Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BSO EMS Protocols > Trauma Resuscitation > Flashcards

Trauma Resuscitation Flashcards

1
Q

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

A

immediate defibrillation, if applicable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Do no resuscitate trauma patients if all of the following signs of death are present:

A

Injuries incapable with life and/ or

  1. Apneic
  2. Pulseless (Asystole confirmed in two leads)
  3. Fixed and dilated pupils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Note: Trauma patients in cardiac arrest (either found to be in arrest or have arrested in the presence of Fire Rescue personnel), ____ or ____ SHOULD BE PERFORMED. Resuscitation efforts do NOT need to be continued if ____.

A
  • prophylactic bilateral needle decompression OR FINGER THORACOSTOMY
  • the patient did not regain pulses immediately following the bilateral needle decompression OR
    THORACOSTOMY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hemorrhagic Shock
Adult
Management:

A

• Rapid transport, keep on-scene times less than 10 minutes.
• Maintain an SpO2of 95% and EtCO2 levels between 35-45mmHg.
• Control external severe extremity hemorrhage (direct pressure, Combat Application
Tourniquet (C.A.T.), apply CAT at the most proximal anatomical location 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 or
XSTAT. Pack wound with clotting agent and maintain pressure for a minimum of one minute. USE ISRALI BANDAGE WHEN APPROPRIATE.
• Cervical Spinal Motion Restriction if indicated.
• Maintain body temperature with blankets and consider increasing the
temperature in the patient compartment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hemorrhagic Shock
Fluid Resuscitation
• Internal hemorrhage

A
  • Establish two large bore IVs while en route. NEVER delay transport to start IV’s on scene.
  • Give only enough normal saline to maintain a blood pressure high enough for adequate peripheral perfusion (radial pulse). The presence of a radial pulse equates to a SBP of 90 mmHg, which is the goal of fluid resuscitation for a patient with suspected internal hemorrhage.
  • Bolus of Normal Saline 500mL, reassess blood pressure and lung sounds prior to each bolus. Maximum 1L.- Permissive Hypotension in trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hemorrhagic Shock
Fluid Resuscitation
• Isolated external hemorrhage controlled with direct pressure or Combat Application Tourniquet (C.A.T.)

A
  • Give only enough normal saline to maintain a blood pressure high enough for adequate peripheral perfusion (radial pulse). The presence of a radial pulse equates to a SBP of 80-90 mmHg.
  • Bolus of Normal Saline 500ml, reassess blood pressure and lung sounds prior to each bolus. Maximum 1L.
  • BLOOD TRANSFUSION: See Protocol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hemorrhagic Shock

Pediatric - Management:

A
  • Rapid transport, keep on-scene times less than 10 minutes.
  • Maintain an SpO2 at 95% and EtCO2 levels between 35-45 mmHg.
  • Control external severe extremity hemorrhage (direct pressure, Combat Application Tourniquet (C.A.T.), apply at the most proximal anatomical location 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.
  • Spinal Motion Restriction if indicated.
  • Maintain body temperature with blankets.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hemorrhagic Shock
Pediatric -
* Fluid resuscitation for suspected intra-thoracic, intra-abdominal or retroperitoneal hemorrhage or isolated external hemorrhage

A

• Establish two large bore IV’s or an IO if unable to obtain IV access. Do not delay transport!
• NORMAL SALINE: 20mL/kg bolus, titrated to maintain a SBP as listed below. May repeat 1x prn for
hypotension.
- Assess lung sounds and blood pressure often.
• Minimum Pediatric Systolic Blood Pressure Values
- Neonates: 60mmHg
- Infants: 70mmHg
- Children 1-10 years old: 70 +(age in years x 2) mmHg
- Children greater than 10 years old: 90mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pediatric

* Signs & Symptoms of Compensated Shock

A

• Anxiety, agitation, restlessness, normotensive, capillary refill normal to delayed
• Tachycardia (a weak rapid pulse greater than 130 beats/min is usually a sign of
shock in children of all ages except neonates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pediatric

* Signs & Symptoms of Decompensated Shock

A

Decreased LOC, hypotension, peripheral cyanosis, delayed capillary refill, inequality of central/distal pulses, and tachycardia (later progressing to bradycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Neurogenic Shock

Signs & Symptoms

A
  • Skin – Warm/Dry
  • Hypotension with bradycardia
  • Paralysis : Injury present above the T6 spinal cord level
  • (Neurogenic Shock vs. Spinal Shock)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Neurogenic Shock

Adult - Management

A

• Rapid transport, keep on-scene times less than 10minutes.
• Maintain an SpO2of 95% and EtCO2 levels between 35-45mmHg.
• Cervical Spinal Motion Restriction if indicated.
• Maintain body temperature with blankets and consider increasing the temperature in
the patient compartment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Neurogenic Shock

Adult - Fluid Resuscitation

A

• Establish two large bore IVs while en route. NEVER delay transport to start IV’s on scene.
• Internal hemorrhage
• Give enough normal saline up to 1L to maintain a blood pressure high enough for
adequate peripheral perfusion (radial pulse). The presence of a radial pulse equates to a SBP of 90 mmHg, which is the goal of fluid resuscitation for a patient with suspected
internal hemorrhage.
• Bolus of Normal Saline 500mL, reassess blood pressure and lung sounds prior to each bolus. Maximum 1L.-
• Push Dose Epinephrine: If patient remains hypotensive despite IVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neurogenic Shock

If Patient remains hypotensive after fluid administration.

A

Push dose Epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Neurogenic Shock
If Patient is hypotensive
(SBP less than 100mmHg)

A

NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Transfusion Protocol

Universal Patient Guidelines

A
  • Assure Scene safety. Primary Survey / Control Severe Traumatic Bleeding
    18 or 20-gauge catheter x (2) or IO Humeral (preferably)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Transfusion Protocol

History

A

• What was the mechanism of injury – blunt (MVC, fall, blow to body) vs. penetrating
(stabbing, GSW, foreign body)?
• Did a medical condition contribute to the mechanism of injury? Other medical
conditions?
• Medications – Coumadin? Plavix? Aspirin? Pradaxa? Xarelto? Eliquis? (any blood thinners or anticoagulants)
• Beta Blockers and Calcium Channel Blockers may not allow HR to increase
appropriately

18
Q

Transfusion Protocol

MARCHES Protocol

A

• Massive bleeding control
• Airway – NPA/OPA/Advanced Airway
• Respiratory – decompress chest if tension pneumothorax, occlusive dressing for open
pneumothorax
• Circulation- IV/IO, tourniquet, pelvic binder, wound packing
• Hypothermia care
• Eye injuries – cover with rigid shield and no pressure on the eye
• Spinal motion restriction if indicated

19
Q

Transfusion Protocol
Criteria
HEMORRHAGIC SHOCK in medical or trauma Adult and Pediatric patients
* Relative Contraindications

A

• Patient < 6 years old
Consult Medical Direction if patient is in hemorrhagic shock and < 6 y/o
Medical Director may elect to give blood in patients < 6 y/o

20
Q

Transfusion Protocol

Contraindications

A

• Religious objection to receiving blood products—consult On Call Medical Director

21
Q

Transfusion Protocol
For Patients in HEMORRHAGIC SHOCK: Blunt or Penetrating Trauma-1 of the following
Administer Whole Blood with signs of acute hemorrhagic shock as evidenced by:

A

• Systolic Blood Pressure <70 mmHg

OR

• Systolic Blood Pressure <90 mmHg with- Heart Rate ≥ 110 beats per min

OR

• ETCO2 < 25

OR

• Witnessed traumatic arrest < 5 min prior to provider arrival and continuous CPR
throughout downtime

OR

• Age ≥ 65 y/o and SBP ≤ 100 AND HR ≥ 100 beats per minute

22
Q

Transfusion Protocol

Information

A

In general one unit 500mL (1 unit) of Low Titer O+ Whole Blood (LTO+WB) will be
available per patient. If more than 500 mL of Whole Blood is available on scene the
following general guidelines apply:
• 6-10 y/o are eligible for 500 mL of Whole Blood
• 11-13 y/o are eligible for 1000 mL of Whole Blood
• ≥13 y/o are eligible for >1000 mL of Whole Blood
Of Note: At this time the LTO+WB does not have volume markings on the bag.

23
Q

Transfusion Protocol

Confirmation Procedure

A
  1. Confirm patent administration site if any question exists utilize a new site
  2. Identify the patient meets criteria above
  3. Record baseline vitals
  4. (2) EMS personnel must confirm the tag and the blood product match including
    number, blood type, Rh factor, expiration date and fluid amount
  5. Both confirming personnel must sign the accompanying blood component tag
24
Q

Transfusion Protocol

Administration

A
  1. Place flat thermometer on patient’s forehead.
  2. Whole Blood 1 unit IV/IO via blood Y-tubing. Flow through blood warmer to
    completion and / or hemodynamic stability. Repeat PRN x 1. Utilize low titer O+ for most
    patients, utilize low titer O – for female patients < 40.
  3. In the event Whole Blood is not available Low Titer A Liquid Plasma may be
    given to reach permissive hypotension with hemodynamic stability. Repeat PRN x 1.
25
Q

Transfusion Protocol

EPCR Documentation

A
  • Document administration in the flow chart section, currently the only option is blood, please indicate the type and volume. In the narrative please describe the reason for blood, what products where used, Patients Temperature Before,
    During and After administration, response to blood products, Qin Flow warmer was used, any adverse reactions, patient or family consulted about blood products and if medical director contact was made.
26
Q

Transfusion SOG

Purpose

A

To maintain blood products for EMS delivery

27
Q

Transfusion SOG

Scope

A

Describes the storage and maintenance of blood products for use in the
field

28
Q

Transfusion SOG

Blood Refrigerator:

A

Approved refrigeration device to store blood products long term.

29
Q

Transfusion SOG

Blood Cooler:

A

Approved cooler used to store blood outside of the blood refrigerator, and deliver products to the field.

30
Q

Transfusion SOG

Freezer

A
  • Separately maintained freezer to hold the cooler inserts
31
Q

Transfusion SOG

LTOWB

A

Low Titer Group O Whole Blood

32
Q

Transfusion SOG

Procurement

A

– Blood products are distributed to the Broward County Air Rescue Station 85 , through ONE BLOOD, via regular or PRN delivery

  • O -/+ Whole Blood
  • LTOWB , titer should be < 256
33
Q

Transfusion SOG

Maintenance

A
  • Upon receipt the blood products will be logged in, triage tag added and placed in the refrigerator at station 85 in the EMS supervisors office.
34
Q

Transfusion SOG

Temperature Controls

A

The blood product refrigerator will be temperature checked daily at 7am and 7pm and recorded in the log. If at anytime the
temperature is below or above normal range, remove the units and place in the
cooler, contact EMS Chief for storage options
1. Check and log freezer Temp Daily
2. Each Thursday, change the temp graph in the blood refrigerator and scan and send a copy to the blood Bank along with fridge and freezer logs
3. Monthly copy all logs and send to EMS Assistant chiefs office for filing

35
Q

Transfusion SOG

Cooler Usage

A

At shift change the insert should be removed from the freezer, and allow to thaw for 20 minutes. The insert should be loaded in the cooler and the blood products container from the blood refrigerator placed in it, assuring temperature controls are in place. The routine time for products in this cooler is to be 12 hours, with a maximum time of 24 hours. The products from the previous shift should be rotated back to the blood refrigerator. Be sure the temp probe is maintained in the cooler and monitored throughout the shift.

36
Q

Transfusion SOG

Rotation

A
  • LTOWB has a 21 day shelf life. At 72 hours out, be sure to contact ONE BLOOD to re-order.
37
Q

Transfusion SOG

Usage

A
  • When the blood products are used, maintain the proper paperwork as per EMS
    Guideline. Be sure the usage card is filled out, sticker both copies, white top copy stays with the patient, yellow copy goes back to the blood bank and a copy should be scanned into the run record.
    Contact ******* for replacement units.
38
Q

Transfusion SOG

EPCR Documentation

A
  • Document administration in the flow chart section,
    currently the only option is blood, please indicate the type, titer and volume.. In
    the narrative please describe the reason for blood, what products where used,
    Patients Temperature Before, During and After administration, response to blood products, Qin Flow warmer was used, any adverse reactions, patient or family consulted about blood products and if medical director contact was made.
39
Q

Transfusion SOG

Scene Delays

A
  • In the event the storage window is getting close and the supervisor can not make it back to the office to exchange blood products,
    contact the EMS Chief to arrange the swap. In the event the Chief is not
    available request an EMS crew to do the exchange. In the event the product is
    out past 24 hours maximum time, monitor temp, if at anytime the temp is out of
    range, alert the blood bank and request immediate exchange of blood products
40
Q

Transfusion SOG

Adverse Reaction

A
  • Immediately STOP, maintain alternate fluids and follow
    appropriate protocol. Any transfusion reaction, will need to be reported to the
    receiving facility. The blood products should also be packaged up in appropriate
    material and returned with all tubing to the blood bank
41
Q

Transfusion SOG

Religious Observations

A

Some religions will refuse to accept blood products. In

this instance follow EMS protocol, and document the refusal in the EPCR.

42
Q

Transfusion SOG

Out of Temperature

A

If any product is discovered out of temperature , range
notify the EMS Chief and generate and incident report. Take the blood out of
service in the fridge, the blood bank will be contacted and an incident investigation will be done to prevent reoccurrence.

BSO EMS Protocols (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions