Trauma Flashcards
Trauma Arrest
AutoPulse is contraindicated
Control bleeding
Provide spinal immobilization if indicated
Multi System Trauma
LOAD AND GO IS PRIORITY
Maintain body heat
C-spine or pediatric restraint if less than 60lbs
O2 at 95% or greater
Consider SAM pelvic splint
Secure impaled objects in place unless effecting airway
Control bleeding : bleeding from nose and/or ears should not be stopped, place a sterile dressing over the nose or ears
BGL
Head Trauma
Maintain body warmth
C-spine; infants and children less than 60lbs, use Pedi-Immobilizer
Pt w/helmet
All helmets other than football should be removed
Pt wearing football helmet (indications for removal)
Helmet in place and NO shoulder pads
Head/facial trauma
C-spine regions are unstable because helmet fits poorly
Airway management cannot be achieved with just face mask removal
Pt is in cardiac arrest (requires removal of shoulder pads)
Helmet removal procedure
Stabilize helmet in a neutral in-line position
Second individual removes chin strap and supports occipital and mandible of the pt
Individual stabilizing helmet now removes helmet
Once helmet is removed, apply C-Collar and immobilize on a long back board, KED, or pediatric immobilizer device
If unable to remove helmet:
Assure airway by removing face shield/mask
An athletic trainer may be on scene with designated tools
Assure C-spine and immobilize with tape and towels
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Immobilize impaled objects in place unless object must be removed to stabilize airway
Control bleeding:
Bleeding from nose and/or ears should not be stopped, place a sterile dressing over the nose and/or ears
Determine BGL
Spinal Trauma
In cases of isolated spinal injuries, scene time is less critical and care should be taken in performing proper spinal immobilization
Provide C-spine if indicated
Pt w/helmet
All helmets other than football should be removed
Pt wearing football helmet (indications for removal)
Helmet in place and NO shoulder pads
Head/facial trauma
C-spine regions are unstable because helmet fits poorly
Airway management cannot be achieved with just face mask removal
Pt is in cardiac arrest (requires removal of shoulder pads)
Helmet removal procedure
Stabilize helmet in a neutral in-line position
Second individual removes chin strap and supports occipital and mandible of the pt
Individual stabilizing helmet now removes helmet
Once helmet is removed, apply C-Collar and immobilize on a long back board, KED, or pediatric immobilizer device
If unable to remove helmet:
Assure airway by removing face shield/mask
An athletic trainer may be on scene with designated tools
Assure C-spine and immobilize with tape and towels
Airway/breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
High cervical injury may cause apnea
Consider SAM pelvic splint
Immobilize impaled objects in place unless object must be removed to stabilize airway
Chest Trauma
Chest trauma pt may deteriorate rapidly. Load and go is a priority
Maintain body warmth
Transport to a Trauma Center when discoloration, severe tenderness, crepitus, or respiratory distress are present
Consider Trauma Alert
C-spine if indicated
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Immobilize impaled objects in place unless object must be removed to stabilize airway
Control bleeding
Treatments based on injuries:
Sucking chest wound - Apply Vaseline-type occlusive dressing(s) to cover wound(s)
Cover occlusive dressing with sterile 4x4
Tape dressing on 3 sides
Abdominal Trauma
Mechanism of Injury is the most important indicator of abdominal trauma. Best treatment for pt w/severe abdominal trauma is rapid transport
Maintain body warmth
Transport to Trauma Center when discoloration and/or severe tenderness are present
Consider Trauma Alert
C-spine if indicated
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Immobilize impaled objects in place
Control bleeding
Abdominal evisceration: Never replace
Cover w/sterile dressing and moisten w/IV fluid (may need to periodically remoisten)
Secure wet dressing in place if possible
Trauma Pregnancy
S/S of shock may be delayed due to increased maternal blood volume
Maintain body warmth
Provide C-spine if indicated
Immobilizing a pregnant pt greater than 20 WEEKS may cause supine hypotension syndrome from pressure on the inferior vena cava and may also impair ventilation as the fetus and the uterus press against the diaphragm
After immobilization is complete and pt secure, elevate the pt’s right side on the LSB 6”. This will displace the uterus and fetus to the left side and off of the inferior vena cava
If the LSB cannot be elevated, manually displace the uterus to the left as much as possible without causing spinal movement and maintain this displacement throughout the transport
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Immobilize impaled objects in place
Control bleeding
BGL
Extremity Trauma
Maintain body warmth
Provide C-spine if indicated
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Consider SAM pelvic splint for pelvic fx
Immobilize impaled objects in place
Control bleeding
Splint all areas of tenderness and deformity: Consider pain management prior to moving or splinting Splint dislocations and joint injuries in location found Consider ice pack to reduce swelling and pain Reduce fx (opened or closed) by axial traction if absent distal pulses Consider traction splint for presumed femur fx Elevate extremity when practical Locate, mark and monitor distal pulses. Record sensation and motor function before and after splinting
Amputation:
Place amputated part in sterile gauze, moisten w/IV fluid
Keep amputated part cool
Dress and splint partial amputations in alignment w/extremity, being careful to avoid torsion
Do NOT clamp vessels
Crush Injury
Maintain body warmth
C-spine if indicated
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Control bleeding
Taser Trauma
Only Law Enforcement Officers are permitted to remove probes
Pt Transport:
Pt should be transported to the hospital if any of the following underlying circumstances apply:
Hx of delirium, mania, or irrational bizarre behavior before being tased
Abnormal vital signs
Hx of physical findings consisted w/amphetamine or hallucinogenic drug use
Cardiac Hx
Altered LOC or aggressive, violent behavior including resistance to evaluation
Evidence of hypothermia
JSO unable or unwilling to remove probes
Any pt meeting transport criteria
Tx
C-spine if indicated
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Immobilize impaled objects in place
Control bleeding
BGL
Burns
Burns are classified according to type (Thermal, Electrical, and Chemical) and thickness
Burn Trauma Alert Criteria:
Adult - Partial/full thickness (2nd/3rd degree) burns equal to or greater than 15% of the BSA
Pediatric - Partial/full thickness (2nd/3rd degree) burns equal to or greater than 10% of the BSA
Rule of 9’s
Adult:
Head - 9% Front torso - 18% Back torso - 18% Arms - 9% each Legs - 18% each Genitalia - 1%
Toddler/Infant:
Head - 18% Front torso - 18% Back torso - 18% Arms - 9% each Legs - 13.5% each Genitalia - 1%
Burn Treatment
Maintain body temperature
Airway/breathing management:
Pt w/known inhalation injury or w/signs of potential airway burns who are in respiratory distress should be intubated early to prevent airway collapse
O2 via proper adjunct to maintain levels at 95% or higher
Remove all clothing, jewelry or constricting items from the burned area unless adhered to the pt
Request HAZMAT team when appropriate
Tx:
Chemical burns (not involving Lime, Carbolic Acid, Sulfuric Acid, Solid Potassium or Sodium metals)
Irrigate with IV fluid for 20 min
Chemical burns involving Lime, Carbolic Acid, Sulfuric Acid, Solid Potassium or Sodium metals-
Do NOT flush wound(s) with water, IV fluid, sterile water, etc
Contact receiving physican for tx
Superficial burns:
Apply burn gel dressing if needed
Partial-Thickness/Full-Thickness burns:
Apply dry sterile dressings
Leave blisters intact
Electrical Trauma
Florida experiences more lightning strikes than any other state in the nation
Maintain body warmth
C-spine if indicated
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
On lighting strike scenes where there are multiple pts, reverse triage shall apply and pt in cardiac arrest shall be worked first
Eye Trauma
Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
Immobilize impaled objects unless needing to stabilize airway
Penetrating injury to the eye shall be considered a Trauma Alert
Remove contact lenses when applicable
Assess nature of ophthalmologic emergency:
Direct Trauma -
Patch both eyes gently without pressure to the globes
Maintain pt in supine position to reduce leakage of fluids from the eye
If blood is noted in anterior chamber, place pt in Semi-fowler’s
Stabilize any impaled object and cover both eyes
Dim lights for pt comfort
Chemical/Irritant Exposure (pepper spray, tear gas, etc):
Irrigate affected eye w/IV fluid during transport
Apply dry sterile dressing to both eyes
Dim lights for pt comfort
Atraumatic:
Patch both eyes gently w/out pressure to the globes
Dim lights for pt comfort
