other types of injuries Flashcards
Pregnancy and trauma
Mechanism of Injury
think what sort
Possible causes of trauma:
Domestic violence
RTC’s
Falls from height
Possible trauma to enlarged internal organs
Organs are displaced especially in the third trimester
Anatomy and physiology somewhat altered
Pregnancy and trauma
Mechanism of Injury
Consider…..
Signs of shock appear very late
Hypotension is an extremely late sign
Any signs of hypovolaemia = stage 3 shock
Compression of the inferior vena cave >20 weeks is a serious potential complication
Pregnancy and trauma
Assessment and Treatment
Consider MOI (could have been 3-4/7 ago) Ensure AcBC are assessed and managed O2 @ 15L per minute Stage of pregnancy Specifically assess for abdominal pain Vaginal blood loss Analgesia 15-30 degree tilt to the left if supine Anything else…….
Suspension injuries
What is it….
Often no physical injury Form of syncope Causes venous pooling in the legs Reduced cardiac output due to reduced venous return Reduced cardiac output = fall in BP Known as orthostasis
Suspension injuries
Treatment
No evidence that toxins build up as suspected by several authors
No need to change first aid procedures
As soon as possible, place in horizontal position even if still suspended
High flow O2 if unconscious
Consider they may have injuries that have caused the unconsciousness, might not be a syncope
Blast injuries
Mechanism of Injury
Terrorism - CBRNe
Industrial accidents
Potential for mass casualties
Blast waves can travel at 5000m per second – https://youtu.be/2yWwAsABIlM
Multi system injury
Initial blast wave increases pressure in the body causes stress and shear in gas filled organs
Immediate death (barrow trauma) occurs more often in enclosed space than open air bombings
Injuries generally categorised into five groups:
Primary
Secondary
Tertiary
Quaternary
Quinary
Blast injuries
Signs and Symptoms
Primary – tympanic membrane rupture, blast lung, eye injuries, concussion
Secondary – penetrating injuries, traumatic amputations, lacerations
Tertiary – blunt injuries, crush syndrome
Quaternary – burns, inhalation injury
Quinary – injuries from ‘dirty bombs’ such as bacteria and radiation (NAEMT, 2011)
Ballistic injuries
Mechanism
Type of GSW Medium energy (handguns and some rifles) High energy Caliber Missile size Bullet construction Tumbling/yaw Distance traveled – increased distance will decrease the energy at impact resulting in less injury Internal wound Tissue contact damage High-velocity transfer of energy Shock waves Temporary cavity up to 25 x greater than caliber of bullet Pulsation of temporary cavity Highly dense tissue sustains more damage
Gunshot Wounds: Cavitation Signs and Symptoms
Pain
Wounds – entry and exit
If shotgun potential for up to 2000 pellets (birdshot shell)
Consider the anatomy the GSW has potentially effected
What was the bullet trajectory?
Gunshot Wounds:Assessment and Treatment
Safety – ballistic trained staff to respond with Police if still active shooting
Catastrophic haemorrhage management
Seal open chest wounds
Analgesia
IV access and consider fluids (paramedic)
TXA
Emergency Department with pre-alert
Drowning
Conscious – hold breath <60 seconds
Victim will then take a breath inhaling fluid
Laryngospasm will occur
This is rapidly terminated by hypoxia and aspiration will resume
To drown requires active ventilation while submerged hypoxia, hypercarbia and acidotic = unconsciousness and apnoea
Diving Response
Drowning
Diving Response
Cooling of cold thermoreceptors on the face
Profound bradycardia
Parasympathetic stimulation
Sympathetic nervous vasoconstriction to trunk and limbs
Stimulation of both parasympathetic and sympathetic nerves can result in life threatening arrhythmias
Drowning
Signs and Symptoms
Submersed or immersed in fluid
Respiratory impairment
Absence of breathing
Cardiac arrest
Drowning
Management
Do not go within three metre’s of the water’s edge unless you are water rescue trained and have the appropriate PPE
If conscious, encourage them to self rescue – buoyancy aids
If unconscious, rescue as soon as safely possible
How long have they been submerged if <90 minutes resuscitate
Remove horizontally from water
Increased pressure on the legs from the water increase venous return and cardiac output. Baroreceptors mistake this for hypervolaemia and increase diuresis. Alomgside this there is peripheral vasoconstriction which exacerbates this further. When removed from the water, this pressure is lost and the sudden reduction in venous return can result in cardiac arrest so remove from water horizontally to aid venous return.
Drowning
Management Cardiac Arrest
If still in water, ventilations only, 10-15 per minute
Incidence of spinal injuries is low (0.5%) and immobilising can cause delay and inadequate resuscitation
Spinal immobilisation is not indicated unless signs of severe injury are apparent or MOI is consistent with possibility of severe injury
Must be removed from water as quickly as possible even if back board not available
