Chp 28 Your Approach to the Trauma Patient

Question 1

Anatomy of Injury

Answer 1

the term used in the National Trauma Triage Protocol to identify life-threatening injuries, which require the highest level of transport priority and emergency care.

Question 2

Focused Secondary Assessment

Answer 2

a variation of the secondary assessment during wheich the EMT focuses on the specific body part or region affected; performed on a stable medical and trauma patients

Question 3

Mechanism of Injury

Answer 3

the forces involved in causing an injury

Question 4

Medical Patient

Answer 4

a patient whose chief complaint is related to an acute illness or disease process

Question 5

Mentation

Answer 5

the mental activity of a patient

Question 6

Non-significant Mechanism of Injury

Answer 6

a mechanism of injury that does not result in a high likelihood of life-threatening injury

Question 7

On-Scene Time

Answer 7

the time spent on scene assessing, caring for , and preparing the patient for transport.

Question 8

Rapid Secondary Assessment

Answer 8

a variation of the secondary assessment that is performed on unstable patients and on patients who have sustained a significant mechanism of injury.

Question 9

Significant Mechanism of Injury

Answer 9

a mechanism of injury that results in a high likelihood of life-threatening injury.

Question 10

Trauma Centers

Answer 10

Specially designed trauma receiving hospitals that are staffed and equipped to manage victims of a trauma.

Question 11

Trauma Patient

Answer 11

a patient whose chief complaint is related to a sudden injury.

Question 12

28-2 Differentiate a medical patient from a trauma patient.

Answer 12

Identify a trauma patient as soon as possible. many life-threatening injuries can only be corrected by rapid surgical intervention at a hospital. In contrast many important interventions required for a medical patient may be provided at the scene.

Question 13

28-3 Discuss the importance of differentiating the medical patient from the trauma patient.

Answer 13

When you suspect a medical patient you will center on a complete and thorough patient history. On a trauma patient your evaluation will focus on the mechanism of injury and your physical assessment of the injured body part or area.

Question 14

28-4 Discuss the importance of general impression

Answer 14

Your gut decision of whether the patient is big sick or little sick. It comes from combining information all the way to the patient. You use information from dispatch, observations at the scene and your first visual contact with the patient. Your first view of the patient uses their mentation, skin color, and level of distress.

Question 15

28-5 Discuss the importance of vital signs and the anatomy of injury when assessing the trauma patient.

Answer 15

Certain vital signs abnormalities have been identified as reliable indicators to objectively identify the most severely injured trauma patients. GCS 29 Breaths/min (<20 in infants younger than 1 year)
Significant Anatomy of Injuries also increase level of transport.
All penetrating injuries to head, neck, torso and extremities proximal to the knee or elbow.
Flail Chest
2 or more proximal long bone fractures
Crushed, de-gloved, or mangled extremity
Amputation proximal to the wrist or ankle
Pelvic Fractures
Open or depressed skull fracture
Paralysis

Question 16

28-6 Discuss the significance of the mechanism of injury when assessing the trauma patient.

Answer 16

Beyond abnormal vital signs and anatomical injuries, one of the most important factors in determining the priority of a trauma patient is the mechanism of injury. Examples are Falls, Gunshot, Vehicle Collisions, Blunt trauma, Amputation. You need to further examine these to determine the likelihood of injury. ie Vehicle collision-speed, location of impact, use of restraints.

Question 17

28-7 Differentiate between significant and non-significant mechanism of injury.

Answer 17

Should it ever be unclear which category a patient falls in, it is best to consider the MOI significant and provide care accordingly. National Trauma Triage Protocol establishes a basic guideline for Significant MOI’s:
Falls
Adults: More than 20 feet (one story is equal to 10 feet.
Children: More than 10 feet or 2 to 3 times the height of the child
High Risk Auto Crash
Intrusion: More than 12 inches a the occupant site; more than 18 inches at any site.
Ejection from vehicle (partial or complete)
Death in same passenger compartment
Vehicle telemetry data consistent with high risk of injury
Auto vs Pedestrian/bicyclist thrown, run over, or with significant impact (more than 20 mph)
Motorcycle crash at more than 20 mph

Question 18

28-8 Discuss the role of time on scene with the trauma patient.

Answer 18

Time spent assessing and caring for a patient on-scene. When caring for victims of significant trauma, scene time should be kept to a minimum. Often the only intervention that is going to save the patient from life-threatening injuries is surgery. The faster you can get them to the most appropriate receiving hospital, the greater the chances of survival.

Question 19

28-9 Discuss the importance of choosing the appropriate receiving facility when caring for trauma patients.

Answer 19

When dealing with a trauma patient, sometimes it may be beneficial to bypass a regular hospital to get the patient to a trauma center that is better staffed and equipped to handle a patient with certain trauma injuries.