Trauma and Trauma Systems Flashcards
Blunt
Injury caused by the collision of an object with the body in which the object does not enter the body.
Presentation often masks patient’s true condition
– Extremity trauma is often obvious and grotesque
– May be a distraction from internal bleeding and shock which may have a more subtle presentation
Serious trauma is a surgical disease
Proper care in often immediate surgical intervention
Trauma care system integration of
- EMS
- Hospital Care
Trauma Care System Reduces
- Cost
- Time to Surgery
- Mortality
Trauma Care System Proper Care
-Immediate surgical intervention to repair hemorrhage sites
Current Canadian model for trauma care involves the designation of trauma centres
– Tertiary Trauma Centres (TTC)
– District Trauma Centres (DTC)
– Primary Trauma Centres (PTC)
– Or graded Level 1-‐5, Level 1 = Tertiary Centre
Trauma systems should be flexible enough to meet local needs
Urban vs Rural
Specialty Centres
- Neurocentres
- Pediatric trauma centres
- Microsurgery
- Hyperbaric centres
- Burn units
Role of the Paramedic
• Triage – Trauma triage guidelines • Rapid assessment • Trauma care • Transport to the appropriate facility
Mechanism of Injury Analysis
• Processes and forces that cause trauma
• Identify:
– Forces involved
– Direction of the forces
– Affected areas of the patient
• First step in focused history is the physical assessment of the trauma patient
Index of suspicion
• Anticipation of injury to a body region, organ or structure based on analysis of mechanism of injury
• Shock and head injuries are the principle killers in trauma
– May present subtly at first
– Trauma patients require frequent reassessment and trending
Golden Hour
-Current goal for incident to surgery time
Time of incident to time of inside OR
Platinum 10 minutes
Limit scene time to 10 minutes
Air Transport
– Usually governed by protocol
– Balance of speed versus need
Decision to Transport
Based on trauma triage criteria
– Designed for “over-‐triage””
– Ensures that pa/ents with subtle signs and symptoms do not get missed
Trauma Triage Criteria MOI-Adults
• >6 m fall (3 x height of patient) • Pedestrian/Bicyclist versus auto – Thrown or run over by vehicle – Struck by vehicle traveling >10 kph • Motorcycle impact >30 kph • Ejected from a vehicle • Severe vehicle impact – > 60 km/hr – > 30 cm intrusion – > 50 cm vehicle deformity • Rollover with signs of serious impact • Death of another occupant • Extrication time > 20 minutes
Trauma Triage Criteria Infants & Children
- >3 m fall (3 x height of patient)
- Bicycle/vehicle collision
- Vehicle collision at medium speed
- Any vehicle collision involving an unrestrained infant or child
Trauma Triage Criteria Physical Findings
• Revised Trauma Score 29
Trauma Triage Criteria Physical Findings
- > 2 proximal long bone fractures
- Flail chest
- Pelvic fracture
- Limb paralysis
- Burn > 15% BSA
- Burn to face or airway
- Penetra/ng trunk, neck and head trauma
Injury Prevention
One of the best and most cost effec/ve way to reduce mortality and morbidity is to prevent the trauma in the first place – Bicycle safety programs – Firearm safety – Boat safety – Child Safety Seat classes and checking
Data and Trauma Registry
- Data retrieval system for trauma patient information
- Used to evaluate and improve the trauma system
- Requires accurate documentation
- Supports research
Penetrating
Injury caused by an object breaking the skin and entering the body.
