WEEK 11 - Traumatic Events 2

Question 1

Treatment principles of an amputation

Answer 1

• managing ABCs and haemorrhage
• pain control
• bandaging injured limb
• preserving amputated body part (an amputated body part should be placed in a sealed bag and then placed into another bag of cold water to keep the part cool and prevent tissue deterioration. Do not put the part directly into water or on ice).
• urgent transport and notification

Question 2

Prehospital management of an amputation

Answer 2

• haemorrhage control (direct pressure, indirect pressure, tourniquet)
• estimate blood loss
• locate limb - place in plastic seal bag and the place bag in cold water to preserve tissue
• consider clinical support
• pain management
• rapid transport with notification

Question 3

Classification of burns

Answer 3

• Superficial – these burns cause damage to the first or top layer of skin only. The burn site will be red and painful.
• Partial thickness – these burns cause damage to the first and second skin layers. The burn site will be red, peeling, blistered and swelling with clear or yellow serous fluid leaking from the skin. The burn site is very painful.
• Full thickness – involves damage to both the first and second skin layers, plus the underlying tissue. The burn site generally appears black or charred with white exposed fatty tissue. Very deep burns may damage the underlying muscle or bone and the nerve endings are generally destroyed and so there is little or no pain at the site.

Question 4

Prehospital management of burns

Answer 4

• manage ABCs (particularly in airway burns)
• stopping the burning process
• cooling the burn (running water) for a minimum of 20 mins
• monitor for hypothermia
• covering/dressing the wound (cling wrap/wet sheet)
• assessment of burn size/severity (use Rule of 9’s or Lund and Browder Charts)
• IV cannulation and fluids
• analgesia
• transport with notification
• request clinical support if significant burns, airway burns or uncontrolled pain
• consider fluid management if signs of poor central perfusion (20mls/kg in 250 ml aliquots)

Question 5

Clinical features of a crush injury

Answer 5

• Crushing injury to a large mass of skeletal muscle
• Sensory and motor disturbances in the compressed limbs, which subsequently become tense and swollen
• The ‘5 Ps’ - pain, pallor, paraesthesia, poikilothermy (cold skin), and pulselessness
• Myoglobinuria and/or haemoglobinuria (there may be oliguria with profound hypovolaemic shock)
• Nausea, vomiting, confusion and agitation may occur as consequences of disturbed body chemistry; urea, creatinine, uric acid, potassium, phosphate and creatine kinase are elevated.

Question 6

Prehospital management of a crush injury

Answer 6

• managing ABCs
• administering oxygen (maximise oxygenated blood to injury site)
• cardiac monitoring (early detection of dysrhythmias)
• analgesia
• IV fluid (attempt to dilute myoglobin) pre and post removal compressor (2
• extrication planning (joint effort to remove the crushing force as soon as possible)
• urgent transport (trauma centre)
• request clinical support +ICP/meds tar
• minimise scan time
• salbutamol nebulised to draw potassium out and reduce hyperkalemia

Question 7

Prehospital management of penetrating traumas

Answer 7

mitigating danger
managing ABCs
preventing blood loss
wound dressing
analgesia
permissive hypotension
transport
Do not remove object, package around it

Question 8

Fluid therapy in burns

Answer 8

Parklands formula

Question 9

Fluid therapy in crush injury

Question 10

Fluid therapy in head injury

Answer 10

• aim for a MAP of 90mmHg

Question 11

Fluid therapy in all other traumas

Answer 11

• aim for permissive hypotension