2013 Trauma Basics:
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Transcript of 2013 Trauma Basics:
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2013 Trauma Basics:
“Blood, Heat & Gears”
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RTACs: Regional Trauma Advisory
Councils Wisconsin Trauma Field Triage
Guidelines Injury Prevention Education Performance Improvement
Regional Trauma System...
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Quickly identify traumatic injuries at the scene Provide highest possible level of care at the
scene Triage and transport patients according to
severity of injury Transport each patient to facility with
appropriate level trauma resources and capabilities
EMS’ Role in the State Trauma System…
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TRIAGE
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START Triage
vs.
SALT Triage
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START vs. SALT...
VS.
START vs. SALT...
The use of a triage system is strongly encouraged
Rapid determination Number of patients Severity of injury/illness Resources needed Patient identification
Unified system used by all responders is beneficial
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Which Triage System Will Wisconsin Use?
S.T.A.C. and the WI EMS Board have endorsed the M.U.C.C.
Therefore, they support transition to SALT Triage
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SALT Triage: Step 2: Assess
Assess:
Limited rapid life-saving interventions Open airway, NPA/OPA, tourniquet, DP by others, etc Only in your scope of practice Only if equipment/resources are readily available
Look for Critical Criteria; (No breathing = DEAD*) Respiratory Distress No peripheral pulses Major hemorrhage uncontrolled
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No purposeful movement
Does not follow simple commands
What is your SALT Triage Priority?
Sort Assess Life Saving Interventions Triage / Transport
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What is this patient’s SALT priority?
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What else is new for Wisconsin Trauma?
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Wisconsin Trauma Field Triage Guidelines2013
(Please see your handout)
WI Trauma Field Triage Guideline...
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WI Trauma Field Triage Guideline...
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Transport To A…
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Bleeding Control
Bandaging or Stopping the Bleeding?
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Stopping Active Bleeding...
‘Pressure’ Dressings: Applied over a sterile dressing Circumferential pressure
Elasticity of the bandage Tightness of wrap by EMT
Pros: Cons:
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Tourniquets....
Long history of military use in ALL American wars, Civil War to Operation Enduring Freedom
When properly applied, can cease extremity circulation, therefore stopping any active bleeding
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antiquescientifica.com
www.share.com
Tourniquet Application...
Follow Manufactures Instructions
Tighten until all bleeding STOPS
Secure tourniquet to make sure it cannot loosen
Note the time of application Keep area uncovered for
ongoing observation
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www.share.com
Tourniquet Usage: Fact or Fiction?
FICTION: Tourniquet application = loss of extremity Tourniquets can only be applied for 20 mins. Only commercially made tourniquets work Tourniquets can be removed if bleeding has been stopped
for over 20 minutes.
FACT: Tourniquets application is generally safe for up to 2 hours Tissue damage can occur, even with proper application,
and for short durations.22
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DEMONSTRATION
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Now, it is time to turn up the heat!
http://www.layoutsparks.com/1/231919/burning-flames-yellow-fire.html
Where do burns occur?
68% Home 10% Occupational 7% Street / Highway 15% Other
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American Burn Association Burn Incident Fact Sheet
photoblog.nbcnews.com
Chemical Burns...
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www.eplasty.com
Thermal Burns...
Heat Injury: Direct Contact /
Conduction
Scalding
Convection
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Anatomy of the Skin...
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2nd Degree Burn = Partial Thickness
Moist Pink/Red Blanches VERY painful Cells of the
Dermis destroyed too
Infection risk
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www.healthcentral.com
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2ND
Rule of Nines... Adult:
Body surface is divided into areas representing 9% ...or multiples of 9%
Limitations: Smaller burns Different burn types
31www.my.firefighternation.com
What are Significant Burns?
1. Partial thickness burns greater than 10% TSBA 2. Burns that involve the face, hands, feet, genitalia,
perineum, or major joints. 3. Any third-degree burns. 4. Electrical burns, including lightning injury. 5. Chemical burns. 6. Inhalation injury. 7. Burn injury in patients with pertinent preexisting
medical disorders that could complicate management, prolong recovery, or affect mortality..
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Burn Injury AND other Trauma...
Patient has significant burns and s/s of major traumatic injury
Patient has significant burns and has endured a major MOI, consistent with traumatic injury
Unknown MOI, but patient unstable, or with unstable airway/breathing.
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Transport to a TRAUMA CENTER if Possible
Thermal Burn Care... 2nd Degree
Cover burn area with sterile dry dressing and elevate Protection, don’t pop blisters! Exposure to air increases pain Plastic Wrap?
Pain management! Do not use ice/cold water, etc to cool large areas of
2nd degree burns Hypothermia Decreased circulation from vasoconstriction
Remove Jewelry ASAP 34
IV Fluids
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www.blog.supermedia.com
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The Main Event…
Given a ‘scene’ to manage From onset to transport of all
patients to definitive care You MUST follow a few simple
parameters…
You Must…
Use SALT TriageUse The Wisconsin Trauma Field
Triage Guidelines
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What we know so far...
House Explosion
Multiple Victims
Probable Methamphetamine Lab
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No purposeful movement
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Triage: Patient #1 Individual Assessment...
Life-Saving Interventions: No major bleeds, airway is open
Breathing?: Yes Obeys Commands?: No Radial Pulse?: Yes Not in Respiratory Distress?: No Expected to Survive given current
resources? Yes43
Triage: Patient #2 Individual Assessment...
Life-Saving Interventions: Opened the airway..now agonal gasps
Breathing?: Yes, agonal? Obeys Commands?: No Radial Pulse?: No Not in Respiratory Distress?: No Expected to Survive given current
resources? No44
Triage: Patient #3 Individual Assessment...
Life-Saving Interventions: Profuse bleed from right thigh... Now what?
Breathing?: Yes Obeys Commands?: Yes Radial Pulse?: No Not in Respiratory Distress?: Yes Expected to Survive given current
resources? Yes45
Triage: Patient #4 Individual Assessment...
Life-Saving Interventions: No major bleeds; airway patent
Breathing?: Yes Obeys Commands?: Yes Radial Pulse?: Yes Not in Respiratory Distress?: Yes Expected to Survive given current
resources? Yes46
All Minor Injuries?
Hospital Communications...
Early hospital communications vital to the success of the incident. 2-way communication
Scope of incident # and severity of patients, ages Special considerations
Hospital capability # and severity of patients, ages
Establish ‘Base’ Hospital concept?
On-going communications47
Patient #1... Rapid Trauma Assessment:
Head/Neck: Partial thickness facial/neck burns on the anterior
Chest: GSW entrance to right anterior chest wall
Abdomen: Soft, not distended Pelvis: Stable Extremities: Angulated right forearm; partial
thickness hand burns bilaterally
Posterior: No exit wounds; no burns.48
Patient #1… Ongoing concerns
Airway: Potential loss of patency Decreasing LOC Airway constriction from inhalation injury
Breathing: Potential need for ventilatory support
CNS Depression from hypoxia/hypoperfusion Inability to create negative pressure Tension Pneumothorax
Circulation: SHOCK! 49
Patient #2... Rapid Trauma Assessment:
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Head/Neck: Large open skull fracture, grey matter visible and not intact
Chest: No signs of trauma Abdomen: No signs of trauma Pelvis: Stable Extremities: Partial and full-thickness burn to
bilat arms and hands distal from the elbow
Posterior: No signs of trauma
Patient #2… Ongoing Concerns
SALT Triage allows this patient to be re-assessed after other patients have been managed
START Triage -- would categorize the patient as Immediate due to ‘failure to obey simple commands’
- OR –
Deceased due to ‘not breathing (agonal) after airway
positioning'
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Patient #3... Rapid Trauma Assessment:
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Head/Neck: No signs of trauma Chest: Abrasions to anterior
chest by right clavicle
Abdomen: Soft, not distended Pelvis: Stable Extremities: Large laceration to right
leg at the mid-thigh; major active
bleed Posterior: No signs of trauma
Patient #3… Ongoing Concerns
Hemorrhage control: Is the bleeding really stopped
Bleeding through dressings? Bleeding resumes after initially stopped
Shock!: The clock is ticking Be prepared for rapid deterioration
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Patient #4... Rapid Trauma Assessment:
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Head/Neck: Partial-thickness facial and neck burns; singed nasal hairs
Chest: Partial-thickness and superficial burns to anterior and posterior chest
Abdomen: Superficial burns to anterior abdomen Pelvis: No signs of trauma Extremities: Circumferential full-thickness burns to
bilat lower arms Posterior: Partial-thickness burns to 50% of
back
Patient #4… Ongoing Concerns
Inhalation Injury: Potential for rapid deterioration Pro-Active vs. Re-Active management
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Fluid Resuscitation When? How much? What fluid?
Which Hospital?
Our Patients… Initial treatment
1 2 3 4
Hospital Options…
CONGRATULATIONS!
Triage
Assessment
Treatment
Transport
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Any questions about the Wisconsin Trauma Field Triage Protocol,
tourniquet devices, or burn care?
Special thank you to…
Bob Nack
and
Acme Regional Hospital
for hosting this program.
SCRTAC…
Saving Lives By Strengthening Our Region’s Trauma Care System