TABLE I.
ChatGPT-Generated Title, Explanation, and References for Each Step of the Airway, Breathing, Circulation, Disability, Exposure Approach to Trauma
| ChatGPT Title | ChatGPT Explanation | ChatGPT References |
|---|---|---|
| A: Airway | ||
| Airway with cervical spine protection | This is the first and crucial step. The responder checks if the patient's airway is open and free from obstructions. It is vital to ensure the patient is able to breathe and that their cervical spine is protected, especially in cases of suspected spinal injuries. Techniques such as the head-tilt-chin-lift or jaw-thrust maneuver are used to open the airway if it is blocked. This step may also involve inserting airway adjuncts such as oropharyngeal or nasopharyngeal airways to keep the passage open | American College of Surgeons. (2018). Advanced Trauma Life Support Student Course Manual (10th ed) |
| Carney N, Totten AM, O'Reilly C, et al. (2017). Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery, 80(1), 6-15 | ||
| Walls RM, & Murphy MF. (2008). Manual of Emergency Airway Management (3rd ed). Philadelphia: Lippincott Williams & Wilkins | ||
| Thiboutot F, Nicole PC, Trépanier CA, Turgeon AF, & Lessard BM. (2009). Prehospital Airway Management in the Acutely Injured Patient: The Role of Surgical Cricothyrotomy Revisited. Journal of Trauma: Injury, Infection, and Critical Care, 67(3), 583-586 [PubMed ID: 19741395] | ||
| Sakles JC, Mosier JM, Patanwala AE, & Arcaris B[missing author]. (2016). First Pass Success Without Hypoxemia is Increased with the Use of Apneic Oxygenation During RSI in the Emergency Department. Academic Emergency Medicine, 23(6), 703-710 [PubMed ID: 26836726] | ||
| Crewdson K, Lockey DJ, & Røislien J. (2017). The impact of pre-hospital intubation with and without sedation on outcome in trauma patients with a GCS of 8 or less. Resuscitation, 118, 80-86 [PubMed ID: 28736051] | ||
| B: Breathing | ||
| Breathing and ventilation | The focus is on the patient's breathing effectiveness. The health care provider assesses the breathing rate, depth, and pattern. They look for symmetry in chest movements, listen for breath sounds on both sides, and check for signs of respiratory distress such as cyanosis (bluish skin due to lack of oxygen). Treatment at this stage may include administering supplemental oxygen, providing ventilation support, or performing procedures such as needle decompression if a tension pneumothorax (a type of collapsed lung) is suspected | American College of Surgeons. (2018). Advanced Trauma Life Support Student Course Manual (10th ed) |
| Zideman DA, Singletary EM, De Buck EDJ, et al. (2015). European Resuscitation Council Guidelines for Resuscitation 2015: Section 9. First aid. Resuscitation, 95, 278-287 | ||
| Kortbeek JB, Al Turki SA, Ali J, et al. (2008). Advanced trauma life support, 8th edition, the evidence for change. Journal of Trauma, 64(6), 1638-1650 | ||
| Leigh-Smith S, & Harris T. (2005). Tension pneumothorax—time for a re-think? Emergency Medicine Journal, 22(1), 8-16 [PubMed ID: 15611534] | ||
| Galvagno SM, Nahmias JT, & Young DA. (2020). Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations. Anesthesiology Clinics, 38(2), 291-303 [PubMed ID: 32471636] | ||
| Zeng J, Qian S, Zheng M, Wang Y, Zhou J, & Qiu H. (2019). The Epidemiology and Prehospital Management of Traumatic Pneumothorax. Prehospital Emergency Care, 23(4), 575-583 [PubMed ID: 30431398] | ||
| C: Circulation | ||
| Circulation with hemorrhage control | This step involves evaluating the patient's circulatory status. It includes monitoring heart rate, blood pressure, and skin condition (color, temperature, and moisture). The assessment identifies signs of shock, such as rapid heart rate, low blood pressure, and cold, clammy skin. Controlling any external bleeding is a priority, which might involve applying pressure, tourniquets, or using hemostatic agents. Intravenous access is established for fluid and blood product administration if needed to maintain circulation | Kauvar DS, Lefering R, & Wade CE. (2006). Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. Journal of Trauma, 60(6 Suppl), S3-11 |
| Holcomb JB, Tilley BC, Baraniuk S, et al. (2015). Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA, 313(5), 471-482 | ||
| Pusateri AE, Weiskopf RB, Bebarta V, et al. (2013). Tranexamic acid and trauma: current status and knowledge gaps with recommended research priorities. Shock, 39(2), 121-126 | ||
| Kragh JFJr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. (2009). Practical use of emergency tourniquets to stop bleeding in major limb trauma. Journal of Trauma, 64(2 Suppl), S38-49; discussion S49-50 [PubMed ID: 19177521] | ||
| Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, & Yelon JA. (2017). Damage control resuscitation in patients with severe traumatic hemorrhage. Journal of Trauma and Acute Care Surgery, 82(3), 605-617 [PubMed ID: 28030486] | ||
| Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R & Silliman CC. (2018). Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. The Lancet, 392(10144), 283-291 [PubMed ID: 30032977] | ||
| D: Disability | ||
| Disability or neurological status | In this phase, the patient's neurological function is evaluated. This includes assessing the level of consciousness, usually with the Glasgow Coma Scale, which scores eye, verbal, and motor responses. Pupil size and reaction are also checked. This step helps in identifying any immediate neurological impairments that may need urgent attention | Teasdale G, & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2(7872), 81-84 |
| Ropper AH. (2014)Traumatic brain injury-A review. New England Journal of Medicine, 370(10), 898-901 | ||
| Marion DW, & Carlier PM. (1994). Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries: results of a national survey. Journal of Trauma, 36(1), 89-95 | ||
| Majdan M, Mauritz W, Wilbacher I, Brazinova A, Rusnak M, & Leitgeb J. (2013). Glasgow Coma Scale score at intensive care unit discharge predicts the 1-year outcome of patients with severe traumatic brain injury. European Journal of Trauma and Emergency Surgery, 39(3), 285-292 [PubMed ID: 26815230] | ||
| Spaite DW, [missing author], Bobrow BJ, Keim SM, Barnhart B, Chikani V, Gaither JB, & Vadeboncoeur TF (2017). Association of out-of-hospital hypotension depth and duration with traumatic brain injury outcomes. JAMA Neurology, 74(10), 1206-1214 [PubMed ID: 28846763] | ||
| Sun M, Meurer WJ, Domeier RM, Shields JF, & Layton KF. (2017). The cause of death in trauma: A study in brain injured patients who died during emergency medical rescue. Prehospital Emergency Care, 21(5), 583-590 [PubMed ID: 28394703] | ||
| E: Exposure | ||
| Exposure/environmental control | Finally, the patient is fully exposed for a thorough physical examination to ensure no injuries are missed. However, it is essential to maintain the patient's privacy and protect them from environmental conditions. For instance, the patient should be covered with blankets to prevent hypothermia, which is a risk, especially in a cold environment or if the patient is in shock | Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, & Flanagan, ME. (1996). A revision of the Trauma Score. Journal of Trauma, 29(5), 623-629 |
| Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, & O'Keefe GE. (2002). Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Annals of Surgery, 236(4), 492-500 | ||
| Seekamp A, Regel G, Tscherne H. (1998). Hypothermia in patients with multiple injuries. Injury, 29 Suppl 2, B7-12 | ||
| Lapostolle F, Sebbah JL, Couvreur J, Koch FX, Savary D, Tazarourte K, & Adnet, F. (2007). Risk [factors for onset] of hypothermia in trauma victims: the importance of the prehospital phase. Prehospital Emergency Care, 11(4), 460-467 [PubMed ID: 17907033] | ||
| Ireland S, Endacott R, Cameron P, Fitzgerald M, & Paul E. (2018). The incidence and significance of accidental hypothermia in major trauma–A prospective observational study. Resuscitation, 122, 11-17 [PubMed ID: 29141153] | ||
| Søreide K. Clinical and translational aspects of hypothermia in major trauma patients: from pathophysiology to prevention, prognosis and potential preservation. Injury. 2014;45(4):647-654. doi:10.1016/j.injury.2012.12.023. PMID: 23352151 |