Slide 2 Primary/Secondary Survey of the Casualty Slide 3
Objectives Discuss the importance of the primary/secondary survey
Outline how ATLS applies to the casualty Slide 4 Time of death
Slide 5 Primary/Secondary Survey Why is it important? What and
where are the wounds? What resuscitation is required? Mode of EVAC?
Slide 6 What is the Approach? ATLS Created by surgeons for the
non-surgeon Designed in the urban environment Performed in the
hospital setting Requires a lot of high tech resources This is our
classical training platform Will this approach work in firefight?
Slide 7 How Do We Develop Our Approach? What are we going to see?
Injury patterns Civilian trauma? Firefight trauma? Slide 8 How Do
We Develop Our Approach? Civilian trauma Trimodal death
distribution First peak Death results in the pre-hospital setting
from massive head injury and massive vascular injury. Second peak
Death in the first few minute of arrival to the hospital and due to
massive head, chest and abdominal injury Third peak Post
resuscitation/operative complications Firefight TraumaFirefight
Trauma We dont know the death distribution It is believed that if
the casualty can arrive alive and relatively stable to the ERthey
will live.It is believed that if the casualty can arrive alive and
relatively stable to the ERthey will live. Slide 9 How Do We
Develop Our Approach? ATLS Based on urban injury patterns Primary
Survey A-Airway/c-spine control B-Breathing C-Circulation
D-Disability E-Exposure Detailed secondary survey Head-to-toe exam
Slide 10 How Do We Develop Our Approach? The Firefight Casualty
Slightly different injury pattern-in this order! Penetrating
extremity trauma Tension pneumothorax Loss of airway Instead of
ABCsthink CBAs Slide 11 The Firefight Casualty Primary Survey
Assess for hemorrhage first Intervene Intervene for life
threatening bleed only! Then, assess for tension pneumothorax Then,
assess for an airway Utilize Utilize a Combitube or surgical airway
Rarely Rarely a need for c-spine control Slide 12 Slide 13 Slide 14
Slide 15 Slide 16 The Firefight Casualty Primary Survey
D-disability- decision to evacuate E-exposure Explore ideas on how
to expose your casualty while protecting them from the environment
Hypothermia is BAD Remember, they may need that kevlar!!! Slide 17
Heat loss during transport Slide 18 Hypothermia Slide 19 The
Firefight Casualty Secondary Survey Occurs after you have performed
your primary survey and appropriate interventions Head-to-toe exam
along ATLS guidelines. Be very thorough-many injuries are subtle!
Slide 20 Commonly used acronyms DCAP-BTLS- deformities, contusions,
abrasions, penetrations, burns, tears, lacerations, swelling. TIC-
tenderness, instabilities, crepitus. TRD- tenderness, rigidity,
distension PMS- pulse, motor, sensory Slide 21 Head exam
DCAP-BTLSPupils Raccoon/Battle signs Mid-face instability Slide 22
Neck exam Step-off Tracheal deviation Jugular vein distention Slide
23 Chest exam DCAP-BTLSTICAuscultationPercussion Slide 24
Abdominal/Pelvic exam DCAP-BTLSTRD-P Pelvic instability Priapism
Scrotal/labial hematoma/blood at the meatus Slide 25 Extremity exam
DCAP-BTLSTICPMS Slide 26 Posterior Thorax Log roll casualty Spine
DCAP-BTLSTenderness/step-off DRE Gross blood only Slide 27 Slide 28
Slide 29 Slide 30 Slide 31 Questions?
