05 Traumatic Emergencies
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Transcript of 05 Traumatic Emergencies
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8/10/2019 05 Traumatic Emergencies
1/15
TRAUMATIC
EMERGENCIES
ALS Section E 1
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INITIAL TRAUMA CARE TRAUMA
NOTE: Appropriate Body Substance Isolation euip!ent !ust be used on all
trau!a patients"
CRITERIA: All trauma patients
TREATMENT:
1. Perform BTLS primary survey:
a. If loa an !o situation is present:i. Perform only life"#riti#al interventions on s#ene.
ii. Avise re#eivin! fa#ility an transport rapily.
iii. Perform se#onary survey enroute to re#eivin! fa#ility.iv. Perform all ot$er interventions% su#$ as I& insertion% #aria#
monitorin! an PAS' inflation enroute to re#eivin! fa#ility.
v. In all #ases% s#ene time s$oul (e limite to 1) minutes% unless
entrapment e*ists.(. If a loa an !o situation is not present:
i. Continue se#onary survey.
ii. Provie supportive #are as ini#ate.iii. Attempt to limit s#ene time to 1) minutes or less% unless entrapment
e*ists.
+. Conta#t Mei#al Control to report assessment finin!s.,. Air-ay an /0'EN aministration:
a. Apply /0'EN at 1 Lpm (y non"re(reat$er.
(. Perform avan#e air-ay #ontrol measures% as neee.#. Apply pulse o*imeter if availa(le.
2. (tain SAMPLE $istory an vital si!ns3 repeat vital si!ns every to 1)
minutes an relay to re#eivin! fa#ility.
. PAS':a. May (e use if patient #onition -arrants% an no #ontraini#ations are
present.
(. Conta#t Mei#al Control for orers to inflate.#. Refer to PAS' Care 'uieline for pro#eure.
4. Continue reassessment of patient urin! transport:
a. Continuously reassess t$e patient5s level of #ons#iousness usin! t$e'las!o- Coma S#ale.
(. Continuously monitor life"#riti#al interventions an ABC5s.
#. Report any #$an!es in patient #onition to Mei#al Control.
6. Conta#t Mei#al Control.7. If patient nees immeiate intu(ation re8uirin! #ons#ious seation -it$
&ERSE9% refer to CNSCIS SE9ATIN " &ERSE9 proto#ol.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Re#ised: Au$ust %&&&
ALS Section E +
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3/15
GLASGO' COMA SCALE TRAUMA
Indicator Response Score
Eye Openin$ Spontaneous 2
To voi#e ,
To pain +
None 1(erbal Response riente
Confuse 2Inappropriate -ors ,
In#ompre$ensi(le +
None 1
Motor Response (eys #omman 4
Lo#ali;es pain
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AM*UTATION TRAUMA
NOTE: +o not delay transport o, patient to retrie#e an entrapped or lost part"
+o not co!plete partial a!putations"
CRITERIA:
1. Partial or #omplete amputation of a (oy part
TREATMENT:
1. Initial Trauma Care.
+. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er.
,. Bleein! #ontrol.2. I& of LR enroute to re#eivin! fa#ility3 #onsier +)")) mL flui (olus to
maintain SBP (et-een >) ? 1)).
. Treat for s$o#@ if ini#ate.
4. Consier MRPINE SL=ATE m! I&P pus$ as neee for pain #ontrol.May repeat * 1 after 1 minutes as neee.
6. Tissue preservation:
a. Rinse part !ently -it$ normal saline -+O NOT SCRUB..(. . Conta#t Mei#al Control.
"""""""""""""""""""""""""""""""""""""""
Re#ised: /uly %&&0
ALS Section E 2
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BURNS TRAUMA
NTE: *atients 1it2 unstable #ital si$ns s2ould not routinely recei#e pain!edications"
CRITERIA: Any may (e present
1. In$alation inury
+. Ele#tri#al inury
,. Si!nifi#ant partial or full t$i#@ness (urns
2. C$emi#al e*posure
TREATMENT:
1. Assure s#ene an res#uer safety.
+. Initial Trauma Care.
,. Remove patient from sour#e of (urn% an e*tin!uis$ flames on patient.2. Treat (urn a##orin! to type:
a. T$ermal ? #over -it$ moist ressin!.
(. C$emi#al ? flus$ -it$ -ater or saline (rus$ off any ry #$emi#al firstD.
#. Tar ? #ool -it$ -ater or saline3 o not attempt to remove tar.. Ele#tri#al ? remove from #onta#t -it$ #urrent only if fully traine an
properly e8uippe3 note any se#onary fra#tures or e*it -ouns.
. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er.4. Perform avan#e air-ay #ontrol measures as neee.
6. Monitor.
7. I& of LR3 Consier +) ? )) mL flui (olus to maintain SBP >) ? 1)).
>. Consier MRPINE SL=ATE m! I&P as neee for pain #ontrol. Mayrepeat * 1 after 1 minutes as neeeor #onsier =ENTAN0L 1 m#!@! slo-
I&P over 1"+ minutesD instea of MRPINE. May (e repeate on#e after minutes at 1 m#!@! slo- I&P.
1). (tain (urn $istory:
a. Type of (urn3 #ausative a!ent3 time of (urn.
(. Lo#ation of (urn.#. Estimate e!ree an per#ent surfa#e area (urne.
. Inury environment.
e. SAMPLE $istory.11. Conta#t Mei#al Control.
"""""""""""""""""""""""""""""""""""""""
1+. If MRPINE anor =ENTAN0L aller!y% #onsier 9EMERL + m! I&
pus$.
Re#ised: /uly %&&0
3ebruary %&44
ALS Section E
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C5EST IN/URIES TRAUMA
CRITERIA:
1. Si!ns an symptoms of serious #$est inury% in#luin!:a. Penetratin! or su#@in! #$est -ouns
(. nsta(le #$est -all se!ment#. Si!ns of (lunt trauma to #$est. Parao*i#al movement
e. Ta#$ypnea or respiratory istress -it$ suspe#te #$est inury
TREATMENT:
1. Initial Trauma Care.
+. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er% or B&M as ne#essary.,. Perform avan#e air-ay #ontrol measures as neee.
2. Neele #$est e#ompression% if patient meets (ot$ of t$e follo-in!:
a. Si!ns an symptoms of s$o#@.(. 9e#rease or a(sent (reat$ souns on one sie.
. Immo(ili;ation.
4. Treat any o(vious #$est inuries% as ini#ate:
a. Apply o##lusive ressin! to su#@in! #$est -ouns% leavin! one #orneropen.
(. Support any unsta(le #$est -all se!ments -it$ !au;e or $an.
6. Initiate rapi transport3 reassess vitals 8 minutes.7. Monitor.
>. I& of LR3 #onsier +) ? )) mL flui (olus to maintain SBP >) ? 1)).
1). Conta#t Mei#al Control.
"""""""""""""""""""""""""""""""""""""""
ALS Section E 4
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3IEL+ TRIAGE TRAUMA
CRITERIA:
1. Multiple inure patients (eyon immeiate #apa(ility.+. Maor EMS In#ient. MEMSID
TREATMENT:
4" Se#ure s#ene an par@ in a safe lo#ation3 ACTI(ATE REGION 0 MCI*LAN"
%" Esta(lis$ In#ient Comman System ICSD3 esi!nate #omman an tria!ese#tors.
6" Count total num(er of patients involve% in#luin! all uninure% ea an
refusals.
7" Rapily #ate!ori;e inure patients usin! METTA' system:
a. Bla#@ ? (vious eat$3 non"(reat$in! patients -it$out spontaneous
respiration after repositionin! air-ay.(. Re ? Immeiate3 life t$reatenin! inuries% respiratory #ompromise% s$o#@
an altere mental status.
#. 0ello- ? 9elaye3 inuries -$i#$ #an -it$stan up to an $our elay
-it$out treatment% fra#tures an (urns.. 'reen ? Am(ulatory3 all -al@in! -oune an uninure patients.
8" Esta(lis$ treatment an loain! areas for -oune patients.
0" Treat an transport a##orin! to priority:a. All re patients s$oul (e transporte as soon as possi(le.
(. 0ello- patients may (e ta@en to treatment area% an transporte as soon as
all re patients $ave (een eva#uate.
#. 'reen patients may (e transporte (y pu(li# transportation or ot$erve$i#les.
9" As#ertain family relations$ips of vi#tims an transport family mem(ers to t$esame $ospital estination if possi(le.
" Lo! patient information an provie upates to In#ient Commaner.
;" Reassi!n patient priorities as neee to e*peite #are% an as patient
#onitions #$an!e.
4&" Conta#t Mei#al Control.
"""""""""""""""""""""""""""""""""""""""
Re#ised: /anuary %&&0
ALS Section E 6
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5EA+ OR S*INE IN/UR< TRAUMA
CRITERIA: Any may (e present
1. nresponsive or 'CS F 1,
+. Posturin!
,. ne8ual pupils2. Loss of motor or sensory fun#tion. Me#$anism t$at ini#ates potential for inury.
E/CLSIN:
1. SBP F >) ? See s$o#@ proto#ol
TREATMENT:
1. Initial Trauma Care.
+. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er.,. If un#ons#ious or semi"#ons#ious% intu(ate as per avan#e air-ay
mana!ement3 if si!ns of elevate intra#ranial pressure posturin!% unilateral
pupil ilation% 'CS7 -it$ $ypertension(ray#ariaD% initiate #ontrolle
ventilation at 12"+) (reat$smin -it$ 1))G o*y!en @eepin! en"tial pC+ at,,",G if availa(le.
2. Immo(ili;e patient an #ontrol (leein!.
. Initiate transport.4. Monitor
6. I& of LR at H&.
7. 0PERTNIC SALINE ,G solutionD at ##@! I& over ,) minutes if si!ns
of elevate intra#ranial pressure present% if availa(le.>. Assessment fa#tors to #onsier:
a. Restlessness may (e a si!n of $ypo*ia.
(. Assume #ervi#al spine inury in all patients -it$ si!nifi#ant $ea inury.#. (serve patient #losely for #$an!es in LC.
. Avoi t$e use of nasal air-ays in patients -it$ suspe#te fa#ial fra#tures.
e. 9o not treat $ypertension in t$e $ea"inure patient.1). Conta#t Mei#al Control.
"""""""""""""""""""""""""""""""""""""""
11. Consier PAS' for refra#tory $ypotension -it$ suspe#te spinal #or trauma.
Re#ised: October %&&8
No#e!ber %&&0
ALS Section E 7
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*AIN3UL= S'OLLEN OR
+E3ORME+ E>TREMIT. Conta#t Mei#al Control."""""""""""""""""""""""""""""""""""""""
1). If MRPINE or =ENTAN0L aller!y e*ists% #onsier 9EMERL + m! I&
pus$.
Re#ised: /uly %&&0
3ebruary %&44
ALS Section E >
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TRAUMATIC ARREST TRAUMA
CRITERIA:
1. Pulseless an apnei# trauma patient not meetin! t$e Trau!a 3ield+eat2
+eclaration#riteria refer to t$e Trau!a 3ield +eat2+eclarationproto#olD.
TREATMENT:
1. Assure res#uer safety3 maintain inline sta(ili;ation t$rou!$out
assessment an treatment.
+. Perform avan#e air-ay #ontrol measures3 initiate CPR.,. Immo(ili;e an initiate rapi transport -it$in 1) minutes of
e*tri#ation.
2. Monitor. Esta(lis$ t-o lar!e (ore I&5s of LR:
a. Run -ie open until patient re!ains pulse
(. Maintain SBP 1))"11)4. Aminister EPINEPRINE 1:1)%))) 1m! I& ," minutes until
pulses return or until arrival at $ospital.
6. Treat su(se8uent ysr$yt$mias per appropriate proto#ol.
7. Conta#t Mei#al Control."""""""""""""""""""""""""""""""""""""""""""""""
>. Consier PAS' inflation as ini#ate
1). Mei#al Control may orer Peri#ario#entesis if your servi#e $as t$at #apa(ilityD as per Peri#ario#entesis Care 'uieline.
Re#ised: /anuary %&&%
May %&&7
3ebruary %&44
ALS Section E 11
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TRAUMA 3IEL+ +EAT5 TRAUMA
+ECLARATION
Si!nifi#ant traumati# inury AN+
patient foun pulseless an apnei# NOupon EMS arrivalJ
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f. ea inury -it$ sei;ure a#tivity% unilaterally ilate pupil% or open
epresse s@ull fra#ture
!. T-o or more pro*imal lon! (one fra#tures$. M&C motor ve$i#le #ras$D -it$ ee#tion
i. 9eat$ of o##upant in same passen!er #ompartment
. =alls O +) ft C$ilren: 1) ft or +" , * $ei!$t of t$e #$ilD@. Separation of rier from motor#y#le
l. Peestrian (i#y#list stru#@ (y ve$i#le an t$ro-n or run overm. &e$i#le rollover -it$ un(elte passen!ers
Treatment:
1. BLS an ILS units s$oul a#tivate a tiere response or aeromei#al transport to
!ain ALS level s@ills for t$e patient if t$ey anti#ipate prolon!e s#ene or transporttime.
+. BLS units -it$out mutual ai rapi tiere response option s$oul transport t$e
patient to t$e nearest lo#al $ospital.,. Consier aeromei#al transport if 8ui#@er an of #lini#al (enefit.
2. Pre"etermine lanin! ;ones s$oul (e utili;e -$enever feasi(le for patient
$anoff to aeromei#al teams. T$e lanin! ;ones s$oul (e availa(le to allaeromei#al transport a!en#ies.
October %&4&
ALS Section E 12
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October %&4&
ALS Section E 1