndPrioritizeFractures̀SPO 110 Describetheindicationsforperformingarapidtraumaassessment 120 Describeinorderhowtoperformarapidtraumaassessment 130 Describehowtoprioritizefractures 140 Listthegeneralprinciplesforthemanagementofsuspectedfracturesordislocations{,k(&` X ,*X&I.0 Introduction A.0 EMTB'srespondingtoincidentswithareportofsignificantMechanismofInjury,shouldbepreparedtoperformthefollowingbasicobjectives:  1.0 SceneSurvey  2.0 SimultaneousActions(LOC,cspine,jawthrust)  3.0 Assessmentoftheairway  4.0 Assessmentofbreathing  5.0 Possiblesupportofventilation/supplemental02   6.0 Assessmentofcirculation  7.0 Controlbleeding  8.0 DCAPBTLSpatientsentirebody(Fxassessedandstabilized)  9.0 Determineifpatientisacriticaltrauma  10.0 Loadandgo/ortreatpatientatscene  11.0 Baselinevitals  12.0 SAMPLEHISTORY  13.0 Detailedphysicalexam  140 Ongoingassessment(enroutetotraumacenter)Note:Itisimportanttodoascenesizeuppriortostartingpatientcare.Dependingonthenumberofvictims,andtheMOI,yourtreatmentcandrasticallychangefromincidenttoincident.II.0 Rapidpatientassessment A.0 SCENESURVEY  1.0 Bodysubstanceisolation  2.0 Scenesafety/Hazards  3.0 DetermineMOIorNOI(mechanismofinjuryornatureofillness).  4.0 Howmanyvictims?  5.0 Areotherresourcesneeded?   B.0 SIMULTANEOUSACTIONS  1.0 DetermineLOCusingthefollowingscale:   a.0 A=Alert   b.0 V=Respondstoverbalstimulus   c.0 P=Respondstopainfulstimulus   d.0 U=Unresponsive  2.0 ManuallyimmobilizeCspine  3.0 Jawthrusttoestablishairwayifnecessary C.0 AssessmentofAIRWAY  1.0 Jawthrustneeded?  2.0 Isairwayopen?  3.0 Inspectforforeignbodies  4.0 Needsuctioning?  5.0 Considerairwayadjunct D.0 AssessmentofBREATHING   1.0 Isitpresent?  2.0 Approximaterate  3.0 Characterofrespirations  4.0 Arerespirationsadequate? E.0 SupportingVENTILATIONS  1.0 Give15lpmO2viaNRBifrateisgreaterthan8andbreathingisadequate  2.0 BagValveMaskw/reservoirand15lpmO2at24perminuteif:   a.0 Respiratoryratelessthan8   b.0 Breathingisinadequate   c.0 Headtraumaissuspected F.0 AssessmentofCIRCULATION  1.0 Carotidpulse   a.0 Present?   b.0 Approximaterate?   c.0 Character?  2.0 Whatisthegeneralskincolorandtemperature? G.0 CONTROLBLEEDING H.0 ASSESSTHEHEAD(quicklythrough)DCAPBTLSforobviousinjury(inspectandpalpate)  D eformity  C ontusions  A brasions  P unctures/penetrations  B urns  T enderness  L acerations  S welling I.0 AssesstheNECK(anteriorandposterior)DCAPBTLS  1.0 Trachea:midlineordeviated?  2.0 Jugularveinsdistendedorflat?  3.0 Anysignsoftrauma?  4.0 Stoma?  5.0 MedicAlertTag?  6.0 Applyacerviclespinalimmobilizationcollar J.0 AssesstheCHEST  1.0 Expose,inspectandpalpatethechestDCAPBTLS  2.0 AuscultateChestBilaterally   a.0 Midclavicular   b.0 Midaxillary   c.0 Comparesoundsfromsidetoside  3.0 Heartsounds   a.0 Present?   b.0 Samerateaspulse? K.0 Expose,inspectandpalpateabdomenDCAP!BTLS  1.0 FirmorSoft  2.0 Distended L.0 Expose,inspectandpalpatepelviswithgentlepressuredownwardandinwardDONOTROCK!DCAPBTLS0 M.0 Expose,inspectandpalpateLOWEREXTREMITIESDCAPBTLS  1.0 Distalpulses  2.0 Motorfunction  3.0 Sensoryfunctioǹ N.0 CRITICALTRAUMASITUATIONSappropriatetoLOADandGO. 0 Stabilizepatientonaspineboard.Treatnonlifethreateninginjuriesenroute.Donotwastetimeonthescene. O.0 ASSESSBASELINEVITALS,butdonotdelaycriticaltreatmentortransport.Theycanbedoneenroute.  1.0 Pulse  2.0 Respirations  3.0 Bloodpressure  4.0 Skincolor,temperature,moisture  5.0 Pupils P.0 SAMPLEHISTORY  1.0 Symptomsandsigns  2.0 Allergies  3.0 Medications  4.0 Pastillness  5.0 LastMeal  6.0 Eventsprior Q.0 DetailedPhysicalExaminationenroutetotraumacenter(oldsecondarysurvey). R.0 RepeatandrecordfindingsofinitialassessmenteveryfiveminutesIII.0 Prioritizingandassessingextremityfractures A.0 Problemsthatdemandcarebeforejointandboneinjuries  1.0 Airway  2.0 Breathing  3.0 Circulation  4.0 Disability  5.0 Shock  6.0 Neckandspinalinjuries  7.0 Openchestwounds  8.0 Openabdominalwounds  9.0 Seriousburns B.Priorityofcareforfractures  1.0 Fracturesofthespine  2.0 Fracturesofthehead,ribcage,andpelvis  3.0 Fracturesoftheextremities C.0 Priorityofcareforextremityfractures  1.0 Lowerextremitiesbeforeupperextremities  2.0 Pelvis  3.0 Femurs  4.0 Joints  5.0 LongbonesIV.0 GeneralPrinciplesformanagementofsuspectedfracturesordislocations̀ A.0 Assessmentandtreatmentofthefracture  1.0 Calmandreassurethepatient.  2.0 Recognizeandassessfractureordislocation.  3.0 Cutawayclothingandremovejewelryfromtheinjurysite.  4.0 Splintfracturesinamannerthatimmobilizesthejointaboveandbelowthefracturesite.  5.0 Allfracturesshouldbesplintedinthepositionoffunctionwithoutusingexcessiveforceorcausingthepatienttoexperienceextremepain.    6.0 Distalpulsesandneurologicalfunctionshouldbecheckedbeforeandaftersplinting.  7.0 Straightenangulatedfracturesoflongboneswithgentletractionpriortosplinting.  8.0 Coverallopenwoundswithsteriledressingspriortoapplicationofasplint.  9.0 Padallsplintstopreventexcessivepressure.  10.0 Applycoldpackstoischemicfractures,fromsiteofinjurytodistalend.  11.0 Immobilizefracturespriortomovementofthepatient.  12.0 Leavefingersandtoesexposedifpossible.  13.0 Wrapextremitiesdistaltoproximal.  14.0 Splintsshouldnotimpaircirculation  15.0 Elevatetheextremitiesfollowingimmobilizationwherepossible(notifthepatienthasapotentialcspineinjury).  16.0 3"klingisusedforupperextremityfractures,and6"klingisusedforlowerextremityfractures.  17.0 Whenindoubt,SPLINT. ` X" X Review: RapidTraumaAssessment,AssessmentandPrioritizingExtremityFractures` XN X0  Introduction0  RapidPA0  Prioritizingfractures0  Principlesoftreatingfractures ` XRemotivation:0 EMTB'srespondingtoincidentswithareportofsignificantMOIshouldbepreparedtotriage,anddorapidpatientassessment.Rememberthatextremitytraumamaylookdramatic,however,itisrarelylifethreatening.Assignment:0 Createmocksituationsgivingvictimssignificantmechanismofinjury.Assigneachvictimtwolifethreateninginjuries,andfourextremityfractures.̀     ̄Evaluation:0 Studentsshoulddemonstratearapidtraumaassessment,andtelltheinstructorthepriorityofallfracturesfoundduringtheassessment.