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Technician Course MOD E 2016 > MOD E Tech 36 Trauma Management > Flashcards

MOD E Tech 36 Trauma Management Flashcards

1
Q

Trauma Management

Trauma Survival

A

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
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2
Q

Patient Assessment

A
  • Primary Survey
  • Scene Size-up
  • Initial Assessment

•Rapid Trauma Survey
or Focused Exam

• Secondary Survey

Ongoing Exam

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3
Q

Scene Size-up (“The first five”)

A
  1. Standard precautions (Gloves, Helmet, Coat)
  2. Scene safety
  3. Initial triage (total number of patients)
  4. Need for more help or equipment
  5. Mechanism of injury
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4
Q

Mechanism of Injury

A

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
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5
Q

Acceleration & Deceleration Injuries

A
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6
Q

Other Collisions

A

Secondary collisions

•Objects are missiles
at original speed

Additional impacts

•Vehicle collides
with another object

•Other vehicles collide with original vehicle

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7
Q

Basic Motion Mechanisms

A

Blunt injuries

  • Rapid forward deceleration
  • Rapid vertical deceleration

•Blunt instrument energy transfer

Penetrating injuries

  • Projectiles
  • Knives
  • Falls upon objects
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8
Q

Clues to Injury

A

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?

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9
Q

Head-on Collision

A

Windshield injuries

•Brain, soft-tissue injury, cervical spine

Steering wheel injuries

•Traumatic tattooing of skin

Dashboard injuries

•Face, brain, cervical spine, pelvis, hip, knee

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10
Q

Lateral-Impact Collision

A

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

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11
Q

Rear-Impact Collision

A

Posterior displacement

•Rapid forward deceleration also possible

Headrest position

•Hyperextension injuries

Damage back and front

•Deceleration injuries

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12
Q

Rollover Collision

A

Multiple impacts

  • Multiple directions
  • Multiple injuries

Axial-loading injuries

•Spine injury

Ejection

•Chance of death
increases 25 times

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13
Q

Rotational Collision

A

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

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14
Q

Occupant Restraint

A

Lap belt

  • Pocket-knife effect
  • Abdomen
  • Lumbar spine

Three-point restraint

•Cervical spine

Clavicular fracture

Air bags

  • First impact only
  • Always “lift and look”
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15
Q

Small-Vehicle Crashes

A

Small vehicles

  • Motorcycles
  • All-terrain vehicles
  • Personal watercraft

Factors

  • Protective gear
  • Additional impacts
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16
Q

Pedestrian Injuries

A

Mechanism

  • Primary collision
  • Additional impacts

Common injuries

•Severe internal injuries
and fractures

  • Adult: bilateral leg, knee
  • Child: pelvis, torso
17
Q

Penetrating Injuries

A

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

18
Q

Primary Survey - Initial Assessment

A

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
19
Q

Inspect Head and Neck

Detailed Exam: DCAP-BTLS

A

Deformities

Contusions

Abrasions

Penetrations

Burns

Tenderness

Lacerations

Swelling

20
Q

Inspect Chest

A

Asymmetry, Contusion, Penetrations,
Paradoxical Motion, Instability, Crepitation

Breath Sounds

Present? Equal?

(If unequal: Percussion)

Heart Sounds

21
Q

Abdomen & Pelvis

A

Bruising, Penetration/Evisceration, Tenderness, Rigidity, Distention

Tenderness.

Pelvic Splint Required ?

22
Q

Extremities & Posterior

A

Swelling, Deformity, Instability, Motor, Sensory

Place Patient on Scoop/Backboard

Penetrations, Deformity,

23
Q

Rapid Trauma Survey

If critical situation,
transfer to ambulance to complete exam.

A

Baseline Vital Signs

Measure Pulse, Respirations, Blood Pressure

Pupils

Size? Reactive? Equal?

(If Altered Mental Status:)

Glasgow Coma Scale Score

Eyes, Voice, Motor

24
Q

Primary Survey

A

Less than 2 minutes

•Initial Assessment and Rapid Trauma Survey

Delegate any intervention.
Interrupt survey only for:

Scene danger

Airway obstruction

Cardiac arrest

25
Q

Load-and-Go Situations

A

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

26
Q

Critical Interventions

On-scene procedures

A
  • 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

27
Q

Rapid Extrication?

A

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.

28
Q

Initiate Transport

A

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
29
Q

Major Trauma Bypass

A

Major Trauma Centre:

–Stable and maximum travel time 45 minutes.

•

Trauma Unit (Stabilisation):

–Airway not secure or uncontrollable haemorrhage.

30
Q

Secondary Survey

A

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
31
Q

Ongoing Exam

A

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

Technician Course MOD E 2016 (18 decks)

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