OBJECTIVES

Preparation
In-hospital
- Assemble a team and prepare to resuscitate an injured patient.
- Explain the importance of teamwork in the initial assessment of a trauma patient.

Triage
- Define triage.
- Explain the principals involved and the factors that must be considered during the triage process.

Assessment
Primary Survey

A + cervical spine immobilization

- Identify the clinical situations in which airway compromise is likely to occur.
- Recognize the signs and symptoms of acute airway obstruction.
- Describe the techniques for establishing and maintaining a patent airway.
- Define the term definitive airway.
- List the indications for rapid sequence intubation.
- Outline the steps necessary for maintaining oxygenation before, during, and after establishing a
definitive airway.
- In a given simulated clinical and surgical skills practicum, demonstrate/ describe the following
skills, which are often required in the initial assessment and treatment of patients with multiple
injuries:
o Establishment of a patent airway and initiation of assisted ventilations, with protection
of the cervical spine.
o Orotracheal intubation on an adult manikin.
o Pulse oximetry and carbon-dioxide detection.

B
- Recognize ventilatory compromise and signs of inadequate ventilation.
- Describe the techniques for confirming the adequacy of ventilation and oxygenation, including.
pulse oximetry and end-tidal CO2 monitoring.
- Identify and initiate treatment of the following injuries during the primary survey:
o Airway obstruction
o Tension pneumothorax
o Open pneumothorax
o Flail chest and pulmonary contusion
o Massive hemothorax
o Cardiac tamponade
- In a given simulated clinical and surgical skills practicum, demonstrate the following skills, which
are often required in the initial assessment and treatment of patients with multiple injuries:
o Pleural decompression via needle thoracentesis and chest tube insertion.
o Recognition of cardiac tamponade and appropriate treatment.
o Clinical and radiographic identification of thoracic injuries.
C
- Explain the importance of early identification and control of the source of hemorrhage in trauma
patients, with staunching of exsanguinating external blood loss taking precedence “over anything
else.”
- Recognize shock and correlate a patient’s acute clinical signs with the degree of volume deficit.
- Compare and contrast the clinical presentation of patients with various classifications of
hemorrhage.
- Describe the initial management of hemorrhagic shock and the ongoing evaluation of fluid
resuscitation and organ perfusion.
- Explain the role of blood replacement in the management of shock.
- Recognize a patient at risk for intrathoracic, abdominal and pelvic injuries based on the
mechanism of injury.
- Apply the appropriate diagnostic procedures to identify ongoing abdominal hemorrhage and
injuries that can cause delayed morbidity and mortality.
- Describe the acute management of massive hemothorax, abdominal and pelvic injuries, and
cardiac tamponade.
- Explain the significance of musculoskeletal injuries causing shock in patients with multiple
Injuries, and the initial management of such injuries.
- In a given simulated clinical and surgical skills practicum, discuss the use of ultrasound (FAST) and
computed tomography (CT) in abdominal evaluation.

D
- Evaluate a patient with head and brain injuries.
- Perform a focused neurologic examination.
- Evaluate a patient with suspected spinal injury.
- Explain the importance of adequate resuscitation in limiting secondary neurologic injury.

E
- Recognize the potential for hypothermia in any trauma patient.
- In a given simulated clinical and surgical skills practicum, demonstrate the skills which are often
required in the initial assessment to prevent or treat hypothermia.

Additional measures
- Explain that before performing a Secondary Survey the following should have been addressed.
o log roll
o antibiotics if indicated
o gastric tube if indicated
o bladder catheter if indicated

Re-assessment
- Reevaluate a patient who is not responding appropriately to resuscitation and management.

Secondary Survey
- Explain how a patient’s medical history and the mechanism of injury contribute to the
identification of injuries.
- Explain that the Secondary Survey should only be performed in ABC normal patients.
- Assessment of head and facial trauma by physical examination.
- Describe how to perform the physical examination of head, spine and musculoskeletal system.
Transfer to definitive Care
- Recognize patients who will require transfer for definitive Management and describe how to
perform such a transfer safely.

Special groups
Thermal
- Demonstrate the initial assessment and treatment of patients with thermal injuries.
- Identify the unique problems that can be encountered in the treatment of patients with thermal
injuries, and explain how to resolve them.
- List the criteria for transferring patients with burn injuries to burn centers.
- In a given simulated clinical and surgical skills practicum, demonstrate the specific skills for
burned patients, which are often required in the initial assessment and treatment of patients
with multiple injuries.

Pediatric
- Identify the unique characteristics of the child as a trauma patient, including common types of
injuries, patterns of injury, anatomic and physiologic differences in children as compared with
adults, and the long-term effects of injury.
- Describe the primary management of the following critical injuries in children, to include issues
unique to pediatric patients, emphasizing the anatomic and physiologic differences as compared
with adults and their impact on resuscitation.
- In a given simulated clinical and surgical skills practicum, demonstrate the following skills for
children, which are often required in the initial assessment and treatment of patients with
multiple injuries.

Geriatric
- Identify the unique characteristics of elderly trauma patients, including common types of injury,
patterns of injury, and anatomic and physiologic differences
- Describe the primary management of critical injuries in geriatric patients, including the issues
unique to geriatric patients, emphasizing the anatomic and physiologic differences from younger
patients and their impact on resuscitation.
- In a given simulated clinical and surgical skills practicum, demonstrate the specific skills the
elderly, which are often required in the initial assessment and treatment of patients with
multiple injuries.

Pregnancy
- Identify common mechanisms of injury in pregnant patients and their fetuses.
- Outline the treatment priorities and assessment methods for both patients (mother and fetus).
- State the indications for operative intervention that are unique to injured pregnant patients.
- Explain the potential for isoimmunization and the need for immunoglobulin therapy in pregnant
trauma patients.
- In a given simulated clinical and surgical skills practicum, demonstrate the specific skills for
pregnant women, which are often required in the initial assessment and treatment of patients
with multiple injuries.