MOD E Tech 36 Trauma Management

Question 1

Trauma Management

Trauma Survival

Answer 1

Golden Hour

• From moment of injury
• To definitive treatment

EMS “platinum 10 minutes”

Assessment and management

• Every action must have lifesaving purpose
• Organized, detail-oriented, selective, rapid

Question 2

Patient Assessment

Answer 2

• Primary Survey
• Scene Size-up
• Initial Assessment

•Rapid Trauma Survey
or Focused Exam

• Secondary Survey

Ongoing Exam

Question 3

Scene Size-up (“The first five”)

Answer 3

1. Standard precautions (Gloves, Helmet, Coat)
2. Scene safety
3. Initial triage (total number of patients)
4. Need for more help or equipment
5. Mechanism of injury

Question 4

Mechanism of Injury

Answer 4

Energy follows physics laws

•Injuries present in predictable patterns

High-energy at risk for severe injury.

•Consider injured until proven otherwise

Factors to consider:

• KE = ½MV2
• Direction and speed of impact, patient kinetics and physical size, signs of energy release

Question 5

Acceleration & Deceleration Injuries

Answer 5

Question 6

Other Collisions

Answer 6

Secondary collisions

•Objects are missiles
at original speed

Additional impacts

•Vehicle collides
with another object

•Other vehicles collide with original vehicle

Question 7

Basic Motion Mechanisms

Answer 7

Blunt injuries

• Rapid forward deceleration
• Rapid vertical deceleration

•Blunt instrument energy transfer

Penetrating injuries

• Projectiles
• Knives
• Falls upon objects

Question 8

Clues to Injury

Answer 8

Deformity of vehicle

• What forces were involved in collision?
• (KE = ½MV2)

Deformity of interior structures

•What did patient hit?

Deformity or injury patterns on patient

•What anatomic areas were hit?

Question 9

Head-on Collision

Answer 9

Windshield injuries

•Brain, soft-tissue injury, cervical spine

Steering wheel injuries

•Traumatic tattooing of skin

Dashboard injuries

•Face, brain, cervical spine, pelvis, hip, knee

Question 10

Lateral-Impact Collision

Answer 10

Similar to head-on
with lateral energy

• Not easily predicted
• Consider organ damage

Check impact side

•Head, neck, upper arm, shoulder, thorax,
abdomen, pelvis, legs

Question 11

Rear-Impact Collision

Answer 11

Posterior displacement

•Rapid forward deceleration also possible

Headrest position

•Hyperextension injuries

Damage back and front

•Deceleration injuries

Question 12

Rollover Collision

Answer 12

Multiple impacts

• Multiple directions
• Multiple injuries

Axial-loading injuries

•Spine injury

Ejection

•Chance of death
increases 25 times

Question 13

Rotational Collision

Answer 13

Head-on, lateral-impact combination

•Converts forward motion
to spinning motion

Windshield, dashboard, steering wheel, side

•Same possible injuries
of both frontal impact and lateral impact mechanisms

Question 14

Occupant Restraint

Answer 14

Lap belt

• Pocket-knife effect
• Abdomen
• Lumbar spine

Three-point restraint

•Cervical spine

Clavicular fracture

Air bags

• First impact only
• Always “lift and look”

Question 15

Small-Vehicle Crashes

Answer 15

Small vehicles

• Motorcycles
• All-terrain vehicles
• Personal watercraft

Factors

• Protective gear
• Additional impacts

Question 16

Pedestrian Injuries

Answer 16

Mechanism

• Primary collision
• Additional impacts

Common injuries

•Severe internal injuries
and fractures

• Adult: bilateral leg, knee
• Child: pelvis, torso

Question 17

Penetrating Injuries

Answer 17

Knife-wound severity

•Anatomical area penetrated

•Fourth intercostal space may
be chest and abdomen

• Length of blade
• Angle of penetration

Stabilize impaled object

•Minimize external movement

Question 18

Primary Survey - Initial Assessment

Answer 18

Initial Assessment:

• General impression
• Initial level of consciousness
• Manual stabilization of cervical spine
• <c>ABC’s</c>

General impression

• Approximate age, sex, weight
• General appearance
• Position of patient body and surroundings
• Patient activity
• Obvious major injuries or bleeding
• Consider Catastrophic Hemorrhage

Triage patients rapidly, if necessary.

Airway: look, listen, feel

•simple positioning and suctioning

If not adequate, not quickly correctable

•Interrupt: advanced airway techniques

Breathing: look, listen, feel

•high-flow oxygen

If not adequate

•assisted ventilation

Circulation: peripheral pulse

• No peripheral, check carotid
• Too fast?, too slow?, quality?
• Interrupt: cardiac arrest

Skin

•Color, temperature, condition

Major bleeding scan

• Catastrophic Hemorrhage ?
• Direct: bleeding control

Circulation: peripheral pulse

• No peripheral, check carotid
• Too fast?, too slow?, quality?
• Interrupt: cardiac arrest

Skin

•Color, temperature, condition

Major bleeding scan

• Catastrophic Hemorrhage ?
• Direct: bleeding control

Question 19

Inspect Head and Neck

Detailed Exam: DCAP-BTLS

Answer 19

Deformities

Contusions

Abrasions

Penetrations

Burns

Tenderness

Lacerations

Swelling

Question 20

Inspect Chest

Answer 20

Asymmetry, Contusion, Penetrations,
Paradoxical Motion, Instability, Crepitation

Breath Sounds

Present? Equal?

(If unequal: Percussion)

Heart Sounds

Question 21

Abdomen & Pelvis

Answer 21

Bruising, Penetration/Evisceration, Tenderness, Rigidity, Distention

Tenderness.

Pelvic Splint Required ?

Question 22

Extremities & Posterior

Answer 22

Swelling, Deformity, Instability, Motor, Sensory

Place Patient on Scoop/Backboard

Penetrations, Deformity,

Question 23

Rapid Trauma Survey

If critical situation,
transfer to ambulance to complete exam.

Answer 23

Baseline Vital Signs

Measure Pulse, Respirations, Blood Pressure

Pupils

Size? Reactive? Equal?

(If Altered Mental Status:)

Glasgow Coma Scale Score

Eyes, Voice, Motor

Question 24

Primary Survey

Answer 24

Less than 2 minutes

•Initial Assessment and Rapid Trauma Survey

Delegate any intervention.
Interrupt survey only for:

Scene danger

Airway obstruction

Cardiac arrest

Question 25

Load-and-Go Situations

Answer 25

Initial Assessment * Altered mental status * Abnormal respiration * Abnormal circulation Shock potential * Abnormal chest exam * Tender, distended abdomen * Pelvic instability * Bilateral femur fractures Significant MOI and/or poor general health

Question 26

Critical Interventions On-scene procedures

Answer 26

* Manage airway * Assist ventilation * Administer oxygen * Begin CPR * Control major external bleeding * Stabilize # Pelvis * Seal sucking chest wounds * Stabilize flail chest\* * Decompress tension pneumothorax * Stabilize impaled objects Complete packaging

Question 27

Rapid Extrication?

Answer 27

Indications: •If there is an immediate threat to life. E.g. fire or airway obstruction that cannot be resolved in situ. • •Rapid extrication techniques with manual immobilisation of the cervical spine are appropriate in these circumstances.

Question 28

Initiate Transport

Answer 28

Procedures not on scene, not life-saving * Splinting, bandaging, IV line insertion * Endotracheal intubation, often Provide Pre-Alert * As early as possible * Estimated time of arrival (ETA) * Condition of patient * Special needs on arrival

Question 29

Major Trauma Bypass

Answer 29

Major Trauma Centre: –Stable and maximum travel time 45 minutes. • Trauma Unit (Stabilisation): –Airway not secure or uncontrollable haemorrhage.

Question 30

Secondary Survey

Answer 30

More comprehensive exam * Evaluation for all injuries, not just life-threatening * Establishes baseline for treatment decisions Performed * Critical patients—done during transport * Short transport—may not have time * Non-critical patients—done on scene

Question 31

Ongoing Exam

Answer 31

Change in condition * Patient * Interventions Perform and record * Critical: every 5 minutes * Stable: every 15 minutes * Each time patient moved * With each intervention If condition worsens