Major Trauma
A standard approach
Ballarat Health Services
Emergency Medicine Training Hub
Trauma workshop
Objectives

C-Spine assessment and collar application

Primary Survey

Log Roll
C-Spine Assessment


History
Observe patient




Palpate




Head Holding
Posturing
Failure to tolerate collar
Midline
Paracervical structures
Neurological Examination
Move/collar as indicated
C-Spine Assessment


History
Observe patient




Palpate




Head Holding
Posturing
Failure to tolerate collar
Midline
Paracervical structures
Neurological Examination
Move/collar as indicated
Sizing a collar
Use fingers,
horizontally
placed to assess
distance from
apex of trapezius
to line of
mandible.
Primary Survey
A



Talk to the patient!
Look, listen, feel, monitor
Intervene as required



Oro/naso-pharyngeal
BMV
RSI and ETT
Primary Survey
B


Spring chest and examine for injury
Auscultate for air and blood
Air
Blood
Primary Survey
C

Examine







Heart Rate
Blood pressure
CRT
JVP
Heart Sounds
Abdomen
Long bone injury
Chest, Abdomen, Pelvis, Limbs and one more – the
floor
Primary Survey
D


GCS
Obvious neurological injury


Limb
Spinal
Log Roll

5 people (4 in children)

Four to roll, one to examine
• Keep your hands across your chest.
• You will not fall but will feel like you might.
• I will press down your spine on each bone (demonstrate on an
unbroken clavicle) like this.
• Say yes if it hurts, no if it doesn’t.
• I will then examine your back passage/anus to check for
sensation and tone#@!**.
• Turn to the head person – on your call.
To say to the patient






Keep your hands across your chest.
You will not fall but will feel like you might.
I will press down your spine on each bone
(demonstrate on an unbroken clavicle) like
this.
Say yes if it hurts, no if it doesn’t.
I will then examine your back passage/anus
to check for sensation and tone#@!**.
Turn to the head person – on your call.
Log Roll
Is everybody ready?
We will roll on three. . .
1, 2, 3
Log Roll

Palpate down the spine, each vertebra

Do not forget to


PR (if indicated)
examine the back of the head, c-spine, torso
Log Roll
Is everybody ready?
We will roll back on on three. . .
1, 2, 3
Summary

C-Spine assessment with Canadian C-spine
rules

Primary Survey – intervene and start again at
‘A’

Log roll – team and procedure
Questions?
Thankyou