Lesson 12: Trauma Overview, Ch. 24 - EMT.

Which of the following injuries can be used to assist in triaging patients because they indicate risk of pressure injuries to the lungs? a) Arterial air embolism. b) Disturbances in vision. c) Tympanic membrane injuries. d) Subarachnoid injuries.

c) Tympanic membrane injuries.

The body has increasing difficulty in compensating for shock & traumatic injuries after how long?

60 minutes.

In the case of a motor vehicle crash, the energy of the speeding vehicle is converted into the work of stopping the vehicle, which is accomplished by:

crushing the vehicle's exterior.

Which of the following is NOT true regarding digital photos of a crash scene? a) Photos may become part of the medical record. b) Photos may need to be deleted after review by health care providers. c) Photos may provide valuable information to treating physicians. d) Photos can be shared over social media.

d) Photos can be shared over social media.

Coup-contrecoup brain injury:

A brain injury that occurs when force is applied to the head & energy transmission through brain tissue causes injury on the opposite side of original impact.

Contusion:

A bruise from an injury that causes bleeding beneath the skin without breaking the skin; also see ecchymosis.

Pulmonary edema:

A buildup of fluid in the lungs, usually as a result of congestive heart failure.

Subcutaneous emphysema:

A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues.

Hemothorax:

A collection of blood in the pleural cavity. Causes interference with breathing.

Syncope:

A fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to the brain.

DCAP-BTLS:

A mnemonic for assessment in which each area of the body is evaluated for Deformities, Contusions, Abrasions, Punctures/penetrations, Burns, Tenderness, Lacerations, & Swelling. *In addition, you should also assess for jugular venous (vein) distention & tracheal deviation (late sign of injury).

Revised Trauma Score (RTS):

A scoring system used for patients with head trauma.

Concussion:

A temporary loss or alteration of part or all of the brain's abilities to function without actual physical damage to the brain.

Glasgow Coma Scale (GCS) score:

An evaluation tool used to determine level of consciousness, which evaluates & assigns point values (scores) for eye opening, verbal response, & motor response, which are then totaled; effective in helping predict patient outcomes.

Which of the following injuries would NOT be a primary blast injury? a) Suffocation. b) Limb amputation. c) Rupture of eardrums. d) Disruption of major blood vessels.

a) Suffocation.

Which of the following mnemonics works BEST when assessing a trauma patient? a) SAMPLE. b) DCAP-BTLS. c) OPQRST. d) None of these answers are correct.

b) DCAP-BTLS.

Air bags provide the final capture point of the passengers &:

decrease the severity of deceleration injuries by allowing seat belts to be more compliant & by gently cushioning the occupant as the body slows, or decelerates.

When a driver is in a car equipped with an air bag, but is not wearing a seatbelt, he or she will MOST likely strike the __________ when the air bag deploys upon impact.

door

Bradycardia:

slow heart rate (less than 60 bpm).

What level of trauma center provides prompt assessment, resuscitation, & stabilization of injured patients & emergency operations, but not definitive care for all patients?

Level III.

Which level of trauma center would fit the definition that includes "able to provide prompt assessment, resuscitation, & stabilization of injured patients & emergency operations"?

Level III.

Traction:

Longitudinal force applied to a structure.

abrasion:

Loss or damage of the superficial layer of skin as a result of a body part rubbing or scraping across a rough or hard surface.

Constantly & consistently reevaluate the:

MOI to rule out the possibility that the patient has a more significant injury than initially suspected or identified during the initial phases of care provided at the scene.

When assessing the interior of a crashed motor vehicle for damage, you are gathering info. regarding the:

Mechanism of injury.

A 30-year-old male sustained a stab wound to the neck when he was attacked outside a nightclub. During your assessment, you should be MOST alert for:

Potential airway compromise.

At what step in the ACS-COT/CDC updated field triage decision scheme would you assess mechanism of injury & evidence of high-energy impact?

Step 3.

Hollow organs:

Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, & bladder.

Why should on-scene time be limited to 10 minutes or less for trauma patients?

Surgical intervention is usually required.

Tympanic membrane:

The eardrum; a thin, semitransparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of auditory ossicles. *The tympanic membrane evolved to detect minor changes in pressure & will rupture at pressures of 5 to 7 pounds per square inch above atmospheric pressure. Thus, the tympanic membranes are a sensitive indicator that you can use to help determine the possible presence of other blast injuries. *Patient may report ringing in the ears, pain in the ears, or some loss of hearing, & blood may be visible in the ear canal. *Dislocation of structural components of the ear, such as the ossicles conforming the inner ear, may occur. Permanent hearing loss is possible. These findings can be used to assist in triaging patients as they indicate risk of pressure injuries to the lungs.

Retrograde amnesia:

The inability to remember events leading up to a head injury.

3 concepts of energy are typically associated with injury (not including thermal injury, which causes burns):

potential energy, kinetic energy, & the energy of work.

Tissues at Risk. Organs that contain air, such as the middle ear, lung, & gastrointestinal tract, are most susceptible to:

pressure changes.

Which of these reasons would be an appropriate use of emergency air medical services for trauma patients? a) Traffic conditions or hospital availability make it unlikely that the patient will get to trauma center via ground within ideal time frame. b) There is a mass casualty incident. c) Distance to the trauma center is greater than 20 to 25 miles. d) All of these answers are correct.

d) All of these answers are correct.

Which of the following would MOST likely result from the third collision in the three-collision effect that occurs during a high-speed, frontal impact, motor vehicle collision? a) Extensive damage to the automobile. b) Flail chest & lower extremity fractures. c) Massive external trauma with severe bleeding. d) Aortic rupture or compression injury to the brain.

d) Aortic rupture or compression injury to the brain.

Which category of blast injuries includes mental health emergencies? a) Primary. b) Secondary. c) Tertiary. d) Quaternary.

d) Quaternary.

Which of the following has the greatest impact on producing injury? a) Distance. b) Mass. c) Gravity. d) Speed.

d) Speed.

Work is defined as:

force acting over a distance. *For example: the force needed to bend metal multiplied by the distance over which the metal is bent is the work that crushes the front end of a vehicle that is involved in a frontal impact. Similarly, forces that bend, pull, or compress tissues beyond their inherent limits result in the work that causes injury.

Motor vehicle crashes are classified traditionally as:

frontal (head-on), rear-end, lateral (T-bone), rollovers, & rotational (spins). *The principal difference among these crash types is the direction of the force of impact; also, with spins & rollovers, there is the possibility of multiple impacts.

Type of Transport. As discussed in Ch. 14, Medical Overview, modes of transport ultimately come in one of two categories:

ground or air. *Ground transportation EMS units are generally staffed by EMTs & paramedics. *Air transportation EMS units or critical care transport units are often staffed by critical care transport professionals such as critical care nurses & paramedics.

In contrast to a Level III trauma center, a Level I trauma center must:

have general surgeons who are in-house 24 hours a day.

Mechanism Of Injury (MOI):

is the way in which traumatic injuries occur; it describes the forces (or energy transmission) acting on the body that cause injury.

Different types of MOIs will produce:

many types of injuries. - Examples of nonsignificant injuries include injury to an isolated body part or a fall without the loss of consciousness. - Examples of significant MOIs include injury to more than 1 body system (multisystem trauma), falls from heights, motor vehicle & motorcycle crashes, car vs. pedestrian (AKA, auto vs. pedestrian) (or bicycle or motorcycle), gunshot wounds, & stabbings. *Whether 1 body system or more than 1 system is involved, maintain a high index of suspicion for serious unseen injuries.

Kinetic energy is a calculation of:

mass & velocity.

Kinetic energy reflects the relationship between the:

mass (weight) of the object & the velocity (speed) at which it is traveling.

Ejection & partial ejection are significant:

mechanisms of injury; in these cases, prepare to care for life-threatening injuries.

The ear is the organ system that is:

most sensitive to blast injuries.

Lateral or side impacts (commonly called T-bone crashes) are a very common cause of death associated with:

motor vehicle crashes.

When caring for victims of traumatic injuries, what should an EMT do to avoid delays in treatment & transport?

Call for ALS & helicopter assistance early.

The phenomenon that results from the rapid changes in tissue & fluid pressure that occur with the passage of a projectile, resulting in serious injury to internal organs distant to the actual path of the bullet, is known as what?

Cavitation.

A penetration or perforation of the integrity of the chest wall is called an:

open chest wound. *As air enters the chest cavity, the natural pressure balance within the chest cavity is no longer equal. If left untreated, shock and/or death will result. *Regardless of the particular injury, it's imperative that you reassess a trauma patient's chest region every 5 minutes. The assessment should include DCAP-BTLS, lung sounds, & chest rise & fall. Some patients will not have obvious signs or symptoms such as absent breath sounds or respiratory difficulty immediately.

Petechiae:

or, pinpoint reddish-purple hemorrhages that show up on the skin or in the mucous membranes (mouth or eyelids), as a result of bleeding. *Petechiae are a sign of blood leaking from the capillaries under your skin.

Kinetic energy:

The energy of a moving object.

Motor vehicle crashes & falls are the 2 most common MOIs for:

blunt trauma. *When proving care for your patient, be alert to signs of skin discoloration or reports of pain because these may be the only signs of blunt trauma. During assessment, maintain a high index of suspicion for hidden (internal) injuries in patients with blunt trauma.

While assessing a young male who was struck in the chest with a steel pipe, you note that his pulse is rapid & irregular. You should be MOST suspicious for:

bruising of the heart muscle.

Which of the following patients has experienced the MOST significant fall? a) A 4'8" patient who fell 12 ft. b) A 5'0" patient who fell 13 ft. c) A 4'6" patient who fell 13 ft. d) A 5'9" patient who fell 14 ft.

c) A 4'6" patient who fell 13 ft.

All of the following are concepts of energy, EXCEPT: a) The energy of work. b) Potential energy. c) Expressed energy. d) Kinetic energy.

c) Expressed energy.

Which of the following could be considered a secondary blast injury? a) Disruption of major blood vessels caused by the pressure wave. b) Burns from hot gases or flames. c) Injuries sustained when flying debris strikes the victim. d) An injury caused when the patient falls to the ground.

c) Injuries sustained when flying debris strikes the victim.

Which of the following statements regarding the first collision that occurs during a motor vehicle crash is correct? a) It provides the least amount of info. about the mechanism of injury. b) It has a direct effect on patient care because of the obvious vehicular damage. c) It is the most dramatic part of the collision & may make extrication difficult. d) It occurs when the unrestrained occupant collides with the interior of the vehicle.

c) It is the most dramatic part of the collision & may make extrication difficult.

In which type of vehicle crash are you most likely to find a patient with whiplash injuries? a) Rotational. b) Rollover. c) Rear-end. d) Frontal.

c) Rear-end.

For the symptoms of noisy or labored breathing, decreasing or low Glasgow Coma Scale (GCS) score; & a rapid, weak pulse, which of the following injuries would you expect? a) Broken ribs. b) Bruising to the brain & in & around brain tissue. c) Significant bleeding or foreign bodies in the upper or lower airway. d) All of these answers are correct.

c) Significant bleeding or foreign bodies in the upper or lower airway.

Which of the following might be the only sign of blunt trauma? a) Skin lacerations. b) Marks on skin. c) Skin discoloration. d) Skin abrasion.

c) Skin discoloration.

If a person is standing near a building that explodes, which of the following injuries would he or she MOST likely experience as a result of the pressure wave? a) Severe burns. b) Fractured bones. c) Stomach rupture. d) Impaled objects.

c) Stomach rupture.

Tachypnea:

increased respiratory rate.

What type of blast injury occurs when objects are propelled by the force of the blast wave & strike the victim, causing injury?

Secondary.

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 & package the patient. Optimally, on-scene time for critically injured patients should be less than 10 minutes-- the platinum ten. The following criteria will help you identify a critically injured patient:

- Dangerous MOI. - Decreased level of consciousness. - Any threats to airway, breathing, or circulation. Patients who present with these criteria or who are very young or old or have chronic illness should also be considered to be high risk, thus requiring rapid treatment & transport.

The amount of damage considered significant varies, depending on the type of crash, but any substantial deformity of the vehicle should be enough cause for you to consider transporting the patient to a trauma center. Significant mechanisms of injury are suggested by the following findings:

- Death of an occupant in the vehicle. - Severe deformity of the vehicle or intrusion into the vehicle. - Severe deformities of the frontal part of the vehicle, with or without intrusion into the passenger compartment. - Moderate intrusions from a lateral (T-bone) type of accident. - Severe damage from the rear. - Crashes in which rotation is involved (rollover & spins). - Ejection from the vehicle.

The major components of patient assessment include the following:

- Scene size-up. - Primary assessment. - History taking. - Secondary assessment. - Reassessment. *When you are caring for a patient who has experienced a significant MOI & the patient is considered to be in serious or critical condition, you should rapidly perform a physical examination. *With a patient who has experienced a nonsignificant MOI, focus on the chief complaint while assessing the patient as a whole.

Type of Transport. You should be familiar with your local protocols defining indications for use of air medical transport. The Association of Air Medical Services & MedEvac Foundation International identified the following criteria in the 2006 white paper, Air Medicine: Accessing the Future of Healthcare, for consideration in deciding the appropriate use of emergency air medical services for trauma patients:

- There's an extended period required to access or extricate a remote (eg, injured hiker, snowmobiler, or boater) or trapped patient (eg, in a crashed car) 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 & stabilization at the ALS level, & there's 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 via ground ambulance 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 & stabilization, rather than bypassing those facilities & going directly to a trauma center. This may add delay to definitive surgical care & necessitate air transport to mitigate the impact of that delay. - There's a mass-casualty incident. *These recommendations are not to be understood as fully encompassing, but more as a guideline for local decision makers to develop more comprehensive protocols for the use of air medical transport. Always follow your local protocols when determining what type of patient transportation is appropriate.

The 3 collisions in a typical impact are as follows:

1. "Collision of the car against another car, tree, or some other object. Damage to the car is perhaps the most dramatic part of the collision, but it doesn't directly affect patient care, except possibly making an extrication difficult. However, it does provide info. about the severity of the collision &, therefore, has an indirect effect on patient care. The greater the damage to the car, the greater the energy that was involved &, therefore, the greater the potential to cause injury to patient. By assessing the vehicle that has crashed, you can often determine the MOI, which may allow you to predict what injuries may have happened to the passengers at the time of impact according to forces that acted on their bodies. When you arrive at the crash scene & perform your scene size-up, quickly inspect the severity of damage to the vehicle(s). If there's significant damage to a vehicle, your index of suspicion for the presence of life-threatening injuries should automatically increase. A great amount of force is required to crush & deform a vehicle, cause intrusion into the passenger compartment, tear seats from their mountings, & collapse steering wheels. Such damage suggests the presence of high-energy trauma." 2. "Collision of the passenger against the interior of the car. Just as the kinetic energy produced by the vehicle's mass & velocity is converted into the work of bringing the vehicle to a stop, the kinetic energy produced by the passenger's mass & velocity is converted into the work of stopping his/her body. Just like the obvious damage to the exterior of the car, the injuries that result are often dramatic & usually immediately apparent during your scene size-up or primary assessment. Common passenger injuries include lower extremity fractures (knees into the dashboard), rib fractures (rib cage into the steering wheel), & head trauma (head into the windshield). Such injuries occur more frequently if the passenger isn't restrained. But even when the passenger is restrained with a properly adjusted seatbelt, injuries can occur, especially in lateral & rollover impacts." 3. "Collision of the passenger's internal organs against the solid structures of the body. The injuries that occur during the 3rd collision may not be as obvious as external injuries, but they're often the most life-threatening. For example, as the passenger's head hits the windshield, the brain continues to move forward until it comes to rest by striking the inside of the skull. This results in a compression injury (or bruising) to the anterior portion of the brain & stretching (or tearing) of the posterior portion of the brain. This is an example of a coup-contrecoup brain injury. Similarly, in the thoracic cage, the heart may slam into the sternum, which may rupture the aorta & cause fatal bleeding."

When your patient is a child, the following constitute a significant MOI:

1. Falls of greater than 10 ft (3 m) (or 2 to 3 times the height of the child). 2. Medium-to high-speed vehicle crash (>25 mph). *Also note that young children are top-heavy, so they tend to land on their heads even from short falls. Triage children to a pediatric trauma center if possible.

There are 4 types of motorcycle impacts:

1. Head-on crash: Motorcycle strikes another object & stops its forward motion while the rider & parts of the motorcycle that are broken off continue their forward motion until stopped by an outside force, such as drag from the road or another opposing force from a secondary collision. 2. Angular crash: Motorcycle strikes an object or another vehicle at an angle so that the rider sustains direct crushing injuries to the lower extremity between the object & the motorcycle. This usually results in severe open & comminuted ((of a fracture) producing multiple bone splinters) lower extremity injuries with severe neurovascular compromise, often requiring surgical amputation. 3. Ejection. Rider will travel at high speed until stopped by a stationary object, another vehicle, or by road drag. Severe abrasion injuries (road rash) down to bone can occur with drag. An unpredictable combination of blunt injuries can occur from secondary collisions. 4. Controlled crash. A technique used to separate the rider from the body of the motorcycle & the object to be hit is referred to as laying the bike down. It was developed by motorcycle racers & adapted by street bikers as a means of achieving a controlled crash. As a crash approaches, the motorcycle is turned flat & tipped sideways at 90 degrees to the direction of travel so that 1 leg is dropped to the grass or asphalt. This slows the occupant faster than the motorcycle, allowing the rider to become separated from the motorcycle. If properly protected with leather or synthetic abrasion-resistant gear, injuries should be limited to those sustained by rolling over the pavement & any secondary collision that may occur. When executed properly, this maneuver prevents the rider from being trapped between the bike & the object. However, a rider unable to clear the bike will continue into the vehicle, often with devastating results.

Blast injuries. Although most commonly associated with military conflict, blast injuries are also seen in civilian practice in mines, shipyards, chemical plants, &, increasingly, in association with terrorist activities. As with any explosion there is a risk of contamination of patients from environmental contaminants, toxic chemicals, or dirty bombs. People who are injured in explosions may be injured by any of 4 different mechanisms:

1. PRIMARY BLAST INJURIES. These injuries are due entirely to the blast itself; that is, damage to the body is caused by the pressure wave generated by the explosion. When the victim is close to the blast, the blast wave may cause disruption of major blood vessels & rupture of eardrums & major organs, including the lungs. Hollow organs are the most susceptible to the pressure wave. In some cases, pressure wave injuries can amputate limbs. 2. SECONDARY BLAST INJURIES. Damage to the body results from being struck by flying debris, such as shrapnel from the device or from gas or splinters, which have been set in motion by the explosion. Objects are propelled by the force of the blast wave & strike the victim, causing injury. These objects can travel great distances & be propelled at tremendous speeds, up to nearly 3,000 mph for conventional military explosives. 3. TERTIARY BLAST INJURIES. These injuries occur when the patient is hurled by the force of the explosion against a stationary object. A blast wind (sudden change in the surrounding atmosphere) creates a pressure wave. This can cause the patient's body to be hurled or thrown, resulting in further injury. This physical displacement of the body is also referred to as ground shock when the body impacts the ground. 4. QUATERNARY BLAST INJURIES. This category of miscellaneous injuries includes burns from hot gases or fires started by the blast; respiratory injury from inhaling toxic gases; suffocation; poisoning; medical emergencies incurred as a result of the explosion; crush injuries from the collapse of buildings; contamination of wounds from environmental, chemical, or toxic substances; & mental health emergencies. *Most patients who survive an explosion will have some combination of the 4 types of injuries mentioned.

Traumatic injuries can be considered in 2 categories:

1. blunt trauma 2. penetrating trauma

You are assessing a patient who was in a front-end car crash. His GCS is 12, systolic blood pressure is 81 mm Hg, & respiratory rate is 22 breaths/min. What is this patient's Revised Trauma Score?

10. *This patient's RTS is 10: GCS of 12 = 3, SBP of 81 mm Hg = 3, & RR of 22 breaths/min = 4.

You are assessing a patient who opens her eyes when you speak to her, who can respond to you but seems confused as to time & place, & localizes pain. What is her Glasgow Coma Scale score?

12. *This patient would have a GCS score of 12: 3 for eye opening, 4 for confused conversation, & 5 for localizing pain.

How many categories of trauma are there?

2.

Motor vehicle crashes typically consist of a series of:

3 collisions.

How many collisions are there in a typical vehicle impact?

3.

During your assessment of a patient with a head injury, you note that he opens his eyes when you pinch his trapezius muscle, is mumbling, & has his arms curled in toward his chest. You should assign him a GCS score of:

7.

Cavitation:

A phenomenon in which speed causes a bullet to generate pressure waves, which cause damage distant from the bullet's path. *Consequences of cavitation can be temporary or permanent. *Temporary cavitation injury results from a stretching of the tissues that occurs with the pressure changes. *Permanent cavitation injury results closer to the bullet path where the pressure fluctuations are greatest & remains after the projectile has passed through the tissue. Remain alert during assessment because patients will exhibit various signs & symptoms depending on the organ(s) affected.

Trauma Score:

A score calculated from 1 to 16, with 16 being the best possible score. It relates to the likelihood of patient survival with the exception of a severe head injury. It takes into account the Glasgow Coma Scale (GCS) score, respiratory rate, respiratory expansion, systolic blood pressure, & capillary refill.

Tension pneumothorax:

An accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results.

Blunt trauma:

An impact on the body by objects that cause injury without penetrating soft tissues or internal organs & cavities.

When treating a patient who experienced a pulmonary blast injury, you should:

Avoid giving oxygen under positive pressure.

index of suspicion:

Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury.

Hypotension:

Blood pressure that is lower than the normal range.

A small compact car was involved in a rollover crash. As you are approaching the vehicle, you note that the roof is significantly collapsed. The patient, a 29-year-old male, is complaining of severe pain in his neck & to the top of his head as well as numbness & tingling in his extremities. Witnesses who removed the patient from the vehicle state that he was wearing his seatbelt. What injury mechanism is MOST likely responsible for this patient's condition?

Compression of the head against the roof.

Destination Selection. You'll often be summoned to accident scenes to transport critically ill trauma patients to definitive care. For this reason, it's important for you to be familiar with how the American College of Surgeons' Committee on Trauma (ACS-COT) classifies trauma care. Trauma centers are classified into Levels I through IV, with Level I having the most resources followed by Levels II, III, & IV, respectively. Table 24-2 Key Elements for Trauma Centers. Level I:

Definition: A comprehensive regional resource that is a tertiary care facility; capable of providing total care for every aspect of injury-- from prevention through rehabilitation. Key Elements: 1. 24-hour in-house coverage by general surgeons. 2. Availability of care in specialties such as orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, & critical care. 3. Should also include cardiac, hand, pediatric, & microvascular surgery & hemodialysis. 4. Provides leadership in prevention, public education, & continuing education of trauma team members. 5. Committed to continued improvement through a comprehensive quality assessment program & organized research to help direct new innovations in trauma care.

Table 24-2 Key Elements for Trauma Centers. Level II:

Definition: Able to initiate definitive care for all injured patients. Key Elements: 1. 24-hour immediate coverage by general surgeons. 2. Availability of orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, & critical care. 3. Tertiary care needs such as cardiac surgery, hemodialysis, & microvascular surgery may be referred to a Level I trauma center. 4. Committed to trauma prevention & continuing education of trauma team members. 5. Provides continued improvement in trauma care through a comprehensive quality assessment program.

Table 24-2 Key Elements for Trauma Centers. Level IV:

Definition: Able to provide advanced trauma life support (ATLS) before transfer of patients to a higher level trauma center. Key Elements: 1. Includes basic emergency department facilities to implement ATLS protocols & 24-hour laboratory coverage. 2. Transfer to higher level trauma centers follows the guidelines outlined in formal transfer agreements. 3. Committed to continued improvement of these trauma care activities through a formal quality assessment program. 4. Involved in prevention, outreach, & education within its community.

Table 24-2 Key Elements for Trauma Centers. Level III:

Definition: Able to provide prompt assessment, resuscitation, & stabilization of injured patients & emergency operations. Key Elements: 1. 24-hour immediate coverage by emergency medicine physicians & prompt availability of general surgeons & anesthesiologists. 2. Program dedicated to continued improvement in trauma care through a comprehensive quality assessment program. 3. Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II trauma center. 4. Committed to continuing education of nursing & allied health personnel or the trauma team. 5. Must be involved with prevention & have an active outreach program for its referring communities.

Trauma emergencies:

Emergencies that are the result of physical forces applied to the body; injuries.

Medical emergencies:

Emergencies that require EMS attention because of illnesses or conditions NOT caused by an outside force.

Two of the MOST common mechanisms of injury for blunt trauma are:

Falls & motor vehicle collisions.

You would use the Revised Trauma Score scoring system for a patient if there is potential for what type of trauma?

Head.

Evaluation of the interior of a crashed motor vehicle during extrication will allow the EMT to:

Identify contact points & predict potential injuries.

Penetrating Trauma:

Injury caused by objects, such as knives & bullets, that pierce the surface of the body & damage internal tissues & organs.

The energy of a moving object is called:

Kinetic Energy (KE).

Kinetic energy is expressed as:

Kinetic energy = ½ mass × velocity² or, KE = ½ m × v²

According to the Journal of Safety Research, which type of crash causes approx. 30% of all fatalities that occur in motor vehicle crashes?

Lateral.

Pulmonary blast injuries:

Pulmonary trauma resulting from short-range exposure to the detonation of high-energy explosives. *Or, in other words, Pulmonary blast injuries are defined as pulmonary trauma (consisting of contusions & hemorrhages) that results from short-range exposure to the detonation of explosives.

drag:

Resistance that slows a projectile, such as air.

Trajectory:

The path a projectile takes once it is propelled.

Potential energy:

The product of mass (weight), gravity, & height, which is converted into kinetic energy & results in injury, such as from a fall.

Deceleration:

The slowing of an object.

The driver of a sport utility vehicle lost control & struck a utility pole head-on. The driver was killed instantly. The passenger, a young female, is conscious & alert & has several small abrasions & lacerations to her left forearm. Treatment for the passenger should include:

Transport to a trauma center.

If a patient has a penetrating injury to the neck that results in an open wound, what should the EMT do?

Use occlusive dressings.

Multisystem trauma is a term that describes:

a person who has been subjected to multiple traumatic injuries involving more than 1 body system such as head & spinal trauma, chest & abdominal trauma, or chest & multiple extremity trauma. *You must recognize patients who fit into this classification & provide rapid treatment & transportation, & alert medical control as to the nature of the patient's injuries so that the trauma center is prepared prior to your arrival. *Multisystem trauma patients have a high level of morbidity & mortality; therefore, they require teams of physicians to treat their injuries. These teams may include specialists such as neurosurgeons, thoracic surgeons, & orthopaedic surgeons.

Which of the following is important to do when treating a patient with penetrating trauma? a) Determine the length of the penetrating object. b) Determine which organs would be affected. c) Measure the size of the tear in the tissue. d) Look for additional trauma.

a) Determine the length of the penetrating object.

Which of the following is an example of a nonsignificant injury? a) Injury to an isolated part of the body. b) A fall from a 25-foot scaffold. c) A motor vehicle accident with a car going 30 mph. d) A shallow gunshot wound.

a) Injury to an isolated part of the body.

Factors that should be considered when assessing a patient who has fallen include all of the following, EXCEPT: a) The speed of the fall. b) The surface struck. c) The height of the fall. d) The primary impact point.

a) The speed of the fall.

Which of the following would be considered a significant mechanism of injury? a) Death of an occupant in the vehicle. b) Motor vehicle collision greater than 40 mph or motorcycle crashes greater than 20 mph. c) A car-versus-pedestrian accident greater than 15 mph. d) All of these answers are correct.

d) All of these answers are correct.

Blunt trauma results from:

an object making contact with the body. *Any object, for example a baseball bat, can cause blunt trauma if it's moving fast enough.

When evaluating the mechanism of injury of a car-versus-pedestrian collision, you should first:

approximate the speed of the vehicle that struck the pedestrian.

1 of the most concerning pulmonary blast injuries is:

arterial air embolism (air bubbles in the arterial blood vessels). *Even small air bubbles can enter a coronary artery & cause myocardial injury. Air embolisms to the cerebrovascular system can produce disturbances in vision, changes in behavior, changes in state of consciousness, & a variety of other neurologic signs.

Which of the following would cause blunt trauma? a) A gunshot wound. b) A motor vehicle collision. c) A stab wound. d) None of these answers are correct.

b) A motor vehicle collision.

Which of the following occurs when a medium- or high-velocity object enters the body & creates rapid changes in tissue & fluid pressure that occur with the passage of the projectile? a) Penetrating trauma. b) Cavitation. c) Blunt trauma. d) None of these answers are correct.

b) Cavitation.

All of the following are criteria that can help identify a critically injured patient, EXCEPT: a) decreased level of consciousness. b) Injuries to the head. c) Dangerous MOI. d) Any threats to ABC.

b) Injuries to the head.

A patient is suffering from decreasing blood pressure, asymmetrical chest wall movement, & a narrow pulse pressure. You should have a high index of suspicion for which of the following conditions? a) Injury to the bones of the spinal column or spinal cord. b) Pneumothorax or hemothorax. c) Bruising to the brain. d) Significant bleeding or foreign bodies in the upper or lower airway.

b) Pneumothorax or hemothorax.

When assessing a patient who fell, you need to estimate all of the following, EXCEPT: a) The surface he/she landed on. b) The speed at which the person hit the ground. c) The height from which the patient fell. d) All of these answers are correct.

b) The speed at which the person hit the ground.

Which of the following would be considered multisystem trauma? a) Head & spinal trauma. b) Chest & abdominal trauma. c) Chest & multiple extremity trauma. d) All of these answers are correct.

d) All of these answers are correct.

Passengers who are seated in the rear of a vehicle & are wearing only lap belts have a higher incidence of injuries to the ______________ spine during a rear-end crash. a) Thoracic & sacral. b) Lumbar & coccygeal. c) Thoracic & lumbar. d) Lumbar & sacral.

c) Thoracic & lumbar.

Which of the following statements regarding low-energy penetrating injuries is correct? a) Internal injuries caused by low-velocity bullets are usually easy to predict. b) Exit wounds are typically easy to locate with low-energy penetrating injuries. c) It is usually easy to differentiate between an entrance wound & an exit wound. d) The area of injury is usually close to the path the object took through the body.

d) The area of injury is usually close to the path the object took through the body.

Neurologic injuries & head trauma are the most common causes of:

death from blast injuries. *Subarachnoid (beneath the arachnoid layer covering the brain) & subdural (beneath the outermost covering of the brain) hematomas are often seen. *Permanent or transient neurologic deficits may be secondary to concussion, intracerebral bleeding, or air embolism. *Instant but transient unconsciousness, with or without retrograde amnesia, may be initiated not only by head trauma, but also by cardiovascular problems. Bradycardia & hypotension are common after an intense pressure wave from an explosion.

Rollover crashes. The most common life-threatening event in a rollover is:

ejection or partial ejection of the passenger from the vehicle. *Passengers who have been ejected may have struck the interior of the vehicle many times before ejection. The passenger may also have struck several objects, such as trees, a guardrail, or the vehicle's exterior, before landing. *Passengers who have been partially ejected may have struck both the interior & exterior of the vehicle & may have been sandwiched between the exterior of the vehicle & the environment as the vehicle rolled. *A passenger on the outboard side of a vehicle that rolls over is at high risk for injury because of the centrifugal force (the patient is pinned against the door of the vehicle).

When considering the effects of energy on the human body, it is important to remember that:

energy can be neither created nor destroyed, but can only be converted or transformed.

Similarly, medical illnesses may result from:

recent or remote traumatic injuries (pneumonia develops in a patient a few days after a fall that fractures the patient's ribs).

When you notice a collapsed steering wheel during scene size-up, suspect:

serious chest injuries even if the driver initially has no visible signs of chest injury.

The abdomen is an area of the human body that contains many organs vital to body function. These organs also require a very high amount of blood flow so they can perform the functions necessary for life. The organs of the abdomen & retroperitoneum (the space immediately behind the true abdomen) can be classified into 2 simple categories:

solid & hollow. - The solid organs include the liver, spleen, pancreas, & kidneys. - The hollow organs include the stomach, large & small intestines, & urinary bladder. *When injuries from trauma occur in this region of the body, serious & life-threatening problems may occur. The solid organs may tear, lacerate, or fracture. This causes serious bleeding into the abdomen that can quickly cause death. Be alert for a trauma patient who reports abdominal pain-- it may be a symptom of abdominal bleeding. Also be alert to vital signs that begin to worsen; this can be a sign of serious, unseen bleeding inside the abdominal region of the body. *When the hollow organs of the body have been injured, they may rupture & leak toxic chemicals used for digestion into the abdomen. This not only causes pain, but a life-threatening infection also may eventually develop.

Newton's Third Law:

states that for every action, there is an equal & opposite reaction. *Therefore, if you push on a door, the door pushes back (reacts) with an equal force but in the opposite direction.

Newton's Second Law:

states that force (F) equals mass (M) times acceleration (A), that is, F = M × A, in which acceleration is the change in velocity (speed) that occurs over time. *Therefore, it's not so much that "speed kills" but that the change in velocity with respect to time generates the forces that cause injury. Simply put, it's not the fall, but the sudden stop at the bottom, that causes the injury.

Newton's First Law:

states that objects at rest tend to stay at rest & objects in motion tend to stay in motion unless acted upon by some force.

Traumatic injury occurs when:

the body's tissues are exposed to energy levels beyond their tolerance.

Internal injuries caused by gunshot wounds are difficult to predict because:

the bullet may tumble or ricochet within the body.

Remember, energy cannot be created or destroyed, only converted. In the case of a motor vehicle crash,:

the kinetic energy of the speeding vehicle is converted into the work of stopping the vehicle, usually by crushing the vehicle's exterior. Similarly, the passengers of the vehicle have kinetic energy because they were traveling at the same speed as the vehicle. Their kinetic energy is converted to the work of bringing them to a stop. It's this work on the passengers that results in injury. *Notice that, according to the equation for kinetic energy, the energy that is available to cause injury doubles when an object's weight doubles but quadruples when its speed doubles. When a car's speed increases from 50 to 70 mph, the energy that is available to cause injury doubles. *This point is even clearer when considering gunshot wounds. The speed of the bullet (High-velocity compared with low-velocity) has a greater impact on producing injury than the mass (size) of the bullet. This is why it is so important to report to the hospital the type of firearm that was used. *The amount of kinetic energy that's converted to do work on the body dictates the severity of the injury. High-energy injuries often produce such severe damage that patients require immediate transport to an appropriate facility to have any hope of survival.

The injury potential of a fall is related to the height from which:

the patient fell. *Falls are common MOIs for blunt trauma. *The greater the height of the fall, the greater the potential for injury. A fall from more than 20 ft (6 m) is considered significant.

Traumatic injuries may be caused by:

underlying medical conditions (a patient has a stroke & veers off the road, striking a tree).

It is important to consider _________ as well as obvious injuries with any type of trauma.

unseen

Rear-end crashes are known to cause:

whiplash injuries, particularly when the passenger's head and/or neck isn't restrained by an appropriately placed headrest.