Trauma System/ Kinematics / Trauma Assessment / Musculoskeletal Trauma

Front 1

Trauma is the leading cause of death for age 1-44 (third for all age ranges)

Back 1

N/A

Front 2

Highway safety act of 1966 - Lead to development of EMS

Back 2

"White Paper" - Accidental Death and Disability - The Neglected Disease of a Modern Society

Front 3

American College of Surgeons

Back 3

1990: Trauma Care Systems Planning and Development Act

1st Paramedic Class

Front 4

Trauma Center Levels

Back 4

I-IV

Front 5

Level 1 - Trauma Center

Back 5

- Regional Trauma Center.
- All types of specialty surgical care
- Trauma suite open waiting for trauma pt, surgeons, blood, CT, X-rays in house
- ex) UCLA, Harbor, USC..

Front 6

Level 2

Back 6

• Area Trauma Centers
• Most Common trauma emergencies with around the clock surgical capability

Front 7

Level 3

Back 7

• Community Trauma Center
• Specialized ED and some surgical capability
• They will have to call in the surgery center

Front 8

Level 4

Back 8

• Trauma Facility
• Small Community Hospitals
• Stabilize and transfer - NO SURGERY

Front 9

Trauma Triage Criteria - LA Co. 506.1

Back 9

1. Physiological Assessment
2. Anatomical Injury
3. MOI

Front 10

The Golden Hour
+
Platinum 10 Min

Back 10

- BEST survivability from incident to surgery is < 1 hour
- Platinum 10 minutes (Scene time limited to 10 minutes)

Front 11

Injury Prevention

Back 11

- Engineering
- Enforcement
- Education
- Economics

Front 12

Phases of Crash (3)

Back 12

1. Pre-crash
2. Crash
3. Post-crash

Front 13

3 impacts occur in vehicular crashes

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1. Impact of 2 objects
2. Impact of occupants into the vehicle
3. Impact of vital organs in the occupants

Front 14

Laws of Energy and Motion

Back 14

- Newton's 1st: Body in motion will stay in motion
- Conservation of Energy - Energy cannot be created/destroyed

Front 15

Kinetic Energy

Back 15

KE = 1/2MV^2
*Velocity is more important than weight.

Front 16

Frontal Impact Injuries

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- Up & Over - Head, Face, Neck (Stridor - tracheal crush), Diaphragm (bowel sounds when listening to lungs).
- Down and Under - Patellar, Femur, Pelvis

Front 17

Rear Impact Injuries

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- Cervical hyperextension
- Similar to Frontal

Front 18

Lateral Impact Injuries

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Arms, Clavicle, Ribs

Front 19

Rotational

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Cervical, Spinal, Shearing (Heart, Kidney, Liver)

Front 20

Rollover

Back 20

- 6 X more likely to DIE

Front 21

Falls

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- Depends on Surface
- Falls from 3x Pt height = Critical
***Better to fall 5 ft, then 5 more ft. compared to 10 ft.

Front 22

Blast Injuries

Back 22

Primary - Blast Wave
Secondary - Fragmentation/debris
Tertiary - Impact with ground
Quaternary - Heat or fumes
Quinary - Biological or Chemical

Front 23

Stab Wounds

Back 23

- Intimate Injury
- Cone of injury: length of blade in any direction

Front 24

GSW

Back 24

- Velocity is largest factor (except shotgun = distance)
- Cavitation - Temporary = 6X diameter of bullet (permanent)

Front 25

Trauma Assessment: Primary Assessment Goal

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- Find and correct life threats.
- Treat as you go.
- BLS BEFORE ALS

Front 26

Primary Order

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ABCDE
• Airway with c-spine
• Breathing
• Circulation
• Disability
• Expose

THEN : Make a Treatment and Transport Decision

Front 27

Airway w/ C-Spine

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o Hold manual stabilization
o Is it open?
o Stay open?
o Adjunct needed?
o Suctioning needed?

Front 28

Breathing

Back 28

• Bare/expose the chest
• Rate: Too fast? Too slow? (Below 10, Greater than 30)
- *Minute Volume is more important than tidal vol.
• Abnormal look?
o Paradoxical movement
o Accessory muscle use
• Obtain lung sounds
• Administer oxygen!

Front 29

Circulation

Back 29

• Control external hemorrhage with direct pressure, if inadequate → tourniquet
-* Normal clotting takes 5-7 minutes.
• Central and peripheral pulses (check simultaneously to compare)
• Cap refill
• Skin signs

Front 30

Disability

Back 30

• Glasgow Coma Scale (EYES-VOICE-MOTION: 4-5-6)—If the GCS changes by two VENTILATE
o 14-15: mild dysfunction
o 11-13: moderate to severe dysfunction
o 10 or less: severe dysfunction
o 3: lowest possible score
6.6.13
• Pupils—6 mm, patient hypoxic INTUBATE
- Most concerned with unequal pupils

Front 31

Expose

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• Look for injuries
• Consider environment
• Protect from heat loss
o 3 degrees change of body temperature can affect clotting (cold inhibits coagulation)

Front 32

TRANSPORT DECISION

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• Any insult to ABCD is a critical patient and should be packaged and transport begun immediately

• If CRITICAL:
o 10 minute scene
o Vitals after primary or en route
o Treatment en route such as:
 Splinting
 IV access

• If STABLE:
o Vitals, secondary, splinting, pain management done on scene
o Fractures MUST be splinted before moving patient to spine board or stretcher

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Secondary (Focused) Assessment

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Head/Face
Spine
Chest
Abdomen/Pelvis
Extremities

Front 34

Head/Face

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• Palpation
- Ventilate at a normal rate (10) unless showing signs of herniation
**IE -Cushing's Triad - Hypotensive/ Bradycardia/ Irregular Respiration = Hyperventilate (20/min)
• Fluid leak or blood
o Watery bloody nose can indicate basilar skull fracture
• Raccoon eyes—periorbital ecchymosis
• Pupils
• Battle sign—bruising of the mastoid process
***Shock in Head injury will kill faster than head injury

Front 35

Spine

Back 35

• No cord after L-2
• Two-toned skin indicates neurogenic shock
• Cord takes up 95% of space in cervical spine; only 65% in lower areas of spine
*Resulting in more upper spinal injuries

Front 36

Chest

Back 36

• When to needle decompress
- Decreased or absent lung sounds
- Hypoperfusion
- Severe Respiratory Distress
• Beck's Triad (Pericardial Tamponade)
- JVD
- Hypotension
- Muffled heart tones

Front 37

ABDOMEN/PELVIS

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• Only use pelvic binder for confirmed anterior-posterior pelvic fractures
- Most common for unrecognized site of bleeding

Front 38

EXTREMITY TRAUMA

Back 38

• Significant bleeding is possible
• Pain management to minimize HR, RR, and myocardial oxygen demand
• Tourniquet for hemorrhage (uncontrolled)

Front 39

Back 39

N/A

Front 40

Max crystalloid fluid is...

Back 40

3L
- begin to show signs of shock after 750cc blood loss

Front 41

Life Threatening Musculoskeletal Traumas are...

Back 41

Pelvis / Femur fracture or combination of multiple injuries

Front 42

Splinting

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- Do not have to intentionally replace bone ends
- Return to position of function
- Traction splint for mid-shaft femur only

Front 43

For amputation

Back 43

Irrigate, wrap in wet gauze, place in bag, bag in ice/ice water.

Front 44

Compartment Syndrome

Back 44

1. Condition in which blood supply to an extremity is compromised by increased pressure in limb
2. Muscles of extremities are enveloped by fascia which forms compartments
3. Signs = Pulseless, Pallor (pale), Paralysis

Front 45

Crush Syndrome

Back 45

1. AKA traumatic rhabdomyolysis
2. Greater than 4 HR Crush Force
3. Myoglobin released by muscle cells, clogs kidneys
4. Potassium released causes Hyperkalemia = dysrhythmias
5. Treatment Plan: Fluid resuscitation before extrication (1.5L/hr), Sodium bicarb, albuterol, calcium, dextrose, insulin