Trauma Flashcards
MOI
Used to Predict Injury patterns.
Greater energy applied than body can tolerate leads to injury.
Blunt: force over large area (largest cause of death from trauma)
Penetrating: force to small area
- Breaks skin
Significant IF multiple systems injured.
Golden Principles of Prehospital Care
Patient Care:
- Hemorrhage
- Airway / ventilation support
- Shock
- Spinal immobilization
10 MIN LIMIT on Scene
Primary Assessment (trauma)
AIRWAY: NPA/OPA, Jaw-thrust for c-spine, Suction
BREATHING: chest trauma
CIRCULATION: do blood sweep, treat bleeding
DISABILITY: BE-FAST, CSMS, GCS
Do rapid scan for DCAP-BTLS
Rapid Trauma Assessment
DCAP-BTLS
MAX 90 Seconds
Treat life threats AS you find them.
Head: feel scull and look for DCAP-BTLS
Neck: feel for spinal step-off, look for JVD and tracheal deviation
Chest: large rib sweeps, look for chest wall movement, crepitus, subcutaneous emphysema, and paradoxical motion.
Abdomen: palpate four quadrants, look for rigidity, distention, guarding, tenderness or rebound tenderness
Pelvis: DCAP-BTLS, palpate for stability in and then down
Extremities: palpate circumferentially and visually inspect
Back: roll patient on side, palpate back and look for DCAP-BTLS. Do BREATH SOUNDS.
Prioritizing Patients
Level 1: BP < 90 , GCS <= 14, RR < 10 or RR > 29
Level 2: respiratory compromise, penetrating injury proximal to elbow or knee, flail chest, 2 or more proximal long-bone fractures, crushed extremity or amputation proximal to wrist or ankle, pelvic fracture, open/depressed skull fracture, paralysis
Trauma Centers
Level 1: all trauma, 24/7 on call specialized surgeons, teaching program.
Level 2: capable of stabilizing, 24/7 general surgeons, transfer to level 1 for rehab
Level 3/4: limited, stabilization and transport.
Risk for Patients
Falls > 20 FEET
Crash: intrusion, ejection, death of passenger
Car V. Pedestrian
Motorcycle crash > 20 mph
Age: over 55 or child
Burns — burn facility
Pulseless
Pregnancy or need for dialysis
Secondary Assessment
Do en route.
Full body if trauma not isolated.
Reassessment
Chief Complaint
ABCDs
Baseline Vitals
Intervention
Transport Decision
3 Vehicular Collisions
1) Car to car/object
2) Car interior to passenger
3) Organs against solid body structures
Other: objects in car against passenger
Index of Suspicion
Significant Vehicle damage - life threatening injuries
Damage to car: starred windshield, bent steering wheel, airbag deployed - MOI
Death of vehicle occupant - crash severe
Document: safety restraints (lap belt or shoulder belt)
Air bag: if damage indicates they should have been deployed BUT have not have FIRE disable them.
MVC Injuries
Coup-Contrecoup: brain bouncing between skull
Heart tearing aorta
Types of Car Collision
Frontal - look for contact at dash, windows, and restraint injury
Rear-end - whiplash COMMON, thrust forward
Lateral (T-bone) - body lest tolerant, severe injuries to aorta, intrusion of vehicle into passenger, rib injury / lower extremities
Rollover - variable, ejection possible and most life-threatening
Spin - lateral impact may accompany, multiple impacts
Car V. Non-Car
Pedestrian:
- Determine speed of vehicle, if patient was thrown, surface, structural damage of vehicle
Bike:
- Damage to bicycle, spinal cord injury
Motorcycle:
- Distance of skid, deformity of helmet
- Head-On: person keeps moving when object stops
- Angular rider sustains crushing injuries to lower extremities
- Ejection: stopped by object or road drag
- Controlled Crash: technique to separate rider from motorcycle body
Falls
> 20 Feet significant
Landing on feet reduces internal injury BUT increases leg and spine injury likelihood
Penetrating Trauma
Low-Energy: sharp object
- Locate entrance/exit wound
- See angle
Medium and High Velocity: bullet often
- May flatten, tumble or ricochet
- CAVITATION: pressure waves emanating from bullet that causes damage remote from path
Blast
Primary: force of blast
- Ruptures eardrum, lungs, air embolism in pulmonary veins, head trauma (most common cause of death)
Secondary: flying debris
Tertiary: hurled by force
Quaternary: burns or inhalation from gas, collapse of building
