Chapter 30 Multisystem Trauma Flashcards
Key Terms
more than one serious injury
Multiple Trauma
Key Terms
one or more injuries that affect more than one body system
Multisystem Trauma
Key Terms
a system of evaluating trauma patients according to a numerical rating system to determine the severity of the patient’s trauma
Trauma Score
Critical Decision Making
A determination of criticality (whether the patient has a serious condition or not) is one of the most important decision you can make for the trauma patient. Just identifying when the potential for serious injury exists is vital. Your patient priority and transport decisions are based on these determinations. Assume you have a local hospital 15 minutes away and a trauma center 25 minutes way. Determine which of the following patients should be transported to the trauma center and which could be transported to the local hospital—and explain why.
Your thirty-year-old patient fell 4 feet from a ladder and got his lower leg caught in a rung. He believes he broke his lower left leg. His pulse is 96, strong and regular; respirations 18 and adequate; blood pressure 126/86; pupils equal and reactive to light; and skin warm and dry. He is alert. There are distal pulses in the extremity.
Transportation to a local hospital is likely OK as long as the patient remains stable en route.
Critical Decision Making
A determination of criticality (whether the patient has a serious condition or not) is one of the most important decision you can make for the trauma patient. Just identifying when the potential for serious injury exists is vital. Your patient priority and transport decisions are based on these determinations. Assume you have a local hospital 15 minutes away and a trauma center 25 minutes way. Determine which of the following patients should be transported to the trauma center and which could be transported to the local hospital—and explain why.
Your patient is an eight-year-old male who fell 8-10 feet from a tree to the ground. He is holding his right wrist and says it hurts. As you talk with him and his parents, you note that he appears confused. As you move him to the ambulance, you believe his mental status is decreasing. His vitals are pulse 82, strong and regular; respirations 24; blood pressure 122/86; pupils equal and sluggishly reactive to light; and mental status as previously noted.
The mental status is the most alarming issue. The potential for head injury should point you in the direction of prompt transport to the trauma center.
Critical Decision Making
A determination of criticality (whether the patient has a serious condition or not) is one of the most important decision you can make for the trauma patient. Just identifying when the potential for serious injury exists is vital. Your patient priority and transport decisions are based on these determinations. Assume you have a local hospital 15 minutes away and a trauma center 25 minutes way. Determine which of the following patients should be transported to the trauma center and which could be transported to the local hospital—and explain why.
Your patient is a thirty-two-year-old female who is 30 weeks’ pregnant and fell down a flight of stairs. She struck her head and has pain in her left shoulder. Her main concern is the brisk vaginal bleeding that began since the fall.
This woman has trauma to her extremities—and possible to her uterus. This is a serious condition. The trauma center is the prudent choice, but consult medical direction. The obstetric surgery capabilities at the local hospital may be warranted.
Short Answer
What considerations must the EMT weigh when considering whether to perform an intervention at the scene?
You should consider a number of factors when determining whether to perform an intervention on the scene or en route to the hospital. Life—threatening injuries related to the ABCs of primary assessment must be taken care of immediately. Basically, perform those interventions that, if not done at once, could impact patient outcome (e.g., permanent disability or death). Such interventions usually include any procedure required to open the airway (such as suctioning), support ventilations, or control bleeding. In addition, perform in-line stabilization of the cervical spine.
Short Answer
What are the interventions that should generally be performed for a critical trauma patient at the scene?
Interventions to complete prior to transport for a critical trauma patient include suctioning the airway, inserting an oral or nasal airway, restoring a patent airway by sealing a sucking chest wound, ventilating with a bag-valve-mask device, administering high-concentration oxygen, controlling bleeding, and performing spinal immobilization.
Short Answer
When might it be appropriate for EMTs to bypass a closer hospital for a trauma center?
The decision to bypass a closer hospital in favor of a more distant trauma center is based on local, regional, or state protocols. Specialized trauma centers can usually provide the definitive treatment required by the patient with multiple injuries. They usually have surgical specialists available twenty-four hours a day and can provide lifesaving interventions immediately on the patient’s arrival.
Short Answer
When might it be appropriate not to apply a traction splint in the field to an obviously fractured femur?
Although a fractured femur is a severe injury, it becomes a lesser priority if the patient does not have a patent airway or needs ventilatory support. Life-threatening conditions related to the ABCs must come first. In addition, if application of a traction splint will result in a significant delay in transport and if the patient is a high priority, then splinting might be postponed so the patient can receive definitive care at a trauma center or hospital. Remember to treat the whole patient and avoid distraction by a single injury—even if the injury is as serious as a fractured femur. In other words, interventions must be prioritized while keeping in mind the importance of the “golden hour.”
Critical Thinking Exercises
In a patient who has sustained significant trauma, making the correct transport decision is key. The purpose of this exercise will be to determine and explain the best transport decision for such a patient.
You are called to a patient who has been involved in a crash in which the vehicle sustained significant intrusion into the area where the patient was sitting. The patient is alert and complains of pain in his ribs. His vital signs are pulse 96 and regular, respirations 30 and adequate, blood pressure 100/62, pupils equal and reactive, and skin cool and dry. Your partner says the patient is stable and could be easily transported to the community hospital nearby. You think the patient should be transported to the trauma center. How would you justify your decision to your partner?
Despite what your partner thinks, this patient has borderline vital signs, suffered a significant mechanism of injury, and complains of pain in his chest where he could easily develop any number of life—threatening conditions. The patient meets criteria to go to a trauma center based on the mechanism of injury and perhaps on anatomic criteria. His vital signs might still be adequate to not strictly meet physiologic criteria—but only barely. The patient should go to a trauma center.
Pathophysiology to Practice
For each of the following patients, explain why trauma triage guidelines place them at a higher priority:
Geriatric patients.
Geriatric patients must be prioritized higher because they tend not to compensate for shock as effectively as the rest of the population.
Pathophysiology to Practice
For each of the following patients, explain why trauma triage guidelines place them at a higher priority:
Penetrating abdominal trauma patients.
Any penetrating injury, especially penetrating abdominal trauma, is considered a surgical emergency and should be prioritized higher.
Pathophysiology to Practice
For each of the following patients, explain why trauma triage guidelines place them at a higher priority:
Patients who are on anticoagulants.
A patient taking anticoagulants should be prioritized higher because his blood-clotting mechanism will be diminished.
Pathophysiology to Practice
For each of the following patients, explain why trauma triage guidelines place them at a higher priority:
Patients who have an amputated hand.
Patients with amputations necessitate higher priority because they require prompt surgical intervention to realize the best chance of recovery of the reattached limb.
