Trauma Overview CHAPTER 26: Focused Lecture
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Trauma Overview CHAPTER 26: Focused Lecture National EMS Education Standard Competencies (1 of 3) Trauma Applies fundamental knowledge to provide basic and selected advanced emergency care and transportation based on assessment findings for
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Trauma Overview CHAPTER 26: Focused Lecture<br>
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National EMS Education Standard Competencies (1 of 3) Trauma
Applies fundamental knowledge to provide basic and selected advanced emergency care and transportation based on assessment findings for an acutely injured patient.<br>
Applies fundamental knowledge to provide basic and selected advanced emergency care and transportation based on assessment findings for an acutely injured patient.<br>
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National EMS Education Standard Competencies (2 of 3) Trauma Overview
Pathophysiology, assessment, and management of the trauma patient
Trauma scoring
Rapid transport and destination issues
Transport mode<br>
Pathophysiology, assessment, and management of the trauma patient
Trauma scoring
Rapid transport and destination issues
Transport mode<br>
04
National EMS Education Standard Competencies (3 of 3) Multisystem Trauma
Recognition and management of
Multisystem trauma
Pathophysiology, assessment, and management of
Multisystem trauma
Blast injuries<br>
Recognition and management of
Multisystem trauma
Pathophysiology, assessment, and management of
Multisystem trauma
Blast injuries<br>
05
Introduction Unintentional injury is primary cause of death and disability in people between ages 1 and 44 years.
Proper prehospital evaluation and care minimize suffering, long-term disability, and death from trauma.
Evaluate of the mechanism of injury (MOI) for an index of suspicion.<br>
Proper prehospital evaluation and care minimize suffering, long-term disability, and death from trauma.
Evaluate of the mechanism of injury (MOI) for an index of suspicion.<br>
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Energy and Trauma (1 of 2) Traumatic injury occurs when the body’s tissues are exposed to energy levels beyond their tolerance. © Pthawatc/Shutterstock. © Terry Dickson, Florida Times-Union/AP Photo.<br>
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Energy and Trauma (2 of 2) Different forms of energy produce different kinds of trauma.
Mechanical energy
Kinetic energy
Potential energy
Chemical energy
Thermal energy
Barometric energy<br>
Mechanical energy
Kinetic energy
Potential energy
Chemical energy
Thermal energy
Barometric energy<br>
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Mechanism of Injury Profiles Different types of MOIs produce many types of injuries.
Injuries sustained by trauma patients may be the result of multisystem trauma, falls from heights, motor vehicle and motorcycle crashes, vehicle versus pedestrian, gunshot wounds, and stabbings.
Maintain a high index of suspicion for serious unseen injuries.<br>
Injuries sustained by trauma patients may be the result of multisystem trauma, falls from heights, motor vehicle and motorcycle crashes, vehicle versus pedestrian, gunshot wounds, and stabbings.
Maintain a high index of suspicion for serious unseen injuries.<br>
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Blunt and Penetrating Trauma Blunt trauma
Injury primarily without anything penetrating the soft tissues or internal organs and cavities
Penetrating trauma
Injury by objects that pierce and penetrate the surface of the body<br>
Injury primarily without anything penetrating the soft tissues or internal organs and cavities
Penetrating trauma
Injury by objects that pierce and penetrate the surface of the body<br>
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Blunt Trauma (1 of 13) Results from an object making contact with the body
Two of the most common MOIs:
Motor vehicle crashes
Falls
Maintain a high index of suspicion during patient assessment for hidden injuries.<br>
Two of the most common MOIs:
Motor vehicle crashes
Falls
Maintain a high index of suspicion during patient assessment for hidden injuries.<br>
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Blunt Trauma (2 of 13) Motor vehicle crashes
Three collisions in a typical impact
Vehicle against another vehicle, a tree, or some other object
Passenger against the interior of the vehicle © Rocketegg/iStock /Getty Images Plus/Getty Images. Courtesy of Rhonda Hunt.<br>
Three collisions in a typical impact
Vehicle against another vehicle, a tree, or some other object
Passenger against the interior of the vehicle © Rocketegg/iStock /Getty Images Plus/Getty Images. Courtesy of Rhonda Hunt.<br>
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Blunt Trauma (3 of 13) Motor vehicle crashes
Three collisions in a typical impact (cont'd)
Passenger’s internal organs against the solid structures of the body © Jones & Bartlett Learning. © Dr. E. Walker/Science Source.<br>
Three collisions in a typical impact (cont'd)
Passenger’s internal organs against the solid structures of the body © Jones & Bartlett Learning. © Dr. E. Walker/Science Source.<br>
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Blunt Trauma (4 of 13) Understanding the MOI after a frontal crash first involves evaluation of the supplemental restraint system.
Determine whether the passenger was restrained by a full, properly applied three-point restraint. Courtesy of ED, Royal North Shore Hospital/NSW Institute of Trauma & Injury.<br>
Determine whether the passenger was restrained by a full, properly applied three-point restraint. Courtesy of ED, Royal North Shore Hospital/NSW Institute of Trauma & Injury.<br>
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Blunt Trauma (5 of 13) Contact points are often obvious. © Jones & Bartlett Learning. © Jones & Bartlett Learning. © Jones & Bartlett Learning.<br>
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Blunt Trauma (6 of 13) © Jones & Bartlett Learning. © Jones & Bartlett Learning. © Jones & Bartlett Learning.<br>
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Blunt Trauma (7 of 13) Rear-end crashes cause whiplash-type injuries.
Lateral crashes cause lateral whiplash injury.
Patient could experience rotation of the neck, lateral flexion, or a combination of both. © deepspace/Shutterstock. © Alexander Gordeyev/Shutterstock.<br>
Lateral crashes cause lateral whiplash injury.
Patient could experience rotation of the neck, lateral flexion, or a combination of both. © deepspace/Shutterstock. © Alexander Gordeyev/Shutterstock.<br>
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Blunt Trauma (8 of 13) Rollover crashes
Most common life-threatening event is ejection or partial ejection of the passenger. © iStockphoto/Thinkstock/Getty.<br>
Most common life-threatening event is ejection or partial ejection of the passenger. © iStockphoto/Thinkstock/Getty.<br>
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Blunt Trauma (9 of 13) Rotational crashes
Injuries are a combination of frontal and lateral impacts.
Three-point seat belts are effective in preventing injury.<br>
Injuries are a combination of frontal and lateral impacts.
Three-point seat belts are effective in preventing injury.<br>
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Blunt Trauma (10 of 13) Vehicle-versus-pedestrian crashes
Three phases of impact:
Vehicle-pedestrian impact
Pedestrian rotates onto the hood.
Pedestrian rolls off onto the ground.
Injury pattern depends on the height of the pedestrian and the body area facing the impact.
Multisystem trauma is common after this type of event.<br>
Three phases of impact:
Vehicle-pedestrian impact
Pedestrian rotates onto the hood.
Pedestrian rolls off onto the ground.
Injury pattern depends on the height of the pedestrian and the body area facing the impact.
Multisystem trauma is common after this type of event.<br>
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Blunt Trauma (11 of 13) Vehicle-versus-bicycle crashes
Evaluate the MOI in the same manner as vehicle-versus-pedestrian crashes © Robert Byron/Dreamstime.com.<br>
Evaluate the MOI in the same manner as vehicle-versus-pedestrian crashes © Robert Byron/Dreamstime.com.<br>
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Blunt Trauma (12 of 13) Motorcycle crashes
Patients should undergo cervical spine assessment.
Types of motorcycle impacts
Head-on crash
Angular crash
Ejection
Laying the bike down Courtesy of Rhonda Hunt.<br>
Patients should undergo cervical spine assessment.
Types of motorcycle impacts
Head-on crash
Angular crash
Ejection
Laying the bike down Courtesy of Rhonda Hunt.<br>
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Blunt Trauma (13 of 13) Falls
Greater the height of the fall, greater the potential for injury
Internal injuries pose the gravest threat.
Take into account
Height of the fall
Type of surface struck
Part of the body that hit first
Area of the body over which the impact is distributed © Jones & Bartlett Learning.<br>
Greater the height of the fall, greater the potential for injury
Internal injuries pose the gravest threat.
Take into account
Height of the fall
Type of surface struck
Part of the body that hit first
Area of the body over which the impact is distributed © Jones & Bartlett Learning.<br>
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Penetrating Trauma (1 of 5) Can be classified as low energy, medium energy, or high energy
Low-energy penetrating trauma may be caused by impalement or a knife, ice pick, or other weapon. Courtesy of Andrew N. Pollak, MD, FAAOS.<br>
Low-energy penetrating trauma may be caused by impalement or a knife, ice pick, or other weapon. Courtesy of Andrew N. Pollak, MD, FAAOS.<br>
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Penetrating Trauma (2 of 5) Point-blank and high-velocity gunshot wounds result in more significant injuries.
Body area involved can be estimated by looking at:
Entrance location
Length of weapon © E.M. Singletary, M.D. Used with permission.<br>
Body area involved can be estimated by looking at:
Entrance location
Length of weapon © E.M. Singletary, M.D. Used with permission.<br>
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Penetrating Trauma (3 of 5) Determine the number of penetrating injuries, then combine that information with what you know about the potential pathway.
Gunshot wounds
Frangible bullets increase damage due to multiple fragments.
Hollow point bullets expand as they enter the target.
Full metal jacket bullets cause less damage than fragmented rounds.<br>
Gunshot wounds
Frangible bullets increase damage due to multiple fragments.
Hollow point bullets expand as they enter the target.
Full metal jacket bullets cause less damage than fragmented rounds.<br>
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Penetrating Trauma (4 of 5) The bullet’s speed is a major factor in the resulting injury pattern.
Cavitation results from the rapid changes in tissue and fluid pressure. © Jones & Bartlett Learning.<br>
Cavitation results from the rapid changes in tissue and fluid pressure. © Jones & Bartlett Learning.<br>
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Penetrating Trauma (5 of 5) Relationship between distance and severity of injury varies depending on the type of weapon involved.
Air resistance slows the projectile, reducing tissue damage.
Exit wounds are often much larger than entrance wounds. © Charles Stewart MD, EMDM MPH.<br>
Air resistance slows the projectile, reducing tissue damage.
Exit wounds are often much larger than entrance wounds. © Charles Stewart MD, EMDM MPH.<br>
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Blast Injuries (1 of 4) Most commonly associated with military conflict
Also seen in civilian practice in industrial settings
Primary blast injuries
Entirely due to the blast itself
Damage to the body caused by pressure wave
Proximity to the origin of the pressure wave is associated with a high risk of injury or death.<br>
Also seen in civilian practice in industrial settings
Primary blast injuries
Entirely due to the blast itself
Damage to the body caused by pressure wave
Proximity to the origin of the pressure wave is associated with a high risk of injury or death.<br>
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Blast Injuries (2 of 4) © Jones & Bartlett Learning.<br>
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Blast Injuries (3 of 4) Secondary blast injuries
Result from being struck by flying debris
May cause blunt and penetrating injuries
Tertiary blast injuries
Occur when a person is hurled by the force of the explosion against stationary, rigid objects
Injuries result from both blunt and penetrating mechanisms.<br>
Result from being struck by flying debris
May cause blunt and penetrating injuries
Tertiary blast injuries
Occur when a person is hurled by the force of the explosion against stationary, rigid objects
Injuries result from both blunt and penetrating mechanisms.<br>
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Blast Injuries (4 of 4) Quaternary (miscellaneous) blast injuries
Result from the miscellaneous events that occur during an explosion
Quinary blast injuries
Caused by biologic, chemical, or radioactive contaminants added to a traditional explosive device<br>
Result from the miscellaneous events that occur during an explosion
Quinary blast injuries
Caused by biologic, chemical, or radioactive contaminants added to a traditional explosive device<br>
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Tissues at Risk Organs that contain air are most susceptible to barotrauma.
Tympanic membranes can help determine the possible presence of other blast injuries.
Pulmonary blast injuries results from short-range exposure to the detonation of explosives.
Pneumothorax is a common injury and may require emergency decompression.<br>
Tympanic membranes can help determine the possible presence of other blast injuries.
Pulmonary blast injuries results from short-range exposure to the detonation of explosives.
Pneumothorax is a common injury and may require emergency decompression.<br>
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Multisystem Trauma (1 of 3) Injuries of a person who has been subjected to multiple traumatic injuries involving more than one body system
Provide rapid treatment and transportation, and alert medical control.
Patients have high morbidity and mortality.<br>
Provide rapid treatment and transportation, and alert medical control.
Patients have high morbidity and mortality.<br>
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Multisystem Trauma (2 of 3) Golden principles of prehospital trauma care:
Ensure safety.
Determine the need for additional personnel or equipment.
Evaluate the MOI.
Identify and appropriately manage life threats.
Assess and manage the airway.<br>
Ensure safety.
Determine the need for additional personnel or equipment.
Evaluate the MOI.
Identify and appropriately manage life threats.
Assess and manage the airway.<br>
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Multisystem Trauma (3 of 3) Ensure that basic shock therapy is completed.
Rapidly proceed with spinal immobilization if indicated.
During transport, obtain a SAMPLE history.
For critically injured patients, consider paramedic intercept and/or air medical transportation.<br>
Rapidly proceed with spinal immobilization if indicated.
During transport, obtain a SAMPLE history.
For critically injured patients, consider paramedic intercept and/or air medical transportation.<br>
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Patient Assessment (1 of 4) Identifying life-threatening illnesses and injuries as soon as possible improves patient outcomes.
Assess, triage, treat, and transport patients with traumatic injuries to the most appropriate facility.<br>
Assess, triage, treat, and transport patients with traumatic injuries to the most appropriate facility.<br>
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Patient Assessment (2 of 4) Injuries to the head
Disability and unseen injury to the brain may occur.
Bleeding or swelling inside the skull from brain injury is often life threatening.
Injuries to the neck and throat
Injuries may result in an airway problem.
Use DCAP-BTLS.
Always use an occlusive dressing on any open neck wound.<br>
Disability and unseen injury to the brain may occur.
Bleeding or swelling inside the skull from brain injury is often life threatening.
Injuries to the neck and throat
Injuries may result in an airway problem.
Use DCAP-BTLS.
Always use an occlusive dressing on any open neck wound.<br>
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Patient Assessment (3 of 4) Injuries to the chest
Blunt trauma to the chest can fracture ribs or the sternum.
Large vessels of the heart may be torn.
Pneumothorax, tension pneumothorax
Hemothorax
Reassess a trauma patient’s chest region every 5 minutes.<br>
Blunt trauma to the chest can fracture ribs or the sternum.
Large vessels of the heart may be torn.
Pneumothorax, tension pneumothorax
Hemothorax
Reassess a trauma patient’s chest region every 5 minutes.<br>
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Patient Assessment (4 of 4) Injuries to the abdomen
Solid organs may tear, lacerate, or fracture.
Hollow organs may rupture and leak toxic chemicals.
Healthy young adults are able to compensate longer than others for blood loss.
Maintain a high index of suspicion.
Reassess using DCAP-BTLS.<br>
Solid organs may tear, lacerate, or fracture.
Hollow organs may rupture and leak toxic chemicals.
Healthy young adults are able to compensate longer than others for blood loss.
Maintain a high index of suspicion.
Reassess using DCAP-BTLS.<br>
40
Management (1 of 2) Trauma lethal triad
Major contributor to death in patients
Factors that interfere with blood clotting will cause more blood loss.
Aggressively seek to control all bleeding.
Ensure IV fluids are warmed.
Monitor end-tidal carbon dioxide and ventilations.
Consider calling for paramedic backup. © Jones & Bartlett Learning.<br>
Major contributor to death in patients
Factors that interfere with blood clotting will cause more blood loss.
Aggressively seek to control all bleeding.
Ensure IV fluids are warmed.
Monitor end-tidal carbon dioxide and ventilations.
Consider calling for paramedic backup. © Jones & Bartlett Learning.<br>
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Management (2 of 2) Scene time
Limit on-scene time to the minimum amount.
Should ideally be less than 10 minutes
Criteria to identify a critically injured patient:
Dangerous MOI
Decreased level of consciousness
Any threats to airway, breathing, or circulation
Very young or very old
Chronic illnesses<br>
Limit on-scene time to the minimum amount.
Should ideally be less than 10 minutes
Criteria to identify a critically injured patient:
Dangerous MOI
Decreased level of consciousness
Any threats to airway, breathing, or circulation
Very young or very old
Chronic illnesses<br>
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Transport and Destination (1 of 4) Type of transport
Ground or air
Several factors to be considered to use ground transportation
Be familiar with your local protocols defining indications for use of air medical transport. Courtesy of Mark Woolcock.<br>
Ground or air
Several factors to be considered to use ground transportation
Be familiar with your local protocols defining indications for use of air medical transport. Courtesy of Mark Woolcock.<br>
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Transport and Destination (2 of 4) Criteria for air medical services
Distance to the trauma center is greater than 20 to 25 miles (32 to 40 km)
Patient needs medical care and stabilization at the advanced life support (ALS) level.
Traffic conditions or hospital availability
Air transport to mitigate the effect of delay caused by EMS systems
Multiple-casualty incident<br>
Distance to the trauma center is greater than 20 to 25 miles (32 to 40 km)
Patient needs medical care and stabilization at the advanced life support (ALS) level.
Traffic conditions or hospital availability
Air transport to mitigate the effect of delay caused by EMS systems
Multiple-casualty incident<br>
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Transport and Destination (3 of 4) Destination selection
Know the criteria for referral to a trauma center.
Important to transport your trauma patient to the most appropriate facility<br>
Know the criteria for referral to a trauma center.
Important to transport your trauma patient to the most appropriate facility<br>
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Transport and Destination (4 of 4) Trauma centers: Levels I through IV
Level I has the most resources, followed by Levels II, III and IV.
Adult trauma centers and pediatric trauma centers
Be familiar with how the American College of Surgeons Committee on Trauma (ACS-COT) classifies trauma care.<br>
Level I has the most resources, followed by Levels II, III and IV.
Adult trauma centers and pediatric trauma centers
Be familiar with how the American College of Surgeons Committee on Trauma (ACS-COT) classifies trauma care.<br>