(4) Trauma Instruction Pt. 1

Lab

Golden Hour

Fom time of injury to definitive care (often surgery)

• The first 60 minutes after a severe trauma is crucial to the patient’s survival

• Beyond that, morbidity and mortality significantly increase

60

After a severe trauma, the first ____ minutes are crucial to the patient’s survival.

PMS (Pulse, Motor, Sensation)

a way to test circulatory, motor, and sensory function at the most distal areas of our body

Platinum Ten

Limit scene time to 10 minutes to expedite transport to trauma facility

a complete & rapid head to toe assessment

If you have a high index of suspicion, then you should be performing:

a.) a complete & rapid head to toe assessment

b.) a focused head to toe assessment on the specific body part in complaint

a focused head to toe assessment on the specific body part in complaint

If you have a low index of suspicion, then you should be performing:

a.) a complete & rapid head to toe assessment

b.) a focused head to toe assessment on the specific body part in complaint. 

Exsanguination; Airway; Breathing; Circulation; Disability; Expose

In Trauma assessments, remember XABCDE. What do these mean?

Disability

What does the ‘D’ stand for in XABCDE?

• any altered mental status

Expose

What does the ‘E’ stand for in XABCDE?

• Expose local injuries or the entire body if high index of suspicion prior to head to toe. Address any life threats if found after exposing.

T

T or F?

The head to toe assessment is performed after the XABCEs and exposing the patient.

T

T or F?

If the patient is unable to follow commands or is unresponsive, then the provider will manually hold their head until spinal immobilization (backboard) can be applied.

withholding C-Spine/C-Collar

A pt has experienced an insignificant mechanism of injury. They do not have a complaint of head, neck, or back pain. As EMTs we should practice spinal motion restriction by:

spinal motion restriction (SMR)

The patient is able to follow commands. What protocol should we follow for spine stabilization?

manual C-spine stabilization

The pt is unable to follow commands and is unresponsive. What protocol should we follow for spine stabilization?

Deformities; Contusions; Abrasions/Avulsions; Penetrations; Burns; Tenderness; Laceration; Swelling

What does DCAP - BTLS stand for?

Battle Signs; Raccoon Eyes

Late signs that indicate basilar skull fracture:

bleeding in the brain

Blood/Cerebrospinal fluid coming from the ears and nose indicates:

hypertension; bradycardia; irregular respirations (Cheyne Stokes)

What are the three components that make up Cushing’s Triad?

Cushing’s Triad

Our body’s attempt to compensate for hypoxia in the brain

• hypertension

• bradycardia

• irregular respirations [Cheyne Stokes]

Controlled hyperventilation (ventilate every 3-4 seconds)

What is the treatment for Cushing’s Triad?

Crepitus

crunching, grating, or popping sounds produced when the joints move

3

Chest seals are taped on how many sides?

Pneumothorax

a collapsed lung in progress

• Diminished/absent lung sounds

• Respiratory distress

Tension pneumothorax

a fully collapsed lung

• Severe respiratory distress

• Systemic issue (example of obstructive shock)

  • absent lung sounds on affected side

  • Tracheal deviation

  • JVD

tension pneumothorax

You have a pt who presents with severe respiratory distress. You note that they also have absent lung sounds on the right side, tracheal deviation, and JVD. What would you suspect?

Flail chest

• Two ribs fractured at 2 or more places

• Due to negative pressure created when we inhale, the flail segment will get pulled into the chest and pushed outward upon exhalation

Paradoxical movement

What’s a symptom of flail chest?

CPAP

If you have a pt with paradoxical movement, and no suspected pneumothorax, which O2 treatment should be considered?

bulky (blanket or multi trauma dressing)

Which type of dressing should be provided for the outside of the flail segment?

internal

CPAP should be considered as an ________ splint for flail segment.

Kehr’s sign

• Left shoulder pain

• Referred pain from diaphragmatic irriation

• Ruptured spleen

Kehr’s sign (Splenic rupture)

A pt with Cullen’s sign and left shoulder pain should point you to suspect:

Grey Turner’s sign

Discoloration around the flanks

Cullen’s sign

Discoloration around the umbilicus

Priapism

uncontrolled erection

spinal trauma

Priapism is indicative of what type of trauma if present?

pelvic sling

If pelvic tenderness/crepitus is felt and a fracture is suspected, then apply:

greater trochanter

Where should the pelvic sling be place?

any crepitus or tenderness to the spine

What are we palpating for during log rolling?

2-3 inches proximal to injury

Tourniquets should be applied:

___-___ (proximal/distal) to injury

F

T or F?

Apply the tourniquets on the joints.