MOD E Tech 36 Trauma Management Flashcards
Trauma Management
Trauma Survival
Golden Hour
- From moment of injury
- To definitive treatment
EMS “platinum 10 minutes”
Assessment and management
- Every action must have lifesaving purpose
- Organized, detail-oriented, selective, rapid
Patient Assessment
- Primary Survey
- Scene Size-up
- Initial Assessment
•Rapid Trauma Survey
or Focused Exam
• Secondary Survey
Ongoing Exam
Scene Size-up (“The first five”)
- Standard precautions (Gloves, Helmet, Coat)
- Scene safety
- Initial triage (total number of patients)
- Need for more help or equipment
- Mechanism of injury
Mechanism of Injury
Energy follows physics laws
•Injuries present in predictable patterns
High-energy at risk for severe injury.
•Consider injured until proven otherwise
Factors to consider:
- KE = ½MV2
- Direction and speed of impact, patient kinetics and physical size, signs of energy release
Acceleration & Deceleration Injuries
Other Collisions
Secondary collisions
•Objects are missiles
at original speed
Additional impacts
•Vehicle collides
with another object
•Other vehicles collide with original vehicle
Basic Motion Mechanisms
Blunt injuries
- Rapid forward deceleration
- Rapid vertical deceleration
•Blunt instrument energy transfer
Penetrating injuries
- Projectiles
- Knives
- Falls upon objects
Clues to Injury
Deformity of vehicle
- What forces were involved in collision?
- (KE = ½MV2)
Deformity of interior structures
•What did patient hit?
Deformity or injury patterns on patient
•What anatomic areas were hit?
Head-on Collision
Windshield injuries
•Brain, soft-tissue injury, cervical spine
Steering wheel injuries
•Traumatic tattooing of skin
Dashboard injuries
•Face, brain, cervical spine, pelvis, hip, knee
Lateral-Impact Collision
Similar to head-on
with lateral energy
- Not easily predicted
- Consider organ damage
Check impact side
•Head, neck, upper arm, shoulder, thorax,
abdomen, pelvis, legs
Rear-Impact Collision
Posterior displacement
•Rapid forward deceleration also possible
Headrest position
•Hyperextension injuries
Damage back and front
•Deceleration injuries
Rollover Collision
Multiple impacts
- Multiple directions
- Multiple injuries
Axial-loading injuries
•Spine injury
Ejection
•Chance of death
increases 25 times
Rotational Collision
Head-on, lateral-impact combination
•Converts forward motion
to spinning motion
Windshield, dashboard, steering wheel, side
•Same possible injuries
of both frontal impact and lateral impact mechanisms
Occupant Restraint
Lap belt
- Pocket-knife effect
- Abdomen
- Lumbar spine
Three-point restraint
•Cervical spine
Clavicular fracture
Air bags
- First impact only
- Always “lift and look”
Small-Vehicle Crashes
Small vehicles
- Motorcycles
- All-terrain vehicles
- Personal watercraft
Factors
- Protective gear
- Additional impacts
Pedestrian Injuries
Mechanism
- Primary collision
- Additional impacts
Common injuries
•Severe internal injuries
and fractures
- Adult: bilateral leg, knee
- Child: pelvis, torso
Penetrating Injuries
Knife-wound severity
•Anatomical area penetrated
•Fourth intercostal space may
be chest and abdomen
- Length of blade
- Angle of penetration
Stabilize impaled object
•Minimize external movement
Primary Survey - Initial Assessment
Initial Assessment:
- General impression
- Initial level of consciousness
- Manual stabilization of cervical spine
- <c>ABC’s</c>
General impression
- Approximate age, sex, weight
- General appearance
- Position of patient body and surroundings
- Patient activity
- Obvious major injuries or bleeding
- Consider Catastrophic Hemorrhage
Triage patients rapidly, if necessary.
Airway: look, listen, feel
•simple positioning and suctioning
If not adequate, not quickly correctable
•Interrupt: advanced airway techniques
Breathing: look, listen, feel
•high-flow oxygen
If not adequate
•assisted ventilation
Circulation: peripheral pulse
- No peripheral, check carotid
- Too fast?, too slow?, quality?
- Interrupt: cardiac arrest
Skin
•Color, temperature, condition
Major bleeding scan
- Catastrophic Hemorrhage ?
- Direct: bleeding control
Circulation: peripheral pulse
- No peripheral, check carotid
- Too fast?, too slow?, quality?
- Interrupt: cardiac arrest
Skin
•Color, temperature, condition
Major bleeding scan
- Catastrophic Hemorrhage ?
- Direct: bleeding control
Inspect Head and Neck
Detailed Exam: DCAP-BTLS
Deformities
Contusions
Abrasions
Penetrations
Burns
Tenderness
Lacerations
Swelling
Inspect Chest
Asymmetry, Contusion, Penetrations,
Paradoxical Motion, Instability, Crepitation
Breath Sounds
Present? Equal?
(If unequal: Percussion)
Heart Sounds
Abdomen & Pelvis
Bruising, Penetration/Evisceration, Tenderness, Rigidity, Distention
Tenderness.
Pelvic Splint Required ?
Extremities & Posterior
Swelling, Deformity, Instability, Motor, Sensory
Place Patient on Scoop/Backboard
Penetrations, Deformity,
Rapid Trauma Survey
If critical situation,
transfer to ambulance to complete exam.
Baseline Vital Signs
Measure Pulse, Respirations, Blood Pressure
Pupils
Size? Reactive? Equal?
(If Altered Mental Status:)
Glasgow Coma Scale Score
Eyes, Voice, Motor
Primary Survey
Less than 2 minutes
•Initial Assessment and Rapid Trauma Survey
Delegate any intervention.
Interrupt survey only for:
Scene danger
Airway obstruction
Cardiac arrest
Load-and-Go Situations
Initial Assessment
- Altered mental status
- Abnormal respiration
- Abnormal circulation
Shock potential
- Abnormal chest exam
- Tender, distended abdomen
- Pelvic instability
- Bilateral femur fractures
Significant MOI and/or poor general health
Critical Interventions
On-scene procedures
- Manage airway
- Assist ventilation
- Administer oxygen
- Begin CPR
- Control major external bleeding
- Stabilize # Pelvis
- Seal sucking chest wounds
- Stabilize flail chest*
- Decompress tension pneumothorax
- Stabilize impaled objects
Complete packaging
Rapid Extrication?
Indications:
•If there is an immediate threat to life. E.g. fire or airway obstruction that cannot be resolved in situ.
•
•Rapid extrication techniques with manual immobilisation of the cervical spine are appropriate in these circumstances.
Initiate Transport
Procedures not on scene, not life-saving
- Splinting, bandaging, IV line insertion
- Endotracheal intubation, often
Provide Pre-Alert
- As early as possible
- Estimated time of arrival (ETA)
- Condition of patient
- Special needs on arrival
Major Trauma Bypass
Major Trauma Centre:
–Stable and maximum travel time 45 minutes.
•
Trauma Unit (Stabilisation):
–Airway not secure or uncontrollable haemorrhage.
Secondary Survey
More comprehensive exam
- Evaluation for all injuries, not just life-threatening
- Establishes baseline for treatment decisions
Performed
- Critical patients—done during transport
- Short transport—may not have time
- Non-critical patients—done on scene
Ongoing Exam
Change in condition
- Patient
- Interventions
Perform and record
- Critical: every 5 minutes
- Stable: every 15 minutes
- Each time patient moved
- With each intervention
If condition worsens
