Signs of simple pneumothorax
- Unequal breath sounds
- SpO2 <92% ON RA
- Subcutaneous emphysema
Signs of tension pneumothorax
Any of the following +/- signs of a simple pneumothorax:
- Increased resp distress
- Decreased SpO2 to <92% despite O2
- Decreased conscious state
- Poor perfusion or increased HR +/- decreased BP
- Increased peak insp. pressure / stiff bag
- Decreased EtCO2
- Increased JVP
- Tracheal shift
When can ALS decompress chest outside of a traumatic arrest?
Signs of TPT with GCS <10 and SBP <70 in adult patients only
Chest decompression
SMART AMBO
- Second intercostal space
- Mid clavicular line
- Above the rib below
- Right angle to the chest
- Towards the body of the vertebrae
- Confirm placement with 2nd Ambo
How do you dress an open chest wound?
- Do not occlude open pneumothorax
- Dressing only required if needed for haemorrhage control
What are the principles of fracture management?
- Control external haemorrhage
- Apply good splinting practices
- Resolve neurovascular compromise if possible
- Use judicious analgesia
When is it indicated to relocate a dislocation and what are the steps in doing so?
Dislocations with vascular compromise should be urgently transported if appropriate care within 15 mins.
If travel time exceeds this, consult and relocate on scene.
Principles of relocating dislocations:
- Provide procedural pain relief
- Apply sustained traction downwards away from joint
- Have someone apply counter-traction above site of injury
When is it indicated to reduce a fracture and what are the steps in doing so?
Fractures that have vascular compromise should be realigned ASAP.
Principles of reducing fractures:
- Provide procedural pain relief
- If compound - irrigate with min 500mls saline
- Apply traction and gentle counter traction in line of the limb
- Further manipulation should be done whilst under traction, if required
- Splint
What are the six Ps of compartment syndrome
- Pain
- Pallor
- Paralysis
- Paraesthesia
- Pulseless
- Polikilothermia (temp regulation)
