Traumatic Injuries Flashcards
BCEHS Guidelines 2024
What are the essentials for major trauma?
-Rapidly obtained definitive, haemorrhage control
-Maximize tissue oxygenation
-Prevent or limit the development of hypothermia
-Minimize the use of crystalloid fluid or replacement
-Initiate rapid convenience to a lead trauma hospital
what should your assessment and stabilization patient assessment model follow?
CABCDE approach
Catasphrophic bleeding
Airway
Breathing
Circulation
Disability
Exposure
When our tourniquets indicated?
When bleeding cannot be controlled through direct pressure or wound packing
When is wound packing indicated?
And there are penetrating wounds that cannot be controlled using direct pressure alone
It is also useful in junctional areas of the body like the groi where tourniquets cannot be well utilized
when is the pelvic binder indicated?
When there is a pelvic injury that is suspected or when there is high mechanism of injury in an unconscious patient
can you use a pelvic binder on a hip fracture or falls from standing?
No, they are both contraindicated
when is a cervical collar indicated to be applied?
Multi trauma
Meeting Nexus criteria
High risk patience
In terms of cervical collars, what do they mean multi trauma?
More than one simultaneous injury, such as multiple bone, fractures or major lacerations, and damage to internal organs
What the Nexus criteria?
Is there midline tenderness?
Is there an altered LOC?
Are there new focal logical deficit?
Are they intoxicated?
Is there a major distracting injury?
No to all five of these questions there is no warrant to apply a cervical collar
What are high risk patients in regards to a cervical collar?
Age greater than 65
Osteoporosis
Pre-existing spinal conditions
what medication is used for suspected internal bleeding?
TXA
what is the dosage for TXA?
2 g IV rapid push
What do you do with a failed airway?
Transport to the nearest emergency department
what do you do in a blunt traumatic arrest?
Trauma bundle
Call EPOS for early discontinuation
what is considered the trauma bundle in traumatic cardiac arrest?
Securing an airway, preferably an ET tube
Decompressing both sides of the lungs in blunt traumatic arrest
IV or IO access
Pelvic binder applied
Patient in anatomical position
1 mg of epi
In penetrating traumatic arrest are you to transport early or remain on seen?
Transport to the trauma hospital
Nearest emergency department of time from loss of pulse respiration to a rival at hospital is less than 15 minutes
what are the physiological parameters indicating major trauma and pt. should be transported to the lead trauma hospital?
GCS less than 13
Systolic blood pressure less than 90
Respiratory rate less than 10 or greater than 30
Do you stop CPR in traumatic cardiac arrest?
Yes, to treat all reversible causes which are included in the trauma bundle. CPR is to start again after all of these have been rectified.
What are the three main acute concerns in crush injuries?
Electrolyte imbalances
Hypovolaemia
Metabolic acidosis
What are the four delayed onset effects of crush injuries
Renal failure
ARDS
Coagulopathy
Severe sepsis
What medication can be used to help facilitate potassium shifting intracellularly as a beta agonist?
Salbutamol, and is a consideration during crush injuries
How much fluid should be administered prior to the release of a crush injury?
2 L
if intravenous catheterization is unsuccessful in a crush injury, patient what other methods do ACPs have to gain access?
IO
External jugular cannulation
what can ACP do to correct electrolyte disturbances in a crush injury?
Administer calcium chloride, there is no clinicall phone call required
Administer sodium bicarbonate, clinicall phone call is required
what should your arterial pressure be in a TBI?
80 mmHg
what two universal lethal conditions exacerbate a TBI?
Hypoxia
Hypotension
should you hyperventilate or hypoventilate a patient with a TBI?
Neither, normal ventilation should be maintained
What is the indications for needle thoracentesis?
For the decompression of tension pneumothorax with deteriorating vital signs which include decrease cardiac output, profound shock, or cardiac arrest
is aggressive, fluid resuscitation warranted in abdominal trauma?
No, it is associated with higher mortality rates
what are you to do with eviscerated injuries?
Cover them with a moist sterile dressing with an inclusive layer above
what should you suspect when there’s blunt trauma to the abdomen other than blood filling the spaces?
A pelvic injury
where is pain referred to when there is a spleen injury?
The upper left posterior shoulder
where is pain referred to when there is a hepatic injury?
The upper right posterior shoulder
when should pelvic binding be applied during your assessment?
In the primary assessment, it is a haemorrhage control intervention
if a limb is pulse less and severely agulated, should it be repositioned?
Yes, it should be for the restoration of pulses
What are the procedures in reducing a fracture?
Analgesia
Irrigation of open wounds with 500 mls to 1 L
Applying traction and reigning the limb
Any further manipulation of the lamb it should be done while under traction
Splint the limb following reduction
when is procedural sedation indicated?
At any point where analgesia sedation and amnesia are required to allow paramedics to accomplish patient care tasks.
Examples of these are:
Extrication
Fracture management
Cardioversion
Airway management
is clinicall required prior to procedural sedation?
Yes, in paediatrics <12 years of age
No in adults
how long should paramedics cool burns for?
15 to 20 minutes
what side of burn dressings should be applied to the patient?
The “shiny” side
should paramedics have a low threshold for advanced airway placement in burned patient?
Yes, as edema increases the airway may close and you would have a failed airway. ACP should have a low threshold for airway intervention if there is burns soot, change your voice, coughing, or other respiratory signs that are caused for concern.
If someone is struck by lightning, and is in cardiac arrest, what is the first thing that paramedics should try and do?
Defibrillate and CPR
What type of injuries do high voltage electrical contact may occur in some patients?
Rhabdomyolysis
Hyperkalaemia
