BEC Module 2part 1
BEC Module 2part 1
BEC Module 2part 1
This learning content has been developed in collaboration with the WHO Academy.
Objectives
WHO-ICRC Basic Emergency Care: Approach to the acutely ill and injured
www.who.int/publications-detail/basic-emergency-care-approach-to-the-acutely-ill-and-injured
Goals
• The goal of initial assessment is to identify life-threatening injuries.
• The goal of acute management is to prevent secondary injury from poor
oxygenation and decreased perfusion, to control pain and to plan ongoing
care.
©WHO/Laerdal Medical
The Approach to Trauma
ABCDE Trauma
SAMPLE
Trauma Secondary
History
Primary Survey Survey
If any life-threatening problems are identified
STOP and MANAGE them.
Then, return to ABCDE.
REMEMBER ………… !
People who initially appear uninjured may have hidden life-threatening
injuries, such as internal bleeding. It is very important to re-assess
trauma patients multiple times and, in particular, any time the patient’s
condition worsens.
The Trauma Primary Survey
(ABCDE Approach to Trauma)
Introduction: Trauma Primary Survey
The ABCDE Approach should be done within the first 5 minutes and repeated
anytime the patient’s condition worsens.
Always suspect head and spine injury in a patient with altered mental status.
©WHO/Laerdal Medical
Airway Assessment
Look for vomit, tongue or other objects obstructing the airway.
Look for burned nasal hairs or soot around the nose or mouth.
Look for head or neck trauma.
Look for expanding neck haematoma (bleeding under the skin).
Assess for altered mental status.
Listen for abnormal airway sounds.
• Gurgling
• Snoring
• Stridor
• Noisy breathing ©WHO/Laerdal Medical
Airway Management with Cervical Spine
Immobilization
JAW THRUST
• STABILIZE the cervical spine.
• Open airway using JAW THRUST (not head-tilt / chin lift).
• SUCTION airway secretions and remove any visible
foreign objects.
• Place ORAL AIRWAY if necessary.
• Avoid nasal airway in facial trauma. ©WHO/Laerdal Medical
CERVICAL SPINE
IMMOBILISATION
• Plan for rapid HANDOVER/TRANSFER if:
• Evidence of airway burns
• Expanding neck haematoma
©WHO/Laerdal Medical
Breathing Assessment
Look for increased work of breathing.
Look for abnormal chest wall movement.
Look for tracheal shift.
Look for sucking chest wounds.
Look for cyanosis.
Look for abrasions, bruising or other signs of injury to chest.
Look for circumferential burns to chest or abdomen.
Listen for absent/decreased breath sounds.
Listen for dull sounds or hyperresonance with percussion. ©WHO/Laerdal Medical
OXYGEN
©WHO/Laerdal Medical
Circulation Assessment
Look for capillary refill greater than 3 seconds.
Look for pale extremities.
Look for distended neck veins.
Look for external and internal bleeding.
• Common sites: chest, abdomen, pelvis, femur, amputations,
large external wounds, burns
Look for burns (size and depth).
Feel for cold extremities.
CAPILLARY
Feel for weak pulse or tachycardia. REFILL CHECK
©WHO/Laerdal Medical
Circulation Management
• Apply DIRECT PRESSURE or DEEP WOUND PACKING to control
active bleeding .
• Apply TOURNIQUET to amputated limbs or uncontrolled bleeding.
• Start IV and plan for urgent TRANSFER to a surgical unit. DIRECT
• If ongoing blood loss/poor perfusion → start 2 large IVs and give PRESSURE
IV FLUID.
• If burn injury → start IV FLUIDS according to burn size.
• SPLINT suspected femur fracture.
©WHO/Laerdal Medical
• BIND suspected pelvic fracture.
• LEAVE penetrating objects, stabilize the object and prepare for TRANSFER
• Place pregnant patients on left side while maintaining
spinal immobilization
Disability Assessment
Look for confusion, lethargy or agitation.
Look for seizures/convulsions.
Look for unequal or poorly reactive pupils.
Look for deformities of the skull .
Look for blood or fluid from ears or nose.
Check AVPU or GCS. ©WHO/Laerdal Medical
LOG ROLL
MANOEUVRE
©WHO/Laerdal Medical
Exposure Management
• If spinal injury is suspected → perform log roll manoeuvre to examine the
back.
• Remove restrictive clothing and all jewelry.
• Remove any wet clothes and dry patient thoroughly.
• Cover the patient as soon as possible to prevent hypothermia.
• Respect the patient and protect modesty during exposure.
COVER
©WHO/Laerdal Medical
Important Conditions to be
Managed in the Trauma Primary
Survey
Critical AIRWAY Conditions: Airway Obstruction
Signs and Symptoms Management
• Visible blood, secretions, vomit, • Monitor altered patients for potential
tongue, foreign body in airway aspiration.
• Changes in voice • SUCTION airway as needed.
• Abnormal airway sounds (stridor,
snoring, gurgling)
• Neck haematoma ©WHO/Laerdal Medical
• Burns to head and neck • Open the airway using JAW THRUST.
• Mental status changes • Maintain CERVICAL SPINE
• Poor chest rise IMMOBILIZATION.
• Injury causing airway swelling • Plan for rapid HANDOVER/TRANSFER
for advanced airway management.
Critical AIRWAY Conditions: Airway Obstruction
• Flail chest segments occur when ribs are broken in multiple places.
• At least three ribs next to each other, each broken in two or more places
• The free section moves abnormally with breathing and prevents the lung from
expanding.
FLAIL CHEST
SEGMENT
• Likely damage to underlying lung tissue
©WHO/Laerdal Medical
Critical BREATHING Conditions: Flail Chest
Signs and Symptoms Management
• Difficulty breathing • Give OXYGEN and pain control.
• Chest pain • MONITOR for difficulty breathing and
• Part of chest wall moving in the hypoxia.
opposite direction of the rest of the • Plan for rapid HANDOVER/TRANSFER
chest when breathing to provider capable of chest tube
placement and an advanced airway.
Critical BREATHING Conditions: Haemothorax
©WHO/Laerdal Medical
Haemothorax occurs when there is blood in the space between the lungs and the
chest wall.
Critical CIRCULATORY Conditions:
Hypovolaemic Shock
Signs and Symptoms Management
• Tachycardia, tachypnoea • CONTROL BLEEDING.
• Pale skin • Direct pressure
• Cold extremities • Deep wound packing if wound is deep,
• Slow capillary refill open (gaping wound)
• May have dizziness/confusion/ • Tourniquet for uncontrolled bleeding
altered mental status • Splint fractures, bind pelvis as needed
• External or internal bleeding • Start 2 large IVs, give IV FLUIDS.
(chest, abdomen, pelvis, femur, • Plan for rapid HANDOVER/TRANSFER if large
blood vessels) haemothorax/internal haemorrhage.
Shock can result from rapid blood or fluid loss (burns). Suspect hypovolaemic shock if there is
severe bleeding and signs of poor perfusion.
Children with shock may have a normal blood pressure for a long
time before decompensating. Always check for other signs of shock!
Critical CIRCULATORY Conditions:
Pericardial Tamponade
Signs and Symptoms Management
• Signs of poor perfusion • Give IV fluids to improve heart filling.
• Tachycardia, tachypnoea, • Plan for rapid HANDOVER/TRANSFER for
hypotension, pale skin, cold provider capable of draining the fluid.
extremities, capillary refill >3 seconds
• Distended neck veins
• Muffled heart sounds IV FLUIDS
• Dizziness, confusion, altered mental
status ©WHO/Laerdal Medical
Pericardial tamponade occurs when fluid builds up in the sac around the heart.
This can collapse the chambers and prevent the heart from filling.
Critical DISABILITY Conditions:
Severe Head Injury
Signs and Symptoms Management
• Visual changes • IMMOBILIZE the spine, use LOG-ROLL
• Memory loss technique to examine the back.
• Seizures/convulsions • Use GCS (AVPU in children) to assess.
• Vomiting • Frequently reassess ABCDE.
• Headaches • If concern for open skull fracture → give
• Altered mental status, other IV ANTIBIOTICS per protocol.
neurologic deficit • CHECK glucose, give as needed.
• Scalp wound and/or skull deformity • Do not give food/drink by mouth.
• Bruising to head (especially around • Plan for rapid HANDOVER/TRANSFER.
eyes or behind ears)
• Blood or fluid from ears or nose UNEQUAL
• Unequal pupils PUPILS
©WHO/Laerdal Medical
Severe Head Injury
REMEMBER ………… !
The skull is rigid and bleeding will cause increased pressure on the brain.
Once the pressure is too high, it will prevent blood from entering the skull
and perfusing the brain. Eventually it will squeeze part of the brain through
the base of the skull, causing death.
Trauma Primary Survey
REMEMBER …………