ADULT TRAUMA PROTOCOLS

Question 1

ADULT TRAUMA
BURNS

Initial Interventions

Answer 1

• *1**. Safely remove the patient from the source of the burn and decontaminate:
• *a**. Chemical: Flush as soon as possible with the cleanest readily available water or saline solution using copious amounts of fluids.
• *b**. Electrical:
• *i**. Attempt to locate contact points and identify the nature of the source (AC/DC) and amperage the patient may have been exposed to during the electrical shock.
• *ii**. Anticipate ventricular or atrial irregularity.
• *c**. Radiation: Determine the exposure type and amount of exposure.

Question 2

ADULT TRAUMA
BURNS

Interventions

Answer 2

♦ Airway Management → SMR → Pain Control

♦ Protect burns/wounds with dry sterile dressings. Do not remove clothing adhered to burn area

♦ Establish IV and initiate fluid resuscitation based on the Consensus or Parkland Formula using Lactated Ringers or Normal Saline

♦ Maintain body temp

♦ If multi-trauma, prepare to transport to closest Level One Trauma Center

Question 3

ADULT TRAUMA
BURNS

Parkland / Consensus Formulas

Answer 3

♦ Parkland Formula = 4 ml x pt weight in Kg x TBSA burned. Divide by 2 and then by 8 to calculate hourly fluid administration rate for the first 8 hours post burn.

♦ Consensus Formula= 2 ml x pt weight x TBSA then treat as above

BURN PEARL: Adults use 2 mL: Pediatrics use 3 mL: Electrical injuries use 4mL

Question 4

ADULT TRAUMA

Chest and Abdominal Trauma

Interventions

Answer 4

• *1**. Follow Airway Management Protocol.
• *2**. Consider RSI for conditions such as flail chest.
• *3**. Consider SMR to include pelvic stabilization
• *4**. Consider the necessity to follow Breathing: Pleural Decompression Procedure.
• *5**. Look for Cullen’s, Grey Turners, referred pain, abdomen for rigidity and deformity, stabilize, do not remove impaled objects
• *6**. Consider NG/OG to empty gastric contents
• *7**. Open wounds should be covered with sterile occlusive dressings as necessary.
• *8**. Establish IV (2 large bore) at KVO rate
• *a**. Administer Normal Saline bolus to maintain acceptable MAP.
• *b**. S/S of hypovolemic shock → Circulation: Blood Administration Procedure. May proceed directly to it in cases of extremis.
• *9**. Follow Adult: Pain Management Protocol.

Question 5

ADULT TRAUMA

What is Cullen’s Sign?

Answer 5

Hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage

Question 6

ADULT TRAUMA

What is Grey Turners Sign?

Answer 6

Bruising of the flanks and is a sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum, which is a lining of the abdominal cavity

Question 7

ADULT TRAUMA

Drowning / Submersion Injuries

Interventions

Answer 7

1. Follow Airway Management Protocol.
2. Consider SMR Precautions
3. Apply full noninvasive monitoring
4. Establish IV → Obtain BGL → 12 lead EKG
5. If patient’s temperature is <95⁰F (35⁰C), then follow Adult: Hypothermia Protocol.
Notes:
♦All near drowning patients with a known submersion time of less than 90 minutes in cold water (water temperature <70ºF) shall be resuscitated unless other obvious signs of death are present.

Question 8

ADULT TRAUMA

Head and Face Trauma

Interventions

Answer 8

1. Follow Airway Management Protocol.
2. Consider SMR → GCS: GCS < 8, consider intubation.
3. Obtain BGL → IV (2 large bore) at KVO rate
a. Administer Normal Saline bolus to maintain acceptable MAP >90.
b. S/S of hypovolemic shock → Circulation: Blood Admin procedure or go directly to it if needed
4. Follow Adult: Pain Management Protocol.
5. Consider Mannitol 1g/kg over 10 min (filter must be used) OR 3% Normal Saline 250 ml IO/IV if cerebral edema is suspected.
6. Elevate head 20-30 degrees.
Notes:
♦ In cases of extreme hypertension, w/ S/S of herniation are suspected, consider treating by the Hypertensive Crisis Protocol after contacting OLMD.

Question 9

ADULT TRAUMA

Hypovolemic Shock

Interventions

Answer 9

♦ Consider SMR Precautions → Consider the necessity to follow Breathing: Pleural Decompression Procedure.
♦ Initiate 2 large bore IV at KVO rate – follow Circulation: Intravenous Infusion Procedure.
♦ Administer Normal Saline bolus to maintain acceptable MAP.
♦ If S/S of hypovolemic shock → Circulation: Blood Administration Procedure or proceed directly to it in cases of extremis