ITLS Ch02 Lecture

seventh edition
International Trauma Life Support

for Emergency Care Providers
Trauma Assessment and

Management
CHAPTER 2
Trauma Assessment and

Management
Courtesy of ITLS Ontario, Steve McNenly, Jennifer Lundren, and Sheryl Jackson
International Trauma Life Support for Emergency Care Providers, Seventh Edition
John Campbell Alabama College of Emergency Physicians
Overview
ITLS Patient Assessment
Primary Survey
Ongoing Exam
Secondary Survey
Initial Assessment related to

Rapid Trauma Survey vs. Focused Exam
Interruptions
Critical conditions and the Fix It process


ITLS Primary Survey
Scene Size-up
Initial Assessment
Rapid Trauma Survey
vs. Focused Exam
ITLS Ongoing Exam

ITLS Secondary Survey
ITLS Primary Survey

ITLS Primary Survey
Scene Size-up
Initial Assessment
Rapid Trauma Survey
vs. Focused Exam
Delegate immediate interventions to

partners
Do not stop your assessment unless
Scene becomes unsafe
Airway obstruction
Cardiac arrest
Teamwork
Scene Size-up
Scene Size-up
Hazards
Power lines, gas, animals, people
PPE
Number of patients
Establish command
Additional resources?
MOI
Anticipate type and severity of injuries
Initial Assessment
ITLS Primary Survey

Initial Assessment
General impression
Level of consciousness
Manual stabilization of
cervical spine
ABCs
Prioritize patient
Identify immediate life-threatening
conditions
ITLS Primary Survey

Less than 2 minutes
Initial Assessment and Rapid Trauma Survey
Delegate any intervention

Interrupt survey only for:
Unsafe scene
Airway obstruction
Cardiac arrest
ITLS Primary Survey

General impression
Obvious major injuries or bleeding
immediately control life-threatening bleeding
Approximate age, sex, weight
General appearance
Position of patient body and surroundings
Patient activity
Triage multiple patients

ITLS Primary Survey

Initial Level of Consciousness
Cervical-spine stabilization
ITLS Primary Survey

Airway: look, listen, feel
Direct: simple positioning and suctioning
If not adequate
Pearson
ITLS Primary Survey

Breathing: look, listen, feel
Direct: high-flow oxygen
If not adequate
Pearson
Respiratory Rates
Normal
Abnormal
Adult
1020
<10 and >24
Child
1530
<15 and >35
Infant
2550
<25 and >60
ITLS Primary Survey

Major bleeding controlled?
Fix It
Circulation: peripheral pulse

No peripheral, check carotid
Too fast, too slow, quality
Interrupt: cardiac arrest
Skin
Pearson
Color, temperature, condition

MOI Decision
Dangerous generalized or
unconscious
Rapid Trauma Survey
Dangerous focused
Focused Exam
No significant MOI
Initial Assessment normal
Focused Exam
Mikael Damkier
Rapid Trauma Survey
Rapid Trauma Survey

Assess
Head and neck
Chest
Abdomen
Pelvis
Lower and upper
extremities
Back
Transfer to backboard
Rapid Trauma Survey

If critical situation, transfer to
ambulance to complete exam.
Pawel Nawrot
Rapid Trauma Survey

Obtain baseline vital signs
If altered mental status
Brief neurological exam
Pupils, GCS, and signs of cerebral herniation
Look for medic alert tags

Consider other causes
Glasgow Coma Scale
*Decorticate posturing to pain

**Decerebrate posturing to pain
Priority Patient
Dangerous MOI
History
Loss of consciousness
High Risk Groups
Abnormal Initial
Assessment
Altered mental status
Difficulty breathing
Abnormal perfusion
Pawel Nawrot
Brief Targeted History
S
A
M
P
L
E
Symptoms
Allergies
Medications
Past medical history
Last oral intake
Events preceding incident
Load-and-Go Situations
Initial Assessment
Altered mental status
Abnormal respiration
Abnormal circulation
Shock potential
Abnormal chest exam
Tender, distended
abdomen
Pelvic instability
Bilateral femur
fractures
Significant MOI and/or poor general health
When in doubttransport early!
Critical Interventions
Manage airway
Assist ventilation
Administer oxygen
Begin CPR
Control major external
bleeding
Seal sucking chest

Stabilize flail chest
Decompress tension
pneumothorax
Stabilize impaled
object
Complete packaging
Initiate Transport
Procedures not on scene, not lifesaving
Splinting, bandaging, IV line insertion
Elective intubation
Contact medical direction

As early as possible
Estimated time of arrival (ETA)
Condition of patient
Special needs on arrival
ITLS Ongoing Exam

Change in condition
Patient
Interventions
Perform and record
Critical: every 5 minutes

Stable: every 15 minutes
Each time patient moved
With each intervention
If condition changes
Ongoing Exam
Subjective changes
Mental status
(LOC and pupils)
ABCs
Neck, chest,
abdomen
Previously identified injuries
Interventions

More comprehensive exam
Evaluation for all injuries, not just
life-threatening
Establishes baseline for treatment decisions
Performed
Critical patientsdone during transport
Short transportmay not have time
Noncritical patientsdone on scene

Initial Assessment
Repeat routinely
Vital signs
Repeat routinely
Monitoring
Detailed Exam
Head-to-toe
DCAP-BLS-TIC
Detailed Exam: DCAP-BLS-TIC

Deformities
Burns
Contusions
Lacerations Instability
Abrasions
Swelling
Tenderness
Crepitus
Penetrations
Adjuncts for Patient Assessment

Pulse oximetry
Wave form capnography
Adjuncts for Patient Assessment

Serum lactate
Marker for tissue hypoxia
Finger-stick serum levels
Further studies needed
Portable ultrasound
F.A.S.T.
Summary
Key to trauma care
Not difficult, but time-critical
Rapid, orderly, thorough
Remain calm
Maximize speed through organization and
teamwork

ITLS Ch02 Lecture

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ITLS Ch02 Lecture

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seventh edition

International Trauma Life Support

Trauma Assessment and

Trauma Assessment and

Initial Assessment related to

Critical conditions and the Fix It process

ITLS Patient Assessment

ITLS Ongoing Exam

ITLS Primary Survey

Delegate immediate interventions to

ITLS Primary Survey

ITLS Primary Survey

Delegate any intervention

ITLS Primary Survey

Triage multiple patients

ITLS Primary Survey

ITLS Primary Survey

ITLS Primary Survey

<10 and >24

<15 and >35

<25 and >60

ITLS Primary Survey

Circulation: peripheral pulse

Color, temperature, condition

Rapid Trauma Survey

Rapid Trauma Survey

Rapid Trauma Survey

Rapid Trauma Survey

Look for medic alert tags

Glasgow Coma Scale

*Decorticate posturing to pain

High Risk Groups

Brief Targeted History

Significant MOI and/or poor general health

When in doubttransport early!

Seal sucking chest

Contact medical direction

ITLS Ongoing Exam

Perform and record

Critical: every 5 minutes

ITLS Secondary Survey

ITLS Secondary Survey

ITLS Secondary Survey

Detailed Exam: DCAP-BLS-TIC

Adjuncts for Patient Assessment

Adjuncts for Patient Assessment

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