Managing TRAUMATIC Injuries Flashcards
How do I manage a head injury? (CONSCIOUS)
Dial 999
CONSIOUS?
1. Move pt to calm place and sit them on the ground
2. Ascertain:
- If there was any LOC?
- If head injury was witnessed?
- If pt is taking any blood-thinning medications?
3. wearing clinical gloves -
Inspect wound - try to ascertain any active bleeding, the location and size of injury (this can be difficult)
4. apply swabs to affected area and wrap bandage around head (this can also be tricky)
5. Do NOT irrigate it, as this can prevent wound clotting
6. Assess pt’s GCS
7. Inspect their pupils - are they equal, round and reacting to light? What size are they?
8. Monitor pt’s GCS, alertness, SP02 and BP
BE CAREFUL - head injuries can cause agitation/aggressive behaviour. Consider your own personal safety first. If you feel unsafe, withdraw from scene and monitor pt’s movements from a safe distance - warn SAS crew on arrival.
How do I manage a head injury?
(UNCONSCIOUS)
Possible causes:
Simple slip, trip or fall
Traumatic event (e.g falling object/RTC)
Assault
Seizure
Drug Overdose
Collapse due to medical problem
- Dail 999
- rapid head to toe assessment for head injuries, c-spine, pelvic or femural fractures
- Inspect head wound - ascertain:
- is it still bleeding?
- where is the bleeding coming from?
- how big is the wound?
- is there any debris in the wound? - Apply swabs or trauma dressing to wound and wrap head with bandage to hold dressings in place
- Inspect pupils - are they pinpoint,
dialated or unequal? - If you have concerns over pt’s airway/breathing - consider inserting NPA/OPA
- Maintain pt’s C-Spine until SAS arrival - as unconscious head injuries may also have C-spine fractures.
- Monitor RR, SPO2 and GCS if possible
- Keep them warm
- Refer to flash card “Collapse” for treatment of suspected drug overdose or fainting episode
If pt regains consciousness with a head injury, they may display agitated/aggressive behaviour - try to keep them lying down, but consider your own personal safety FIRST. Forcing pt to lie down can cause further damage to their injuries. Sometimes it is best to remotely monitor if pt is difficult to manage and await SAS arrival.
How do I manage a C-Spine injury?
This looks like:
- Severe neck or back (spinal) pain
- There may be a head injury as well
- There may be reduced GCS/agitation
- On palp of neck, you may notice obvious deformity of vertibrae - you might NOT.
If there is neck pain after a traumatic event, ASSUME C-Spine injury!!
- Dial 999
- Stem any catastrophic haemorrhaging (i,e. head wounds) first!
- Help keep pt calm
- Maintain neutral spinal alignment by placing padding around pt’s head
- support their head between your hands until help arrives
- If you have a collar and are confident in it’s application, ask for assistance to apply it whilst still maintaining C-Spine.
- Consider NPA/OPA if pt loses consciousness
NB: Your main priority is to stop any catastrophic haemorrhaging, followed by maintaining C-Spine, then maintaining their airway.
How do I manage a chest injury?
This may look like:
Obvious injuries to chest area (including posteriorally)
Pain in chest, which worsens on inhallation
Increased work of breathing
Cyanosis
Increasing RR
Irregular RR
Reducing Oxygen Sats
Tachycardia
Reducing BP
Reduced responsiveness
Unconscious
- Dial 999
- Catastrophic haemorrhaging chest wounds - Apply direct pressure to wound using trauma bandage
- Sucking chest wounds - ausciltate and percuss bilatterally first!! Then apply Russell Chest Seal
- Non-sucking chest wound with minimal bleeding - apply Mepore dressing (if in doubt, apply Russell Chest Seal)
- In all circumstances, monitor RR, SPO2, chest sounds, Pulse, BP and GCS
NB: If you apply Russell Chest seal, you must ausciltate and percuss chest before application, then continue to monitor chest sounds after applying it.
This is because, if the injury changes from open pneumothorax into tension pneumothorax, the chest seal MUST be removed!
If there is a Tension Pneumothorax, there will be reducing lung sounds on injured side, and increasing HYPER-resonance on percussion of injured site - it will start to sound like a high pitched drum on percussion!
How do I manage an abdominal injury?
- Dial 999
- Get this pt to A&E ASAP!
- Keep them warm and reassure them
- Allow them to sit in any position that is most comfortable for them
- DO NOT ADMINISTER any drugs, food or water.
- Monitor their pulse, BP and GCS.
How do I manage a pelvic injury?
This looks like:
Pt’s legs splayed outwards and severe pain
- Dial 999
- keep pt warm and still until SAS arrival.
NB: If in remote location/unable to get ambulance within 40 mins - administer 1g Paracetamol and consider applying pelvic binder to reduce catastrophic haemorrhaging.
- Monitor pt’s Pulse, BP and GCS.
(NB: DO NOT give Co-Codamol as this will prevent crew from being able to administer Morphine. NO Aspirin or NSAIDS as these have blood thinning effects).
How do I manage a NOF?
This looks like:
severe pain, swelling, deformity of femur (below hip and above knee).
It will be obviously larger than other femur, hot to touch and extremely painful! Affected leg may appear shortened and rotated when compared to uninjured leg.
- DIAL 999
- keep pt still and warm - pt will need SAS analgesia to treat this effectively.
- try to remove pt’s sock and shoe to assess:
- paedal pulse
- colour
- Motor - can they wriggle their toes/move foot?
- Sensation - can they feel you touching their foot (don’t tickle!!)
NB: If in remote location/unable to get ambulance within 40 mins - administer 1g Paracetamol and consider applying traction splint to reduce risk of internal catastrophic haemorrhaging.
- Monitor pt’s Pulse, BP and GCS.
(NB: DO NOT give Co-Codamol as this will prevent crew from being able to administer Morphine. NO Aspirin or NSAIDS as these have blood thinning effects).
How do I manage a broken arm?
- Consider if it’s possible to take pt to A&E? If not practical, dial 999.
- sit pt down
- apply sling to support the arm (arm should be L-shaped)
- Administer 1g Paracetamol
- Note time of drug administration and transport to A&E
How do I manage a catastrophic haemorrhage?
DIAL 999!
- Apply (CAT) tourniquet above affected area - tighten until blood flow stops
- Apply firm, direct pressure to wound using trauma bandage
- Where applicable, stuff wound with CELOX GAUZE
- Keep applying bandages and direct pressure until no blood seepage
- Lay pt flat, raise legs
