Trauma Administrative Guideline

Question 1

History

Answer 1

• Time/mechanism/speed
• Damage/intrusion
• Restraints or protective equipment

Question 2

Signs and symptoms

Answer 2

• Pain
• Deformity
• Bleeding
• ALOC
• Shock

Question 3

Differential

Answer 3

• Chest injuries
• Intraabdominal injuries
• Pelvic fractures/bleeding
• Head injury
• Extremity trauma

Question 4

Are they pulseless?

Answer 4

DOA dude

Consider Dead on Scene AG

Question 5

Blunt trauma with a pulse?

Answer 5

18-20 g IV access, O 2 , cardiac monitor
Apply SMR procedure
splint obvious deformities and evaluate distal
neurovascular exam
Place pelvic binder for suspected
unstable pelvic fractures

Question 6

TBI - GCS<15 or loss of

consciousness YES?

Answer 6

EPIC TBI
O 2 by NRB 15 L/min
Advanced airway management only if unable to
oxygenate/ventilate wtih BLS airway interventions
IV access - 18 gauge or larger
20 mL/kg NS/LR fluid bolus to keep SBP >100 mmHg
[70+(agex2) for peds]
EtCO 2 target for all mechanically or manually ventilated patients 40mmHg (range 35-45)

Question 7

TBI - GCS<15 or loss of

consciousness NO?

Answer 7

Reassess and monitor VS
Transport per SAEMS Regional Trauma Triage
Perform telemetry with receiving facility

Question 8

Penetrating Trauma or

isolated extremity trauma

Answer 8

Stop the bleed (apply tourniquet as necessary)
Perform distal neurovascular exam as needed
Prevent Hypothermia
18-20 g IV access, O 2 , cardiac monitor
Administer NS/LR fluid bolus to keep SBP >70 mmHg
Needle decompression for tension pneumothorax
Minimize on-scene times!
If isolated penetrating trauma to head, follow EPIC TBI for fluid resuscitation BP goals

Question 9

Things to know about circulation and trauma

Answer 9

The most common cause of shock following trauma is hemorrhage. Scalp wounds, abdominal
organ injury, and long-bone fractures can cause rapid blood loss.
- Bleeding - apply anticoagulant gauze wound packing until resistance is met and/or apply tourniquet until
bleeding is stopped.
- Pulseless - may consider bilateral needle thoracostomy; may terminate as per Dead on Scene AG if
penetrating trauma, and blunt trauma if transport will take > 15 min to Level 1 Trauma Center.

Question 10

Things to know about immobilization and trauma

Answer 10

• Long spine board use in trauma patients should be restricted to extrication procedures only and should
  be avoided in patients with penetrating trauma.
• Spinal motion restriction procedure should be followed for all trauma patients with neck or back pain,
  neurologic deficit, or other risk factor for spine trauma. The elderly are at high risk for spinal injury with
  lower mechanism injury.
• Patients with isolated blunt injuries may not warrant SMR or pelvic binder placement.

Question 11

What is a moderate or severe TBI?

Answer 11

defined as anyone with physical trauma and a mechanism consistent with the
potential to have induced a brain injury, and:
i. Any injured patient with loss of consciousness, especially those with GCS <15 or confusion
OR
ii. Multisystem trauma requiring intubation whether the primary need for intubation was from TBI
or from other potential injuries OR
iii. Post-traumatic seizures, whether ongoing or not
iv. (Pediatric) Infants (where GCS may be difficult to obtain or interpret): any evidence of
decreased level of consciousness, decreased responsiveness, or deterioration of mental
status
See next page (EPIC TBI) for TBI management guidelines.

Question 12

What to know about emergency surgical airways?

Answer 12

• In the event oxygenation and ventilation of the patient cannot be achieved either by BLS maneuvers,
  placement of a SGA or Endotracheal Intubation, perform surgical cricothyrotomy.
• Surgical Cricothyrotomy: 12 years of age and above
• Needle Cricothyrotomy: Under 12 years of age