Chapter 25 Trauma Overview Learning Objectives
Discuss the three specific factors to consider during assessment of a patient who has been injured in a fall, plus additional considerations for pediatric and geriatric patients. (pp 912-913)
- Higher the fall, greater the potential for injury - Internal injuries least noticeable, pose the greatest life threat - Patients who fall on feet may have less severe injuries - Head first will have serious head and seminal injuries - Most falls not the result of high-energy trauma, result in broken bones - Only high-energy trauma if fall is 20 feet or more
Discuss the American College of Surgeons Committee on Trauma classification of trauma centers.
Level 1; -24 hour general surgeons -Available care in all specialties -Cardiac, hand, pedi, and microvascular surgery and hemodialysis Level 2; -24 hour general surgeons -ortho,nureo,anesthesiology,emergency, radiology, and critical care Level 3; -24 hour emergency medicine doctors, and prompt availability of surgeons Level 4; ATLS protocols and 24 hour lab -Transfers to higher level trauma centers
Discuss the effects of high-, medium-, and low-velocity penetrating trauma on the body and how an understanding of each type helps EMTs form an index of suspicion about unseen life-threatening injuries.
Low-energy: Caused by sharp edges of object moving through body; knifes can be moved around internally and cause more damage than external wound would suggest Medium and High Velocity: the path of the projectile may not be easy to predict.bullet can ricochet within body before exiting and fragmentation can increase damage. Cavitation is caused by bullet acceleration
Define the terms mechanism of injury (MOI), blunt trauma, and penetrating trauma. (pp 901, 904)
MOI: the way in which traumatic injures occur; it describes the forces acting on the body that can cause injury. Blunt trauma: the result of force to the body without penetrating the soft tissues or internal organs and cavities. When you come across blunt trauma, maintain high index of suspicion Penetrating trauma: causes injury by object that primarily pierce and penetrate the body and cause damage to soft tissues, internal organs, and body cavities
Provide examples of the MOI that would cause blunt and penetrating trauma to occur. (pp 904-915)
Motor vehicle crashes and falls are two of the most common MOIs for blunt trauma. Stab wounds and gunshot wounds are MOI's for penetrating trauma.
Describe multi system trauma and the special considerations that are required for patients who fit this category.
Multi-system trauma is a term that describes a person who has been subjected to multiple traumatic injuries involving more than one body system, such as head, and spinal trauma, chest and abdominal trauma, or chest and multiple extremity trauma. You must recognize patients who fit into this classification and provide rapid treatment and transportation and alert medical control as to the nature of the patient's injuries so that the trauma center is prepared prior to your arrival. Multi-system trauma patients have a high level of morbidity and mortality, therefore, they require teams of physicians to treat their injuries.
Explain the relationship of the MOI to potential energy, kinetic energy, and work. (pp 901-902)
Potential energy = objects position reletive to another object exe. The ground and a man on a ladder. Potential energy is converted into kinetic energy if he falls. Kinetic energy is the energy of a moving object. It is converted into work. Work is brings the body to a stop.
Explain trauma patient management in relation to scene time and transport selection.
Scene Time: Because survival of critically injured trauma patients is time dependent, limit on-scene time to the minimum amount necessary to correct life-threatening injuries and package the patient. Optimally, on-scene time for critically injured patients should be less than 10 minutes—the platinum 10. Transport Selection: Modes of transport ultimately come in one of two categories: ground or air. Ground transportation EMS units are generally staffed by EMTs and paramedics. Air transportation EMS units or critical care transport units are often staffed by critical care transport professionals such as critical care nurses and paramedics.
Explain the major components of trauma patient assessment; include considerations related to whether the MOI was significant or nonsignificant.
-Begin by assessing and managing the airway, including ventilatory support and high-flow oxygen, while maintaining cervical spine immobilization. -Ensure that basic shock therapy, such as controlling hemorrhages, stopping arterial bleeding, and keeping the patient warm, is completed. -If bleeding cannot be controlled rapidly by direct pressure, use a tourniquet. -During transport, obtain a SAMPLE history and complete a secondary assessment. -For critically injured patients, consider ALS intercept and/or air medical transportation. -Ensure that the patient is transported to an appropriate facility and that the facility is notified as soon as possible
Discuss the special assessment considerations related to a trauma patient who has injuries in each of the following areas: head, neck and throat, chest, and abdomen.
-Head-frequent neurological examinations -Neck and Throat- Frequent physical examinations DCAP-BTLS-TIC, JVD, Tracheal Deviation -Chest- DCAP-BTLS-TIC, lung sounds, chest rise and fall, flail chest
Describe the five types of motor vehicle collisions, the injury patterns associated with each one, and how it relates to the index of suspicion of life threatening injuries.
-Lateral Collisions- if there is substantial intrusion into the passenger compartment you should suspect the patient to have lateral chest and abdomen injuries on the side of impact as well as possible fractures to the lower extremities, pelvis, and ribs -Rollover Crashes- Passengers can be struck several times during the rotation. Passengers who have been ejected will have sustained the blunt trauma of ejecting through a surface. -Rotational Collisions- Basically the same as rollover. The rotation of the vehicle as it spins provides opportunities for the vehicle to strike objects such as utility poles. -Frontal Collisions- Up-and-Over Pathway in which upper steering impacts femurs, abdominal contents compressed, head propels into windshield. Down-and-Under Pathway in which occupants slide downward, knees impact dash, upper body rotates forward, and chest impacts steering column Head injuries and seatbelt injuries can occur -Rear End Collisions: occurs when a person's head moves backward and then forward suddenly with great force. Be weary of whiplash injuries
Discuss primary, secondary, tertiary, and miscellaneous blast injuries and the anticipated damage each one will cause to the body.
Primary: Blast wave itself damages via pressure waves/burns. Affects air filled organs by rupturing and tearing *lungs, ears and intestines. Secondary: Projectiles thrown by blast waves tear away tissues (amputations) Tertiary: Injuries due to impact with another object/ground Miscellaneous: Burns from hot gases or fires started by the blast; respiratory injury from inhaling toxic gases; crush injury from the collapse of a building
List the criteria for the appropriate use of helicopter emergency medical services.
There is an extended period required to access or extricate a remote or trapped patient, which depletes the time window to get the patient to the trauma center by ground. Distance to the trauma center is greater than 20 to 25 miles. The patient needs medical care and stabilization at the ALS level, and there is no ALS-level ground ambulance service available within a reasonable time frame. Traffic conditions or hospital availability make it unlikely that the patient will get to a trauma center within the ideal time frame for best clinical outcome. There are multiple patients who will overwhelm resources at the trauma center(s) reachable by ground within the time window. EMS systems require bringing a patient to the nearest hospital for initial evaluation and stabilization, rather than bypassing those facilities and going directly to a trauma center. This may add delay to definitive surgical care and necessitate air transport to mitigate the impact of that delay. There is a mass-casualty incident
