Chapter 22: Trauma Overview

Question 1

Discuss

Top 5 causes of trauma death

Answer 1

Motor vehicle crash, fall, poisonings, burns, drowning

Question 2

Discuss

What is MOI?

Answer 2

Mechanism of Injury

Question 3

Discuss

Index of suspicion

Answer 3

Awareness for potentially serious underlying and unseen injuries

Question 4

Discuss

List motor vehicle collision types

Answer 4

Frontal, rear end, lateral, rollover, rotation

Question 5

Discuss

In a motorvehicle crash, what are the collisions that take place?

Answer 5

Collision of the car with object, passenger with car, organs with passenger

Question 6

Discuss

What is a coup-contrecoup injury?

Answer 6

Type of brain injury with compression to the frontal lobe and tearing to the posterior, as brain bounces inside head after collision

Question 7

Discuss

What are the suspected injuries in a frontal collision?

Answer 7

Head against windshield (window star), flail chest (steering wheel), lower extremity fx’s (dashboard)

Question 8

Discuss

Injuries suspected in rear end collision

Answer 8

C spine injuries

Question 9

Discuss

Injuries suspected in lateral collisions

Answer 9

Lateral whiplash to c spine, head against doorpost, lateral chest injuries, extremity fx’s.

Question 10

Discuss

What’s a good first glance indicator of the probably damage to passenger in a motor vehicle crash?

Answer 10

Extent of intrusion into passenger compartment

Question 11

Discuss

What should the EMT be aware of with passengers involved in rollovers and spins?

Answer 11

Multiple collisions. Pt restrained? Ejection?

Question 12

Discuss

Things to be aware of with car vs pedestrian

Answer 12

Pt airborne or sucked under? How fast was the vehicle travelling? Look for the pt’s shoes (often stay where hit) and look for impact on vehicle.

Question 13

Discuss

Things to be aware of with car vs. bike accident

Answer 13

Look at the helmet for a gauge of severity of crash

Question 14

Discuss

Types of impacts with car vs. motorcycle crash

Answer 14

Head on, angular, ejection, controlled crash

Question 15

Discuss

What qualifies as a “significant” fall?

Answer 15

Over 15’ (3x body height) or in children: Over 10’ w/o loss of consciousness and <10’ with loss of consciousness

Question 16

Discuss

What are the types of blast injuries?

Answer 16

Primary (from blast wave), secondary (from shrapnel), tertiary (victim thrown against objects from the blast wave), miscellaneous blast injuries (burns, toxins, etc.)

Question 17

Discuss

What’s a simple indicator of severity of blast (bad or not?)

Answer 17

Condition of tempanic membrane

Question 18

Discuss

What are some blast-associated blast injuries?

Answer 18

Pneumothorax, arterial air embolism

Question 19

Discuss

What are some indicators of serious trauma associated with blast injuries?

Answer 19

Subcutaneous emphysema indicates air in chest cavity, petechiae (pinpoint hemorhages that show up on skin) and large hematomas indicate injury of organs

Question 20

Discuss

With a multi system trauma, the EMT should always

Answer 20

Alert med control immediately

Question 21

Discuss

List reasons EMT might use air transport

Answer 21

Extended time on scene (e.g. for extrication), Distance > 20-25 miles, Pt needs ALS but no ground ALS available in reasonable time, Traffic or hospital availability make time to ED too long, Multiple pt’s overwhelm resources available at reachable trauma centers, Mass casualty incident

Question 22

Discuss

What are the levels of trauma centers and what distinguishes each?

Answer 22

Level I: every aspect of trauma care, prevention to rehabilitation, mostly at university based teaching hospitals. Level II: Less densely populated area, expected to provide initial definitive care. Level III: Serves communities without I or II; provides asessment, ressucitation, emergency care, stabilization, and protocol for transfer to I/II. Level IV: In remote areas, provide ATLS before transfer to higher level care. Additionally, specific adult and pediatric trauma centers (and specialized units e.g. burns)

Question 23

Discuss

What is considered a level I trauma pt?

Answer 23

One or more of:

• BP<90,
• Respiratory compromise/obstruction/intubation,
• Receiving blood to maintain vitals,
• GCS score < or = 8 w/ trauma MOI,
• GSW to abdomen, neck, chest

Question 24

Discuss

Describe the Revised Trauma Score

Answer 24

GCS SBP RR Value
13-15 >89 10-29 4
9-12 76-89 >29 3
6-8 50-75 6-9 2
4-5 1-49 1-5 1
3 0 0 0