EMT Chapter 36
Trauma in Pediatric Patient - Shaken Baby Syndrome
1 of many causes of brain injury.
Cognitively Impaired Trauma Patient - Maintain:
A high index of suspicion that impairment results from injury, rather than the preexisting condition.
Geriatric Trauma Patient - Maintain
A clear airway and be prepared to suction due to patient having decreased cough reflex.
Pregnant Trauma Patient - Fetal Death Rates
Are 9x higher than maternal death rates following trauma.
Pregnant Trauma Patient - Uterus and Bladder
Are at greater risk of injury due to displacement into the abdominal cavity (applies for latter)
Pregnant Trauma Patient - Airway, Ventilation, and Oxygenation
Are critical to the pregnant trauma patient. EMTs should anticipate vomiting and have suction readily available.
Pediatric Trauma Patient - BP Readings
Are difficult to obtain in children 3 years of age or younger.
Pregnant Trauma Patient - Fetal and Maternal Outcomes from MVCs
Are more favorable when the mother wears a seatbelt.
Pregnant Trauma Patient - Anticipate:
The need for additional resources if delivery is imminent.
Important to Fetus' Chance of Survival
The number of weeks the patient has been pregnant and the size of the fetus.
Pediatric, Geriatric, Pregnant, and Cognitively Impaired Trauma Patients
There are special considerations in assessment and management with these people.
Cognitively Impaired Trauma Patient - History and Consent
May be difficult to obtain. FIrst attempt to get info from the patient. Rely on others for info if needed.
Pregnant Trauma Patient - Unbelted Crash Victim
2x as likely to have vaginal bleeding or to give birth, and fetal death is 3-4x more likely.
A Down Syndrome Patient
May have a mild-to-moderate developmental impairment. You may have to rely on a parent/caregiver to help reassure the patient and to provide information about the patient's history.
Pediatric Trauma Patient - Subtle Changes in HR, BP, and Skin Perfusion
May indicate cardiovascular failure.
Pediatric Trauma Patient - A Slow HR
May indicate hypoxia.
Pregnant Trauma Patient - Uterine Rupture
May occur as a result of motor vehicle tauma. Can result in maternal and fetal death.
Geriatric Trauma Patient - Hypertensive Patients Prior to Injury
Might have normal BP readings when they're in shock.
Trauma in Cognitively Impaired Patients
More prone to trauma. Conditions include dementia, autism, brain injuries, stroke, Alzheimer's, blindness, deafness, acquired developmental delays, and Down syndrome. Can affect assessment and management.
Patient's Considered to Have Multisystem Trauma When:
More than one major system is involved.
Pediatric Trauma Patient - Traumatic Forces Are:
More widely distributed in pediatric patients.
Geriatric Trauma Patient - Preexisting Medical Outcomes and Medications
Affect the patient's outcome.
Geriatric Trauma Patient - Be Alert to:
Airway obstruction from dentures and impaired cough reflex.
PALS - Appearance/Consciousness Component
Refers to assessing the child's overall mental status, body position, and muscle tone.
Geriatric Trauma Patient - AMS is:
A significant sign; can indicate a severe injury.
Pregnant Trauma Patient - Consider:
ALS intercept or air medical transport for major traumas involving pregnant patients.
Cognitively Impaired Trauma Patient - Physiological Changes Can:
Accompany some forms of cognitive impairment, depending on the underlying cause.
Pediatric Trauma Patient Management Considerations
Assess circulation and control direct bleeding. Manage hypovolemia and shock. Prevent hypothermia. Transport to an appropriate facility. Continually reassess.
Multisystem Truama and Trauma in Special Patient Populations - Scene Size Up
Assess the MOI; suspect injury of more than one body system. Identify whether the patient belongs to any special patient populations. Don't assume AMS if due to a preexisting condition.
Pregnant Trauma Patient - It's Difficult to:
Assess the fetus, so manage the mother aggressively.
PALS - Circulation/Color Component
Assessed by observing the patient's skin color.
Pediatric Trauma Patient - Pediatric Advanced Life Support (PALS)
Assesses consciousness, breathing, and color; can help you form a general impression.
Pregnant Trauma Patient - Airway and Ventilation
Assist inadequate ventilations. Administer oxygen and maintain as high an SpO2 as possible.
Trauma in Pediatric Patient - Children Are:
At risk of being abused by adults; accounts for 25-35% of trauma deaths.
Pregnant Trauma Patient - The Uterus
Becomes highly vascular.
Findings That May Prompt You to Suspect Child Abuse:
Bruises/burns in unusual shapes/locations. An injury that doesn't seem to correlate with the cause provided or the developmental stage of the patient. More injuries than usual for a child that age. Multiple injuries in various healing stages. Delay in seeking EMC.
Pregnant Trauma Patient - Fetal Distress
Can be caused by hypoxia or hypovolemia, but signs of shock can be delayed or masked in pregnant patients.
Pediatric Trauma Patient - Extreme Hyperextension/Flexion Injury
Can result in injury to the phrenic nerve, causing the diaphragm to fail to work. Will lead to respiratory failure.
Pregnant Trauma Patient - Circulation
Check for major bleeding. Absorb maginal bleeding wth a pad; don't pack the vagina. Anticipate and treat for shock.
Cognitively Impaired Trauma Patient - Patients May Be:
Confused, upset, and uncooperative.
Care for Multisystem Trauma Patients
Depends on the systems involved. Definitive care if often surgery.
Involvement of Multiple Body Systems in Trauma
Makes management of the trauma patient more challenging.
Establish and Maintain Manual In-Line Stabilization - For 3rd-Trimester Pregnancy
Elevate the right hip, tilt the backboard to the left, or displace the uterus to the left.
Golden Principles of Prehospital Multisystem Trauma Care
Ensure safety of personnel and patient. Determine additional resources needed. Understand kinematics. Identify and manage life threats. Manage the airway while maintaining cervical spine stabilization. Support ventilation and oxygenation. Control external hemorrhage and treat for shock. Perform a secondary assessment and obtain a medical history. Splint skeletal injuries and maintain SMR if needed. Make transport decisions.
Cognitively Impaired Trauma Patient - Pain Perception
May be altered.
Establish and Maintain Manual In-Line Stabilization - For the Elderly
For the elderly, pad voids beneath the back.
Pregnant Trauma Patient - Decreased
Gastric motility
Pediatric Trauma Patient - Infants and Children Have:
Greater chest wall flexibility than adults. Can allow for internal chest injuries with few external signs of trauma.
Pregnant Trauma Patient - More Severe Injury to the Mother
Greater the chances of fetal injury.
Pediatric Trauma Patient - Pediatric Patient Have:
Heavy heads and weak neck muscles.
Pediatric Trauma Patient - Pediatric Assessment Triangle (PAT)
Helps with formation of a general impression. Assess appearance, work of breathing, and circulation to the skin.
Morbidity/Mortality and Risk of Developing Shock
Higher in patients with multisystem trauma.
Pregnant Trauma Patient - The Diaphragm
Is elevated making her more susceptible to developing a tension pneumothorax.
Pregnant Trauma Patient - Pain Perception
In the abdomen is altered because the abdominal viscera is pushed upward.
Trauma in Pediatric Patient - MOI's
Include drowning, burns, falls, penetrating truama, MVC's, and pedestrian-vehicle collisions.
Significant Forces
Increase the risk for injuries to multiple systems.
Pregnant Trauma Patient - The HR:
Increased by 10-15 bpm by the 3rd trimester.
Pregnant Trauma Patient - The Blood Volume is:
Increased by 50% for plasma in late pregnancy and by 25% for RBC count.
Geriatric Trauma Patient - Changes in Pulmonary, Cardiovascular, Neurological, and Musculoskeletal Systems
Occur with aging. Make injury more likely and make it harder for the elderly patient to compensate when injury occurs.
Pediatric Trauma Patient - In SMR:
Pad beneath the child who's younger than 8 from the shoulders to the hips to prevent neck flexion.
Establish and Maintain Manual In-Line Stabilization - For Children <8
Pad from the shoulders to the hips.
Geriatric Trauma Patient - Use:
Padding (for the voids) when SMR is necessary.
PALS - Breathing Component
Relates to the work of breathing as determine by a visual assessment of the effort of breathing, absence of braething, or decreased respiratory effort plus any audible sounds associated with the patient's respiration.
Multisystem Truama and Trauma in Special Patient Populations - Secondary Assessment
Perform a rapid one for physical exams. Anticipate altered reactions to pain among special patient populations. Obtain vital signs. Normal ones are based on the patient's age.
Pregnant Trauma Patient - Abruptio Placentae
Premature separation of the placenta from the uterine wall. Common result of blunt abdominal trauma. Abdominal pain and vaginal vleeding are often present with this condition; poses a high risk of fetal and maternal death.
Pregnant Trauma Patient - Attempt:
Resuscitation of the pulseless pregnant trauma patient according to your protocol.
Pregnant Trauma Patient - Increased
Risk of vomiting/aspiration.
Cognitively Impaired Trauma Patient - Many Patients Have:
Sensory loss related to aging and disease.
Pregnant Trauma Patient - The Fetus Can Be:
Severely hypoxic before the mother shows signs of hypoxia.
Pediatric Trauma Patient - Administer:
Supplemental O2 to maintain SpO2 95% or greater.
Multisystem Truama and Trauma in Special Patient Populations - Primary Assessment
Suspect spinal injury, provide in-line stabilization. Assess the mental status. Establish an airway using a jaw-thrust maneuver. Anticipate vomiting and be prepared to suction. Provide oxygen for adequately breathing patients. Provide PPB if breathing's inadequate. For bradycardiac pediatric patients, assist ventilatons.
Pediatric Trauma Patient - Open and Assess for:
The airway and for any possible obstructions.
Pediatric Trauma Patient - Assess:
The brachial pulse in an infant >1.
Cognitively Impaired Trauma Patient - Involve:
The caregivers to increase cooperation.
Pregnant Trauma Patient - Oxytocin
The release of it has a similar effect as an infusion of Pitocin which can result in premature labor.
Trauma in Geriatric Patients
The risk of death and significant injury is greater than that for younger patients. A number of physiological changes predispose the elderly to injuries. Falls are the most common cause of injury. Many falls are the result of medical conditions.
Cognitively Impaired Trauma Patient - Err on:
The side of caution and treat as if the patient has a head injury.
Cognitively Impaired Trauma Patient - Gain Information
Through the trauma assessment and reassess frequently.
Pregnant Trauma Patient - When SMR's Required
Tilt the spine board to the left to prevent supine hypotensive syndrome.
Maintain a Patent Away and Adequate Breathing/Oxygenation
Use a jaw-thrust maneuver. Be prepared to suction. Administer O2. Monitor the airway, breathing, pulsem and mental status for deterioration.
Multisystem Truama and Trauma in Special Patient Populations - EMC
Use standard precautions. Establish and maintain in-line stabilization. Maintain a patient airway and adequate breathing and oxygenation. Control bleeding. Treat for shock. Identify and treat other injuries. Transport immediately. Reassess vital signs every 5 minutes.
Pregnant Trauma Patient - Most Common Problem Caused by Maternal Trauma
Uterine contractions that may progress into labor.
Geriatric Trauma Patient - Support:
Ventilation as needed to maintain an SpO2 greater than or equal to 95%.
Multisystem Truama and Trauma in Special Patient Populations - Secondary Assessment (History)
When and how did the incident occur? What's the chief complaint? Are there any S&S associated with the trauma? Is the patient pregnant? If so, how far along is she? Is there any vaginal bleeding or crowning? How old is the patient? Does the patient take any meds? Is the patient allergc to anything? What's the patient's medical history? Is there a history of previous trauma or a cognitive impairment?