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BSO EMS Protocols > Trauma > Flashcards

Trauma Flashcards

1
Q

General Trauma Guidelines

Scene Management

A

• START or JumpSTART (ages 1-8) Triage System to triage patients.
• LEVEL ONE TRAUMA patients shall be transported to closest appropriate Trauma Center,
• On-scene times for LEVEL ONE TRAUMA patients should be 10 minutes or less. On-scene
times greater than 10 minutes shall have the reason for the delay documented in the
ePCR report.
• IV attempts shall not delay transport. A minimum of two large bore IV’s should be
initiated for all LEVEL ONE TRAUMA patients.
• Unless otherwise noted, IV fluids should be given for a SBP less than 100 mmHg and should be given at a rate (boluses) necessary to maintain peripheral pulses (which is typically a
SBP of 80-90 mmHg).
• A minimum of 1 paramedic and 1 EMT must accompany a LEVEL ONE TRAUMA patient in
the back of the rescue, provided it does not cause a significant delay in transport.
• The only things that can cause the treating paramedic to interrupt the primary survey are an unsafe scene or airway obstruction. Respiratory arrest, dyspnea, or bleeding control should be delegated to a crew member so that the treating paramedic does
not have to interrupt the primary survey.

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2
Q

Mass Casualty Incident Designations

A 
Level 1 = 5-10 patients
Level 2 = 11-20 patients
Level 3 = 21-100 patients
Level 4 = 101-1000 patients
Level 5 = Greater than 1000 patients
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3
Q

THE FOLLOWING CONDITIONS SHOULD BE MANAGED AS SOON AS THEY ARE DISCOVERED.
THESE INTERVENTIONS SHOULD BE COMPLETED BY ANOTHER TEAM MEMBER SO THAT THE PRIMARY SURVEY IS NOT DISRUPTED.

A
  • Maintain airway (positioning, suctioning, ETT/IGEL, cricothyrotomy)
  • Assist respirations for a respiratory rate less than 10 or EtCO2 greater than 45
  • Apply Spinal Motion Restriction for neck tenderness or an AMS with MOI present
  • Control major bleeding (direct pressure or a C-A-T)
  • Tension Pneumothorax (needle decompression)
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4
Q

Start Triage Adult

Green (Minor) Criteria

A

Walking wounded, move them to a safe place.

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5
Q

Start Triage Adult

Black (Dead) Criteria

A

No respirations after head tilt

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6
Q

Start Triage Adult

Red (Immediate) Criteria

A
  • Respirations
  • > 30/min
  • Perfusion
  • no radial Pulse
  • cap refil >2 sec
  • (control bleeding)
  • Mental Status
  • unable to follow simple commands
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7
Q

Start Triage Adult

Yellow (Delayed) Criteria

A

Does not qualify for the other triage levels

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8
Q

The goal of Start Triage is ____

A

to provide the greatest good for the greatest number of patients.

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9
Q

____ is often the most common rhythm following an electrical insult.

A

Asystole

* Perform CRP on all electrocution/ lightning strike victims in cardiac arrest.

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10
Q

Jump Start Triage is for ages ____

A

1 - 8

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11
Q

What is the first thing evaluated in Jump Start Triage?

A

Is the patient able to walk

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12
Q

In Jump Start Triage, what is done if a patient is found to not be breathing?

A

Position the airway

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13
Q

In Jump Start Triage, after positioning the airway, the patient is found Apneic, what is assessed next?

A

Pulse

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14
Q

In Jump Start Triage, an apneic patient is found with a pulse, what is done next?

A

The patient is given 5 rescue breaths

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15
Q

In Jump Start Triage, an apneic patient with a pulse, is still apneic after receiving 5 rescue breaths. What is done next?

A

Patient is labeled black, deceased.

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16
Q

In Jump Start Triage, what respiratory rate range determines in a patient is labeled red (immediate)?

A

<15 or >45

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17
Q

In Jump Start Triage, a patient is found with a respiratory rate between 15-45, and a pulse. What is assessed next?

A

Mental Status (AVPU)

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18
Q

In Jump Start Triage, a patient is labeled red (immediate) based on Mental status findings when ____.

A

The patient presents with P (painful stimuli) that is inappropriate, or U (unresponsive).

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19
Q

In Jump Start Triage, a patient whom is presenting with A, V, or P appropriate during mental status evaluation is labeled ____.

A

Yellow (delayed)

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20
Q

Adult Trauma Alert Criteria

Red - Airway

A

Active airway assistance required

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21
Q

Adult Trauma Alert Criteria

Red - Circulation

A

No radial pulse with sustained HR >=120 OR BP <90 systolic

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22
Q

Adult Trauma Alert Criteria

Red - Cutaneous

A
  • 2nd degree or 3rd degree burns > 15% BSA
  • Electrical burns (high voltage/ direct lightning) regardless of surface area
  • amputation proximal to wrist or ankle
  • penetrating injury to head, neck, or torso
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23
Q

Adult Trauma Alert Criteria

Red - Best Motor Response (BMR)

A

BMR <=4, or exhibits presence of paralysis, suspicion of spinal cord injury, or loss of sensation

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24
Q

Adult Trauma Alert Criteria

Red - Miscellaneous

A
  • Paramedic Judgment

* Glasgow Coma Score <=12

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25
Q

Adult Trauma Alert Criteria

Blue - Airway

A

Sustained respiratory rate >=30

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26
Q

Adult Trauma Alert Criteria

Blue - Circulation

A

Sustained HR >=120

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27
Q

Adult Trauma Alert Criteria

Blue - Fractures

A
  • Single long bone FX sites due to MVA

or

  • Single long bone FX site due to fall >= 10 feet.
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28
Q

Adult Trauma Alert Criteria

Blue - Cutaneous

A

Major devolving, flap avulsion > 5 inches, or GSW to extremities

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29
Q

Adult Trauma Alert Criteria

Blue - Best Motor Response

A

BMR = 5

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30
Q

Adult Trauma Alert Criteria

Blue - Mechanism of injury

A
  • Ejection from vehicle (excluding open vehicles)

or

*Deformed steering wheel

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31
Q

Adult Trauma Alert Criteria

Blue - Age

A

Anticoagulated Older Adult >55

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32
Q

Adult Trauma Alert Criteria

Blue - Miscellaneous

A

Blunt Abdominal injury

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33
Q

Pediatric Trauma Alert Criteria

Red - Airway

A

Assisted or intubated

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34
Q

Pediatric Trauma Alert Criteria

Red - Consciousness

A
  • Altered mental status
  • Paralysis
  • Suspected spinal cord injury, or loss of sensation
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35
Q

Pediatric Trauma Alert Criteria

Red - Circulation

A
  • Faint or non-palpable carotid or femoral pulses

* Systolic BP <50

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36
Q

Pediatric Trauma Alert Criteria

Red - Fracture

A

Any open long bone FX or multiple FX sites or multiple dislocations

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37
Q

Pediatric Trauma Alert Criteria

Red - Cutaneous

A
  • Major soft tissue disruption,
  • Amputation proximal to wrist or ankle
  • 2nd or 3rd degree burns to 10% BSA
  • Electrical burns (high voltage/ direct lightning) regardless of surface area
  • Penetrating injury to head, neck, or torso
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38
Q

Pediatric Trauma Alert Criteria

Red - Miscellaneous

A

Paramedic Judgment

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39
Q

Pediatric Trauma Alert Criteria

Blue - Consciousness

A

Amnesia or reliable HX of LOC

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40
Q

Pediatric Trauma Alert Criteria

Blue - Circulation

A

Carotid or femoral pulses palpable; no pedal pulses or systolic BP <90

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41
Q

Pediatric Trauma Alert Criteria

Blue - Fracture

A

Single closed long bone FX site

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42
Q

Pediatric Trauma Alert Criteria

Blue - Miscellaneous

A

Blunt Abdominal Injury

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43
Q

Pediatric Trauma Alert Criteria

Blue - Size

A

Red, Purple <11kg (<24lbs)

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44
Q

Level 2 Trauma Alert Criteria

A
  • Falls > 12ft Adult, > 6ft Pediatric
  • Extrication time > 15 min
  • Rollover motor vehicle crash
  • Burns involving the face, eyes, ears, hands, or perineum that may result in functional or cosmetic impairment.
  • Death of an occupant in the same passenger compartment
  • Separation from Bicycle
  • Pedestrian struck by vehicle not meeting the preceding automatic criteria (I.e. Adults <15mph and pediatrics <5 mph)
  • Any height fall adult >55 on anticoagulant/ antiplatelet
45
Q

Glasgow Coma Score

Best Eye Response

A

1 - No eye opening
2 - Eye opening to pain
3 - Eye opening to verbal command
4 - Eyes open spontaneously

46
Q

Glasgow Coma Score

Best Verbal Response

A 
1 - No verbal response
2 - Incomprehensible sounds
3 - Inappropriate words
4 - Confused
5 - Oriented
47
Q

Glasgow Coma Score

Best Motor Response

A 
1 - No motor response
2 - Extension to pain
3 - Flexion to pain
4 - Withdrawal from pain
5 - Localizing pain
6 - Obeys Commands
48
Q

Pediatric trauma patients are those age ____ or younger.

A

15

49
Q

Antiplatelet medications

A
  • Plavix (Clopidogrel)
  • Brilinta (Ticagrelor)
  • Effient (Prasugrel)
  • *NOT ASPRIN**
50
Q

Anticoagulation medications

A
  • Coumadin (Warfarin)
  • Pradaxa (Dabigatran)
  • Xarelto (Rivaroxaban)
  • Lovenox (Enoxaparin)
51
Q

Any patient that is in cardiac arrest as a result of electrocution or lightning injury should receive ___

A

immediate defibrillation, if

applicable.

52
Q

Traumatic Arrest

Do not resuscitate trauma patients if all of the following presumptive signs of death are present:

A

Injuries incompatible with life and/ or
1. Apneic
2. Pulseless (Asystole confirmed in two leads)
3. Fixed and dilated pupils
Note: Trauma patients in cardiac arrest (either found to be in arrest or have arrested in the presence of Fire Rescue personnel), prophylactic bilateral needle decompression OR FINGER
THORACOSTOMY SHOULD BE PERFORMED. Resuscitation efforts do NOT need to be continued if the patient did not regain pulses immediately following the bilateral needle decompression OR
THORACOSTOMY.

53
Q

GRAY CRITERIA
Informational only
Patients who do not meet “Trauma Alert” criteria, but meet one (1) or more of the
following criteria may be at risk of serious injury and special consideration should be given to them, including bypass of a
local hospital and transport to the nearest Trauma Center:

A

• Blunt head, chest or abdominal trauma on blood thinners with high risk
of bleeding or history of a bleeding disorder
• 65 years or older sustaining blunt trauma exhibiting minimal symptoms or
borderline criteria
• 65 years or older with SBP <110 mmHg
• MVC > 20 mph, with seatbelt marks on the torso
• MVC with partial ejection from an automobile
• End stage renal disease on dialysis

54
Q

Burn Injuries

Adult - considerations

A

• Stop the burning process by irrigating with copious amounts of room temperature water or normal saline for 1-2 minutes. Never apply ice directly to burns.
• Do not attempt to remove tar, clothing, etc., if adhered to the skin.
• Monitor the airway closely and consider early intubation for patients with respiratory
involvement: hoarse voice, singed nasal hairs, carbonaceous sputum in the nose or mouth, stridor or facial burns.
• Remove jewelry and watches from burned area.
• Consider Pain Management Protocol.
• Consider CO and/or Cyanide Poisoning.

55
Q

Burn injuries
Adult
* 1st & 2nd DEGREE BURNS LESS THAN 15% BSA or 3rd DEGREE BURNS LESS THAN 5% BSA

A

Apply a dry sterile dressing or BURN SHEET

56
Q

Burn Injuries
Adult
* 2nd DEGREE BURNS GREATER THAN 15% BSA or 3rd DEGREE BURNS GREATER THAN 5% BSA

A
  • Apply a dry sterile burn sheet.

* NORMAL SALINE: 1L. Assess lung sounds and BP every 500mL.

57
Q

Burn injuries

Electrical Burns

A
  • Treat associated burns as indicated.

* If patient is in cardiac arrest, follow appropriate protocol.

58
Q

Burns injuries

Chemical Burns

A

• Irrigate liquid chemical burns with copious amounts of water or sterile saline. Brush off
dry chemicals prior to irrigation.
• Remove patient’s clothing and ensure that the patient is decontaminated prior to
transport, in order to avoid contaminating personnel and equipment. Personnel shall
wear protective clothing and/or respiratory protection as needed when removing
chemicals

59
Q

Burn Injuries

Pediatric - considerations

A
  • Stop the burning process by irrigating with copious amounts of room temperature water or normal saline.
  • Do not attempt to remove tar, clothing, etc., if adhered to the skin.
  • INTUBATE EARLY FOR RESPIRATORYINVOLVEMENT
  • Tripod position/drooling, singed nasal hairs, hoarse voice/stridor and carbonaceous sputum are all indications for early airway intervention. Consider RSI (it may be necessary to use an ETT 0.5 -1.0 mm smaller to accommodate for swelling).
  • Consider Pain Management Protocol.
60
Q

Burn injuries
Pediatric
* 1st and 2nd degree less than 15% of BSA or 3rd degree less than 5% BSA

A
  • Apply a dry sterile dressing.

* Do not apply ice directly to burns.

61
Q

Burn injuries
Pediatric
* 2nd degree burns greater than 15% BSA or 3rd degree burns greater than 5% BSA

A
  • Apply a dry sterile burn sheet and keep the patient warm.

* NORMAL SALINE: 20mL/kg bolus.

62
Q

Burns Injuries

Pediatric - Electrical

A
  • Treat associated burns as indicated.

* If patient is in cardiac arrest, follow appropriate protocol.

63
Q

BSA proportions for an infant.

A 
Head and Neck = 21%
Abdomen = 13%
Back = 13%
Each arm = 10%
Each leg = 13.5%
Buttocks = 5%
Genital area = 1%
64
Q

Important assessments for Head injuries

A
  • Assess GCS,
  • Pupillary response to light,
  • BGL
65
Q

Head Injuries

- Adult - Management.

A

• Head injury patients are at increased risk for vomiting and seizures.
• Ensure adequate oxygenation and ventilation.
• Administer high flow oxygen 15L NRB
• Ventilatory rate for adults: 10 breaths/min and modify to maintain EtCO2 levels approx. 40 mmHg.
• Head injury patients with a GCS of 8 or less should be INTUBATED OR ADVANCED AIRWAY
• CERVICAL Spinal Motion Restriction. If patient is combative, administer KETAMINE as
per the “Chemical Restraint” Protocol
• Bleeding from scalp lacerations can usually be controlled by applying a pressure dressing or by applying direct pressure along the wound edges.
• Pressure dressings should not be applied to depressed or open skull fractures unless
there is significant hemorrhage present, as this can cause an increase in ICP.

66
Q

Fluid Resuscitation for head injuries.

A

Titrate fluids to maintain SBP of 110-120 should be maintained for patients with a severe head injury (GCS of 8 or less), even if the patient has associated penetrating trauma with hemorrhage.

67
Q

Signs of increased ICP and herniation include:

A

• A decline in the GCS of two or more points
• Development of a sluggish or nonreactive pupil
• Paralysis or weakness on one side of the body
• Cushing’s Triad: A widening pulse pressure (increasing systolic, decreasing diastolic),
change in respiratory pattern (irregular respirations), and bradycardia

68
Q

Treatment for suspected Increased ICP and/or herniation from head injury.

A
  • MILD HYPERVENTILATION: Maintain EtCO2 at 35 mmHg for increased ICP
  • Consider Advanced Airway Management
  • Head of Bed to 30 Degrees
69
Q

A single instance of hypotension in an adult with a brain injury may increase the mortality rate ____. The increase in mortality rate for
hypotension and a severe TBI is ____ in children.

A
  • By 150%

* Even worse

70
Q

Infants with ____ are considered to have a more severe head injury.

A

a bulging fontanelle

71
Q

Head injury

Fluid Resuscitation - Pediatric

A

• Children with severe TBI should have their SBP maintained at the normal range for their age. Administer fluid boluses of 20 ml/kg of NS and repeat prn to maintain systolic blood
pressure normal for age.
• If patient is normotensive, administer NS at a KVO rate

72
Q

• Signs of increased ICP and herniation in Pediatrics include:

A
  • Hypertension for patient’s age
  • Development of a sluggish or non-reactive pupil
  • Bradycardia
  • Abnormal breathing patterns
  • Paralysis or weakness on one side of the body
73
Q

Spinal Motion Restriction will be applied ____

A

to all patients sustaining a traumatic injury or having a
mechanism of injury. All patients are to be moved and or transported in a position of
comfort. If extrication is required, i.e. trapped in vehicle, tight space, compromised position, etc., the key objective is to move the patient in the safest, most anatomically neutral position possible.

74
Q

Perform spinal motion restriction if the patient meets any of the following criteria:

A
  • Any evidence of head trauma - both by history or physical exam
    • Complaint or finding of focal neurologic deficit on motor or sensory exam.
    • Complaint or finding of pain to the neck or back.
    • Presence of a distracting injury.
    • Altered level of consciousness with an MOI (Mechanism of Injury).
    • Intoxication with an MOI present. The cervical collar should not cause the patient
    discomfort such that they are compelled to move.
  • Have a low threshold to place C - Collar.
75
Q

• If an appropriately sized collar is not available or if the collar compels the patient to
move, ____

A

remove the collar and provide Spinal Motion Restriction by placing rolled towels
on the sides of the patient’s head and neck, secured with tape or other similar devices
to allow for comfortable cervical stabilization/immobilization.

76
Q

When applying spinal motion restriction place the patient on the stretcher ____

A

cushion, supine, flat as possible. If the patient is
unable to tolerate this position, place in a position of comfort, that also respects
normal anatomical alignment. A BACKBOARD IS NOT REQUIRED

77
Q

• Patient must be secured to stretcher with ____

A

manufacturer approved stretcher straps.

78
Q

Spinal Motion Restriction

Lifting or moving of patients

A

• Manual cervical and spinal stabilization/immobilization must be performed for all patient movement as appropriate.
• A scoop-type stretcher may be employed to facilitate the lifting or movement of a patient for transit to or from the stretcher.
• Once the patient has been placed on the stretcher, the scoop-type stretcher is to be removed.
• In a combative patient, the same principles asabove apply.
• All obtunded patients must be considered to have a spinal injury. Position patient in the most anatomically neutral position possible while providing
emergency medical care.
• Placing patients in the prone position is contraindicated due to the risks of asphyxiation. However, impalement or other situations may mandate the
prone position. In these instances, clear documentation of justification and attention to airway maintenance is mandatory.
• Patients that are transported in the prone position must have continuous SpO2 monitoring, EtCO2 monitoring if available, and be under constant
surveillance by EMS personnel at all times.

79
Q

Spinal Motion Restriction

Helmet Removal

A

• Helmets should be removed for all patients.
• If applicable, protective pads should also be removed.
• Athletic trainers should be consulted in the helmet/protective pad removal
process if applicable.
• C-SPINE should be manually stabilized during the removal process.

80
Q

Eye Injuries
Adult & Pediatric
Chemical Exposures

A
  • Remove contact lens if present.
  • Irrigate the affected eye(s) with Normal Saline.
  • Be careful not to contaminate the unaffected eye with runoff.
  • Consider Pain Management.
81
Q

Eye Injuries
Adult & Pediatric
Penetration Eye Injuries

A
  • Stabilize any penetrating object.
  • Cover both eyes with gauze and an eyeshield.
  • Consider Pain Management.
82
Q

Chest Trauma

Adult & Pediatric

A

• Ensure adequate oxygenation and ventilation. Maintain an SpO2 of 95% and
EtCO2 levels between 35-45 mmHg.
• If the patient’s systolic blood pressure drops below age appropriate level, with signs of shock, administer IV fluids at a rate sufficient to maintain
peripheral pulses, (which is typically SBP of 80-90 mmHg) once a tension pneumothorax is ruled out.
• Stabilize penetrating objects with a bulky dressing

83
Q

Chest Trauma

Flail Chest

A

Stabilize flail segment with a bulky dressing.

84
Q 
Chest Trauma
Open Pneumothorax (Sucking Chest Wound)
A

Apply a vented chest seal or occlusive dressing to all open chest wounds and monitor for signs & symptoms of a tension pneumothorax. Apply
during exhalation if possible.

85
Q

Chest Trauma

Tension Pneumothorax Signs and Symptoms

A

Patients with a tension pneumothorax present with diminished or absent
breath sounds on the affected side with any or all of the following associated
signs and symptoms:
• Shortness of breath
• Pleuritic chest pain
• Tracheal deviation (not always present)
• Hyperresonance on the affected side
• Distended neck veins (may not be present if there is severe blood loss)
• Poor compliance when attempting to ventilate with a BVM
• Hypotension

86
Q

The indication for performing an emergency needle decompression is ____

A

the presence of a tension pneumothorax as indicated above accompanied by more than one of the following:
• Respiratory distress and cyanosis
• Decreasing level of consciousness
• Loss of radial pulse (late sign)
The anterior approach (second or third intercostal space, midclavicular line) is the preferred site when performing a needle decompression.

87
Q

Finger Thoracostomy is performed ____

A

in the 3rd intercostal space Mid Axillary Line.

88
Q

Penetrating Junctional Trauma:

A

If clotting agent is available, severe junctional hemorrhage (e.g., neck, axillary, thoracic, abdominal, pelvis and
groin) that is not able to be easily controlled using direct pressure shall be controlled using clotting agent or XSTAT

89
Q

Abdominal Trauma
Adult and Pediatric
Impaled Objects

A

• Impaled objects shall be stabilized to prevent movement and subsequent further damage.
• If bleeding occurs around the impaled object, it should be controlled by holding
direct pressure, avoid excessive pressure.
• Do not palpate the abdomen, as it may cause further organ injury from the distal tip of the object.
• If the patient’s systolic blood pressure drops below 100 mmHg with signs of shock,
administer IV fluids at a rate sufficient to maintain peripheral pulses (which is
typically a SBP of 80-90 mmHg).

90
Q

Abdominal Trauma

Evisceration

A

• Do not attempt to replace or move the protruding tissue.
• Protect the tissue from further damage.
• Cover the protruding tissue with a moist sterile dressing and cover with a dry sterile
dressing.
• Keep the patient calm, as crying, screaming or coughing can force more of the tissue outward.

91
Q

Pelvic Fracture

Adult & Pediatric

A
  • Avoid rough handling
    • Assess and treat for shock.
    • Do not perform a pelvic rock. Assess the pelvis by applying gentle pressure anterior to posterior and from the sides to identify crepitus or instability. Do not repeat.
    • Stabilize pelvis by T-POD, sheet wrapped around pelvic griddle or internal feet rotation, if possible.
    • A scoop stretcher should be used whenever possible to move patients with
    suspected pelvic fracture. Remove the scoop once the patient is placed on the stretcher
    • Splint in position of comfort with pillow and blankets.
    • Consider Pain Management Protocol
92
Q

Hip Fracture/ Dislocation

Adult & Pediatric

A
  • Avoid rough handling
    • Consider hip fractures in any elderly patient with a fall that complains of pain in the knee, hip or pelvis.
    • A scoop stretcher should be used whenever possible to move patients with a suspected hip fracture/dislocation.
    • Splint in position of comfort with pillows and blankets.
    • Traction splints should not be used on suspected hip fractures/dislocations.
    • Assess and treat for pelvic fractures and shock prn.
    • Consider Pain Management Protocol.
    • Patients with posterior hip dislocations most often present with the leg flexed and internally rotated, and will not tolerate having the extremity
    straightened. Anterior dislocations present with lateral rotation and shortening of the affected leg.
93
Q

Extremity Trauma

Determine Mechanism of Injury (MOI) and Evaluate:

A

PMS, color, temperature, capillary refill, crepitus

94
Q

Extremity Trauma

Gross contamination ___

A

such as leaves or gravel should be removed if possible.

95
Q

Control external severe extremity hemorrhage ___

A

(direct pressure, Combat Application Tourniquet (C.A.T.), apply to the most proximal anatomical position of extremity until the bleeding stops). Never apply C.A.T. directly over injury site or joint.
• If clotting agent is available, severe junctional hemorrhage (e.g., neck, axillary, thoracic, abdominal, pelvis and groin) and any other severe external hemorrhage that is not able to be easily controlled using C.A.T). Shall be controlled using clotting agent .
Pack wound with clotting agent and maintain pressure for a minimum of one minute. IF APPROPRIATE USE ISRAELI BANDAGE FOR JUNCTIONAL WOUNDS

96
Q

Extremity Trauma

Treat and assess for shock for suspected ____

A

femur fractures

97
Q

Immobilize ____ for all suspected extremity fractures or dislocations (document ____ before and after splinting). For critical patients, splinting can be accomplished via ____.

A
  • the entire limb
  • PMS
  • backboard
98
Q

Fractures should be splinted in the position found, unless ____ or ____.

A
  • there is no pulse present

* the patient cannot be transported due to the extremity’s unusual position

99
Q

No more than ____ attempts can be made to place the injured extremity in a normal anatomical position. Discontinue attempts if ____ or ____.

A
  • two
  • the patient C/O severe pain
  • if there is resistance to
    movement felt
100
Q

Extremity Injury

Transport position

A
  • Elevate extremity and apply ice packs.

* Consider Pain Management Protocol.

101
Q

Extremity Injury

Open wounds, exposed bone ends or amputations should be ____.

A

covered with a moist sterile

dressing

102
Q

• Remove ____ from the affected extremity.

A

jewelry or watches

103
Q

Extremity Trauma

• Small amputated parts should be

A

rinsed off, wrapped in sterile gauze and placed in a
plastic bag. If ice is available, place the sealed bag in a larger container with ice &
water or chilled saline. Label the bag with the patient’s name, date, and time of the
amputation, and the time the part was wrapped and cooled.

104
Q

Femur Fractures
Adult and Pediatric
Treatment

A

• Assess and treat for shock.
• Cover open femur fractures with a moist sterile dressing.
• Consider Pain Management.
• Apply a Traction Splint for mid-shaft femur fractures unless:
• Patient has additional life-threatening injuries
• There is also a suspected pelvic fracture
• There is an open femur fracture with exposed bone. If there is a open
fx where there is no visible bone, you MAY use a traction splint.
• There is also a suspected hip fracture
• There is an avulsion/amputation of the ankle or foot
• Suspected fracture distal to mid shaft femur
• Document neurovascular exam before and after application of the Traction
Splint.

105
Q

Trauma in Pregnancy

Information

A

Remember, there are two (or more) patients. The condition of the fetus often depends on
the condition of the mother. Trauma patients > 20 weeks pregnant in cardiac arrest
should be transported to closest Trauma/OB Center. (Broward Health Medical Center or Memorial Regional)
Begin MICCR and manually displace uterus to the left during transport.

106
Q

Trauma in Pregnancy

Maternal Physiological Changes During Pregnancy .

A

Due to the following physiological changes in pregnancy, it is often difficult to assess for shock:
• Maternal Heart Rate increases throughout the pregnancy. By the third trimester, the HR can be 15- 20 BPM above normal.
• Blood Pressure: Both the systolic and diastolic blood pressures drop 5-15 mmHg during the second trimester, but may return to normal at term (36 weeks).
• Cardiac Output: The mother’s cardiac output and blood volume increases. Therefore, the pregnant patient may lose 30-35% of her blood volume before the signs & symptoms of shock become apparent.

107
Q

Trauma in Pregnancy

Supine Hypotension

A

• Usually occurs in the third trimester.
• Pregnant patients not requiring spinal motion restriction shall be transported on their left side.
• If a pregnant patient requires spinal motion restriction, place 4-6 inches of padding under the right side of the patient while maintaining normal anatomical alignment
as much as possible.

108
Q

Trauma in Pregnancy

Management

A

• Assess for vaginal bleeding and a rigid abdomen. In the third trimester, this could
indicate abruptio placenta or a ruptured uterus.
• Ensure adequate oxygenation and ventilation. Maintain an SpO2 of 95% or greater and EtCO2 levels between 35-45 mmHg.
• Anticipate vomiting. Have suction readily available.
• Assess and treat for shock.
• All 3rd trimester pregnancy trauma patients shall receive 15 Lpm of oxygen via NRB.

109
Q

If patient remains hypotensive after the uterus has been displaced to the left, ____

A

consider the patient to have a significant amount blood loss – CONSIDER WHOLE BLOOD TRANSFUSION

BSO EMS Protocols (13 decks)

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