Trauma Standards Flashcards
Genral Trauma Standard
What should you advise the pt to do 1st?
What Standard should always consider before extricating?
Remain as still as possible
The SMR Standard
General Trauma Standard
When do you perform extrication (if it’s safe to do so)?
What do you do immediately following the primary survey unless otherwise indicated in the standards?
When the scene survey identifies conditions which may immediately endanger the patient
OR
The primary survey identifies conditions requiring immediate interventions which can’t happen at the patient’s locations
A rapid trauma survey
General Trauma Standard
In what ways can you attempt to estimate blood loss?
5 things
When do you perform a complete secondary survey of all body systems (including auscultation)?
Hemorrhage duration
Rate of flow
Presence of clots
Quantity of blood-soaked materials
AND
Quantity of blood vomited
For obvious OR suspected major/multiple trauma
General Trauma Standard
General Trauma Standard
You’ve come across a patient with an impailed object….what should you be doing?
What do you do if the object doesn’t fit in the ambulance?
Are there situations in which you WOULD make an attempt to remove?
Make no attempt to remove
Stabilize the object as found (using bulky dressing/bandages)
Attempt to shorten the object or rquest assistance from alied resources
Unless otherwise stated by the standards
Compromising the airway
Interfering with CPR during cardiac arrest (after already trying to change hand placement)
General Trauma Standard
What do you ASSESS an injury site for?
What do you PALPATE a patient for?
Contusion/colour/cyanosis/contamination
Laceration
Abrasions/asymmetrical motion/abdominal breathing (diaphragmetic)
Penetrations/punctures/protruding objects or organs
Swelling/sucking wounds/subcutaneous emphysema
Distension/deformity/dried blood/diaphoresis
Tenderness
Instibility
Crepitus
Swelling/subcutaneous emphysema
Deformity
General Trauma Standard
What do you assess at a minimum if a patient has an isolated injury?
What’s something that could compromise the injury site?
You assess the injury site/body system
AND
Other body parts/systems likely to be injured by considering potentially assoiciated life/limb/function threats
Clothing or jewelry - remove it
General Trauma Standard
What do you do if, upon arrival, the patient’s injury site is already dressed/splinted?
What are the splinting priorities?
Use judgement - if the site is correctly managed as per the standards then leave it
Spine (neck thoraco-lumbar, head)
Pelvis
Femurs
Lower legs
Upper limbs
General Trauma Standard - Truama and the PREGNANT patient
What’s it most often associated with?
What’s not obvious until well advanced?
Domestic violence
Signs of shock
General Trauma Standard - Truama and the PREGNANT patient
What are the major causes of death in maternal and fetal death respectively?
What’s more susceptible to injury and hemmorrhage?
What could blunt truama result in?
Hemmorrhage shock AND fetal hypoxemia
An enlarged uterus
Premature labour, spontaneous abortion, placental abruption, ruptured diaphragm, liver, spleen, or uterine rupture
General Trauma Standard - Truama and the PREGNANT patient
For WHAT do you maintain a high index of suspicion for and WHY?
What should you observe for in terms of blunt trauma to the abdomin?
For internal injury after MINOR blunt acceleration/deceleration force traumas as a stillbirth or placental abruption could occur within hours.
Abdominal/uterine enlargement
Aputation/Avulsion Standard
Aputation/Avulsion Standard
Aputation/Avulsion Standard
Aputation/Avulsion Standard
What potential LIFE/LIMB/FUNCTION threats SHALL you consider?
What do you assess if the pt has a partial amputation or avulsion?
Hemorrhagic shock
Loss of limb
Loss of function
The injury site for circulation, sensation, and movement
AND
The distal pulses, circulation, sensation, and movement with respect to the injury site
Aputation/Avulsion Standard
With respect to the injury site you SHALL?
6 things
What if the amputation is proximal to the wrist or ankle?
Control hemorrhage as per the ‘Soft Tissue Standard’
Cleanse wound of gross surface contamination
Immoblize affected extremity
Elevate
If PARTIAL amputation/avulsion - place everything in near-normal anatomial position as possible
If COMPLETE amputation - cover the stump with moist sterile pressure dressing followed by a dry dressing whist NOT twisting or constricing any remaining tissue
Evalute the patient under the FTT Standard
Aputation/Avulsion Standard
What do you do with respect to the amputated avulsed part?
Prior to ambulance transport (4 things)?
When you unable to locate the part prior to transport? (2 things)
Preserve all amputated tissue
Gently rinse with saline IF grossly contaminated
Wrap/cover the end with moist sterile dressing
AND
Place the part in a suitable container to then immerse in cold water (if possible)
Attempt to have others at the scene look for the amputated/avulsed part - tell them to bring it to the recieving facility
DO NOT delay transport
Blunt/Penetrating Injury Standard - Abdominal/Pelvic Injury
What potential LIFE/LIMB/FUNCTION threats should you consider?
What do you do if the pt has evisceration of intestines?
Spinal Cord Injury
Rupture, perforation, laceration, or hemorrhage of organes and/or vessels in the abdomen AND potential in the thorax or pelvis
Make no attempt to replace intestines back into the abdomen
AND
Cover eviscerated intestines using moist, sterile, large and bulky dressings
Blunt/Penetrating Injury Standard - Abdominal/Pelvic Injury
What do you do if the pt has a pelvic fracture?
1- attempt to stabilize the clinically unstable pelvis (circumferential sheet wrap/commercial device)
2- Secure the pt to a spinal board or adjustable break-away stretcher
3- Avoid placing anything over the pelvic area (including stretcher straps)
4- Secure and immobilize lower limbs to prevent additional pelvic injury
Blunt/Penetrating Injury Standard - Bite Injury
What LIFE/LIMB/FUNCTION threats are you considering?
What do you attempt to determine?
What should you always be wary of?
Injuries to underlying organs, vessels, or bones
AND - specific to snake bites
- Anaphylaxis
- Shock
- Central nervous system toxicity
- Local Tissue Necrosis
The source of bite + owner
Immunization + communicable disease status
The potential for bacterial contaminations or disease transmission (eg. rabies, Hep B, HIV) through bites
Blunt/Penetrating Injury Standard - Bite Injury
What SHALL you do if there is known or suspected envenomation?
How long SHALL you irrigate bites for IF the pt is stable?
1- Position the pt supine
2- Immobilize the bite area at or slightly below heart level
3- DO NOT apply cold packs
5min
Blunt/Penetrating Injury Standard - Chest Injury
What LIFE/LIMB/FUNCTION threats should you consider?
7 things - what’s the 1st thing you should do after creating a DDX?
What do you assess for if the pt has a PENETRATING chest wound?
Tension Pneumothorax
Hemothorax
Cardiac Tamponade
Myocardial Contusion
Pulmonary Contusion
Spinal cord injury
Flail chest
Auscultate the pt’s lungs for air enry and adventitious sounds
Entry and exit wounds
Tracheal Deviation
Jugular vein distension
AND
Airway and/or vascular penetrating (foamy hemoptysis, sucking wounds)
Blunt/Penetrating Injury Standard - Chest Injury
What do you do if the pt has a SUCKING chest wound?
Should you place the pt sitting /semi-sitting?
What should you do for suspected pnemothorax pt requiring ventilations?
Seal wound with commercial occlusive dressing with 1-way-valve OR 3-sided dressing
Apply a dressing that will cover several cm beyond the edges of the wound
Monitor for tension pneumothorax (rapid deterioration in cariorespiratory status)
If tension pnemo occurs then remove/replace the occlusive dressing
ONLY if the pt is concious AND doesn’t meet the SMR standard
Ventilate at a lower tidal volume and rate of delivery to prevntent exacerbation of increaing intrathoracic pressure
Blunt/Penetrating Injury Standard - Chest Injury
What potential problems would you prepare for in a chest wounded pt situation?
Tension pnemothorax
Cardiac Tamponade
Cardiac Dysrhythmias
Hemoptysis
Blunt/Penetrating Injury Standard - Eye Injury
What should you assume and what should you do if there’s active bleeding?
What do you do if the eyes are swollen shut?
What other standards should you follow to asses the pt and eye respectively?
Assume threats to vision
Control the bleeding with the minimal amount of required pressure
leave eyelids as is
Blunt/Penetrating Injury Standard - Head Injury
AND
Visual Disturbance Standard
Blunt/Penetrating Injury Standard - Eye Injury
What if the eye is EXTRUDED/AVULSED?
What should you do if there’s a suspected rupture or puncture of the glo
What other interventions should you perform for eye injuries? (4)
Do NOT attempt to replace it
Cover with a moist sterile dressing + stabilize as an impailed object
NO manipulation, palpation, irrigation, direct pressure
NO cold packs
Cover the eye with dressing
Cover both eyes IF injury is severe/there’s pain in the affected eye
Advise the pt to keep eye movement at a minimum
Transport the pt supine with head elevated 30 degrees
Blunt/Penetrating Injury Standard - Face/Nose Injury
What should you consider and what standard should use use to assess the pt?
If nose injury is obvious or suspected assess the pt as per the?
Potential concurrent head, c-spine injuries AND the ‘Blunt/Penetrating Injury Standard - Head Injury’
The Epistaxis (non-traumaic) Standard
Blunt/Penetrating Injury Standard - Face/Nose Injury
What’s the guideline for teeth?
What potential problems would you prepare for?
You can replace a completely intact, avlused tooth in the socket and have the pt bite down to stabilize AS LONG AS the pt is alert and stable
Place the tooth in saline or milk if it can’t be replaced
Epistaxis
Airway obstruction if sever injury and/or massive uncontrolled oral hemorrhage
Blunt/Penetrating Injury Standard - Face/Nose Injury
What can you do (or not do) with the pt if they’re conscious, don’t meet SMR, AND you want to transport them on a spinal board/break-away stretcher?
Do NOT apply cold packs
Position the pt to be semi-sitting and leaning forward to assist draining/expectoration of blood (spitting)
Elevate the head 30 degrees
Blunt/Penetrating Injury Standard - Head Injury
What potential LIFE/LIMB/FUNCTION threats are you considering?
Pts with suspected concussions require?
What 7 things are you observing for?
Intracranial and/or intracerebral hemorrhage
Neck/spine injuries
Facial/skull fractures
Concussion
transport for further assessment
Fluid from the ears/nose eg.CSF
Mastoid Bruising
Abnormal Posturing
Periorbital Ecchymosis
Agitation or fluctuating bahviour
Urinary/fecal incontinence
AND
Emesis
Blunt/Penetrating Injury Standard - Head Injury
What are signs of cerebral herniation?
Dilated and unreactive pupils
Asymmetric pupillary response
Motor response that shows either unilateral or bilateral decorticate/decerebrate posturing
Blunt/Penetrating Injury Standard - Head Injury
When vetilating the pt due to apneia or inadequate respirations AND ETCO2 monitoring is available, you SHALL?
Attempt to maintain ETCO2 values of 35-45mmHg
If you notice signs of cerebral herniation after adressing hypoxemia and hypotension THEN hyperventilate the patient attempting to maintain ETCO2 of 30-40mmHg
Blunt/Penetrating Injury Standard - Head Injury
When vetilating the pt due to apneia or inadequate respirations AND ETCO2 monitoring isn’t available, you SHALL?
3 categories (adult, child, infant)
You have already adressed hypoxemia and hypotension but signs of cerebral herniation persist, what do you do?
Adult - approx. 20 breaths/min
Child - approx 25 breaths/min
Infant LESS than 1 year old approx 30 breaths/min
Blunt/Penetrating Injury Standard - Head Injury
What do you do if protruding brain tissue is present?
What do you do if cerebrospinal fluid leak is suspected?
What can you do if they’re conscious, don’t meet SMR, AND you want to transport them on a spinal board/break-away stretcher?
Cover with non-adherant material (moist sterile dressing)
Apply a loose sterile dressing over the source opening
Position them in a sitting or semi-sitting position
Blunt/Penetrating Injury Standard - Head Injury
What are the POTENTIAL PROBLEMS to prepare for?
4
Respiratory Distress/arrest
Seizures
Decreasing level of consciousness
Agitation or Combativeness
Blunt/Penetrating Injury Standard - Neck/Back Injury
What should you assume if it’s a penetrating neck injury?
What should you do 1st?
What do you do if the pt has a penetrating wound?
Vascular and ariway lacerations or tears
Auscultate the lungs for decreased air entry and adventitious sounds
Assess for entry and exit wounds
Apply pressue lateral to the airway NOT directly over
Apply occlusive dressings to wounds
Blunt/Penetrating Injury Standard - Neck/Back Injury
What do you observe for?
What should you always keep in consideration?
What does the secondary survey assess?
Diaphragmetic breathing
Neurologic Deficits
Priapism
Uriniary/fecal incontinence/retention
That you should sit within the pts view to avoid head/neck turns
For airway/vascular penetration
The ausculation of the lungs, whether there’s decreased air entry or adventitious sounds
The head and neck for JVD and tracheal deviation
The chest for subcutaneous emphysema
Burns (Thermal) Standard
What’s the 1st thing you should do if your patient is in a smoke/fume filled environment?
Request assistance from fire personnel and ensure the pt is moved to a fresh air zone as quickly as possible