Principles of First Aid in trauma
Trauma
Trauma is a major problem in all countries
It causes death, disability and both.
Time of death:
50% die immediately at the time of accident.
25% may die in golden hour of trauma.
25% may die late during treatment due to sepsis and
complications.
Triage
Triage : means “ to sort” in French.
Triage is a system to attain trauma patients.
Advanced trauma life support ( ATLS):
is essential for first hour care of an injured patient
Pre-hospitaltrauma life support(PHTLS): is to prevent
deaths while injured patients are transported to the
hospital
Types of triage system
1. multiple casualties
staff and facilities are sufficient but priority is given to life
threatening injuries
2. mass casualties
staff and facilities are not sufficient to manage. Here those
who are likely to have highest chance of survival are given
priority.
multiple casualty:
within the capacity of medical services
Example: road-traffic accidents
Mass casualties:
Exceed the capacity of medical
services.
Example: industrial disaster, large
explosions.
Triage algorithm
STEP 1. assess physiological impact:
Measure vital signs and level of impact- 1. Glasgow coma scale
2. blood pressure
3. respiratory rate
STEP 2. assess anatomical impact:
All penetrating injuries to head, neck and thorax, major burns, fracture
bones and paralysis
STEP 3: assess mechanism: fall from height more than 20 feet,
automobile accidents
STEP 4: assess history- patient’s age
Cardiac, respiratory, metabolic diseases, pregnancy.
Trauma management
GOALS:
1. Identify life-threatening situations
2. decide and implement appropriate treatment to the
area of trauma
3. First think to salvage life, then to salvage limb.
4. Rapid assessment, rapid resuscitation, rapid
stabilisation.
5. Optimum and complete care
6. Transport efficiently to higher trauma center.
Primary survey
Airway management: blocked by food, vomitus, clot, fallen tongue.
Check for : jaw thrust
Oral airway
Nasal airway
Endotracheal intubation
Breathing: assess bilateral chest raise
Assess breath sounds
Use pulse oximetry
Treat chest pneumothorax
Circulation: monitor vitals
Heart sounds
ECG
Iv fluids blood transfusion
Control of external bleed
Disability and level of consciousness: neurological examination
Glassgow coma scale
Pupillary reactions
Exposure of patient : done for complete head to toe examination for final
assessment.
Undress the patient
Hypothermia assessment
Assess injuries
Examine bones, joints, abdomen, other systems
Look for identification marks.
Fingers and tube: examination of all orifices like P/R, P/V
Used required tubes like catheter, foley’s catheter.
Secondary survey
Investigations and re-evaluation of patient:
1. x-ray : spine, chest, pelvis, extremities
2. CT scan: whole body scan is useful as it identifies
all injuries.
3. Blood grouping and cross matching.
4. Arterial blood gas analysis
5. Serum electrolytes
6. Ultrasound abdomen
FAST
FOCUSED ASSESSMENT with SONOGRAPHY for
TRAUMA
Fast is rapid bedside ultrasound examination used in
trauma patients to detect free fluid ( usually blood)
in key body cavities.
Areas examined: 1. Morrison’s pouch.
[Link] recess
[Link] pouch
FAST in trauma management
Overall Steps of first aid
Incident/injury
Ensure safety
(danger to rescuer and victim)
Asses response
(check consciousness)
DR-CAB
D- Danger
R- Response
C- Circulation (pulse/bleeding)
A- Airway ( open, clear)
B- Breathing ( look, listen, feel)
Preserve life measures
-CPR if no pulse
- Control bleeding
- -maintain airway and breathing
- Prevent deterioration measure
- - immobilise fracture
- -treat shock
- -protect spine
- -cover wound/prevent infection
- Promote recovery
- -reassure patient
- -pain relief(basic)
-
Prepare for safe transportation
- Stabilise first
- lift/carry appropriately
- -tranfer to suitable facility
Hand over to medical team
Conclusion to first aid
“the principles of first aid are to preserve life,
prevent deterioration, promote recovery and ensure
safe transport.
This is achieved by ensuring safety, assessing
patient, maintain DR-CAB, controlling bleeding,
managing shock, immobilising injuries, wound care
and prompt evacuation.