Trauma Emergencies Flashcards
1
Q
Burns/Inhalation/ Electrocution and Lighting Strike
A
THERMAL vs CHEMICAL
- Thermal:
> Stop burning with H2O or Saline
> Remove smoldering clothing/jewelry. Do not remove skin/tissue
> Cover burns w/ CLEAN, DRY, STERILE DRESSING
> Attempt to reduce heat loss w/ lg BSA
- Chemical:
> Determine agents, consider HAZMAT
> Irrigate with H2O/NS for 10-15 min. (Contraindicated for Na+, K+, and/or Lithium metals)
> Dry lime/lye, powders and/or Phenol: brush off then irrigate with large amounts of water
> Viscous chemical, may remove w/ tongue depressor - 2nd/3rd degree burns >20% BSA (1st degree not included) utilize the parkland burn formula.
> 4mL/BSA/kg, first half over 8 hrs, second half over next 16 hrs - 2nd/3rd degree burns 4 mL/kg/hr for first 10 kg
> 2 mL/kg/hr for the 2nd 10 kg
> 1 mL/kg/hr for remainder
> Pedi Response time >1 hr - Airway management
- Consider Pain Management
- Suspected cyanide inhalation (hypotension, AMS, seizures, ect): Hydroxocobalamin
> Adult: 5 G IV/IO over 15 min
> Pedi: 70 mg/kg (max 5 G) over 15 min - Suspected CO: High flow O2
2
Q
Eye Emergencies Adult/Pedi
A
- Obtain Visual Hx
- Obtain Visual Acuity, if able
- Assist pt in removal of contacts if applicable, unless chemical burns
- Chemical Irritants: Flush with copious amounts of H2O/NS for 15 min
- Thermal Eyelid Burns: Patch both eyes with cool NS compresses
- Impalement: stabilize and cover
- Blunt: Patch/protect both eyes
- Puncture wound: Ridged protection device over both eyes. No direct pressure. If using a cup do not apply bandage over the top of the cup.
- Foreign Body: Patch both eyes
- Pt unable to close eyelids: keep eyes moist
- Morgans lens for irrigation
MEDCONTROL/SPECIAL CONSIDERATIONS
- Tetracaine: 1-2 eye drops prn
- Sudden vision loss: Sudden loss of vision and suspecting central retinal occlusion w/ non-traumatic, painless lose of in one eye. Applied palm heel pressure, message 3-5 min, prn as listed. Cardiac monitor (12 lead) required. Contraindicated with tetracaine administration.
- Contact lenses w/ Chemical Burns: if suspected contact medical for removal
3
Q
Open Wound Treatment
A
- Stop and control life-threatening hemorrhaging
- Grossly Contaminated: Irrigate w/ NS/H2O
- Remove all restrictive dressing
- Check CSM’s
- Consider Pain and Nausea Management
- Fluids may run KVO, but for fluid bolus with stable hemodynamics contact med control.
4
Q
Spinal Column/Cord Injuries Adult/Pedi (Med Control)
A
- Cardiac monitor: treat arrhythmias
MEDCONTROL - Additional NS 250-500 mL boluses, wide open or titrated to hemodynamic status
- Suspected neuroshock w/o hypovolemia: Dopamine 2-20 mcg/kg/min
5
Q
Thoracic Trauma Adult/Pedi
A
OPEN PNEUMO:
- 3 sided occlusive dressing, monitor for tension pneumo
TENSION PNEUMO: Resp distress/apnea, diff ventilation, JVD, unilat decrease/absent breath sounds, treach deviation.
- Remove occlusive dressing to releave pressure then reapply
- If no improvement, needle decompression. 2nd intercostal space, midclavicular line with at least a 3.25 in, 14 g angiocath.
FLAIL CHEST:
- Place injury side down if not contraindicated
- Immobilize segment
- Provide positive pressure ventilations
6
Q
Upper Airway Obstruction Adult
A
- Partial w/ adequate air exchange: Monitor and tx
- Complete/Partial w/ inadequate air exchange: Abd compression, ventilate, magills, and ETT as indicated.
- Foreign body removed proceed with ETT and capnography
- Foreign body not removed, attempt magills, ventilate, attempt ETT. If unsuccessful Needle Cricothyrotomy.
MED CONTROL
- Consult for tracheostomy tube removal.
7
Q
Upper Airway Obstruction Pedi
A
- BLS/ALS maneuver as listed with adult but w/o Needle Cricothyrotomy
- Croup: Barking cough (no drooling), with severe resp distress and stridor at rest.
> Neb Racemic Epi: 11.25 mg/2.5 mL NS - Epiglottitis: Stridor and drooling
> Maintain open airway, position of comfort and avoid upper airway stimulation.
