EMSP Trauma

Hypertension, bradycardia, irregular respirations

Cushing’s Triad

9%

Rules of 9 for head and neck [adult]

18%

Rules of 9 posterior trunk [adult and child]

18%

Rules of 9 anterior trunk [adult and child]

9%

Rules of 9 each upper extremity [adult and child]

1%

Rules of 9 external genitalia [adult]

18%

Rules of 9 lower extremity [adult]

18%

Rules of 9 head and neck [child]

14%

Rules of 9 lower extremity [child]

Partial and full thickness

Burns that rule of 9 applies to

Shock

A life-threatening condition that occurs when the body’s organs and tissues do not receive adequate oxygen and nutrients, typically due to a failure of the circulatory system. This results in impaired tissue perfusion, leading to organ dysfunction and, if untreated, death.

Obstructive Shock

Occurs when there is a physical obstruction that impedes blood flow, reducing the heart’s ability to pump effectively. Common causes are tension pneumothorax, cardiac tamponade, pulmonary embolism. Issue with the pump.

Tension Pneumothorax

Obstructive shock cause. Air in the pleural space compresses the lungs and the hearts.

Cardiac Tamponade

Obstructive shock cause. Fluid accumulation in the pericardial sac impairs the heart’s ability to fill and pump.

Pulmonary Embolism

Obstructive shock cause. A blood clot obstructs the pulmonary arteries, preventing blood flow to the lungs

Distributive Shock

Results from widespread vasodilation, leading to inadequate blood flow to organs (pipe problem)

Septic Shock

Distributive shock. Due to severe infection causing systemic inflammation and vasodilation. Massive, systemic exaggerated responses to a localized problem. Culprit: Leukotrine

Anaphylactic Shock

Distributive shock. Caused by a severe allergic reaction leading to systemic vasodilation. Culprit: Histamine

Neurogenic Shock

Distributive shock. Results from spinal cord injury causing loss of sympathetic nervous system control over blood vessels.

Hypovolemic Shock

Caused by significant loss of blood or fluids, reducing the body’s circulating blood volume. Issue with the fluid in the pipes

Hemorrhagic shock

Hypovolemic shock. Internal or external bleeding from trauma or medical conditions

Severe Dehydration

Hypovolemic shock. From vomiting, diarrhea, burns, or inadequate fluid intake.

Compensated Shock

The body uses mechanisms to maintain adequate blood volume and perfusion. Symptoms:

• Tachycardia

• Cool, clammy skin: due to vasoconstriction

• Increased respiratory rate: to compensate for decreased oxygen delivery

• Restlessness or anxiety: due to hypoxia

Body is still able to maintain near-normal blood pressure an perfusion through compensatory mechanisms.

Tachycardia

Sign of compensated shock. Increased heart rate to pump more blood.

Vasoconstriction

Narrowing of blood vessel to maintain blood pressure

Compensation for blood loss

• Vasoconstriction

• Release of hormones

Adrenaline

Increase heart rate, blood pressure, releases aldosterone

Aldosterone

Retains sodium and water to boost blood volume

Decompensated Shock

The body’s mechanisms fail, leading to:

• Drop in blood pressure

• Altered mental status

• Weak or absent peripheral pulses

Neurogenic Shock

Conditions of this type of shock are:

• Warm, dry skin below the injury site

• Bradycardia: slowed heart rate due to unopposed parasympathetic stimulation

• Hypotension: Low blood pressure from widespread vasodilation

Anaphylactic Shock

Symptoms of this type of shock are:

• Airway issues

• Breathing issues

Shock critical treatments

• Airway Management: Ensure a patent airway

• Breathing: Administer high flow oxygen

• Circulation: Control bleeding and initiate CPR if necessary

• Transport: Rapid transport to a trauma or emergency center

Geriatric Patients

shock in this type of patient. Often have a blunted response, with a delayed increase in heart rate and reduced capacity to compensate for blood loss. They may decompensate quickly.

Pediatric Patients

Shock in this type of patient. Can maintain normal blood pressure until very late in the shock process. When decompensation occurs, it happens rapidly, making early recognition of increased heart rate and other signs critical.

Mechanism of Injury

How traumatic injuries occurs, focusing on the forces, direction, and types of energy transferred to the body. Understanding this helps predict the types of injuries the patient may have.

Index of Suspicion

Level of concern an EMT has regarding potential injuries based on the MOI and initial patient assessment. If it is high, it might lead to more aggressive management and rapid transport, even if injuries aren’t readily apparent.

Velocity

Most significant factor in creating kinetic energy. KE = ½ MV², which shows that small increase in velocity leads to large increases in energy transfer.

Vehicle Collision

One of the three typical collisions in an MVC. The vehicle strikes an object and comes to a sudden stop.

Body Collision

One of the three typical collisions in an MVC. The body of the occupant strikes interior parts of the vehicle (e.g. steering wheel, dashboard).

Organ Collision

One of the three typical collisions in an MVC. The internal organs continue to move and collide with the body’s structures (e.g. brain against the skull, heart against the ribcage), potentially causing serious internal injuries.

Up-and-over travel path

The patient may go over the steering wheel, striking the windshield. This often leads to head, neck, and chest injuries, including facial trauma and potential cervical spine injury.

Down-and-under travel path

The patient slides under the dashboard, often causing leg injuries, such as femur fractures, pelvic fractures, or knee injuries.

Bent steering wheel

Indicates significant force applied to the chest and abdomen, likely thoracic trauma, such as rib fractures, flail chest, or internal organ damage (e.g. liver, spleen). In an MVC.

Roll-over

Most unpredictable injury pattern, as multiple impacts can cause a wide range of injuries, from spinal trauma to extremity fractures. In an MVC.

Airbag protection

Airbags reduce the force of impact on the upper body and prevent occupants from striking the wheel or dashboard, thus reducing the likelihood of head and chest injury

Airbag Risks

Airbags can cause injuries like burns, fractures, and cervical spine injuries if the person is too close during deployment.

Most at risk:

• Children

• Short individuals

• Older adults

20 feet

Height of serious fall for adult

10 feet

Height of serious fall for child

Low Velocity Penetration

Injuries from sharp objects like knives, which cause damage limited to direct path of object

Medium Velocity Penetration

Injuries from handguns or shotguns, where the damage is more extensive due to bullet speed and potential for cavitation

High Velocity Penetration

Injuries from high-powered rifles, where the energy transfer causes massive cavitation, leading to significant internal damage beyond the bullet’s path.

Cavitation

A pressure wave that creates a temporary cavity in tissues, resulting in additional trauma to surrounding structures. From high-velocity projectiles like bullets from high-powered rifles.

Primary Phase

Injuries caused by the blast wave itself, primarily affecting gas-containing organs like lungs, intestines, and eardrums (e.g. blast lung, tympanic membrane rupture)

Secondary Phase

Injuries caused by flying debris, which can cause penetrating trauma and lacerations

Tertiary Phase

Injuries caused by the body being thrown by the force of the explosion, leading to blunt trauma, fractures, or headinjuries

Quaternary Phase

Other explosion-related injuries, such as burns, crush injuries, or inhalation of toxic substances

Golden Hour

The critical first hour following the traumatic injury when rapid treatment and transport significantly improve survival outcomes

Platinum 10

Refers to the first 10 minutes at the scene of the trauma. EMTs aim to assess, treat life-threatening injuries, and initiate transport to definitive care within this time to optimize patient outcomes

5-6 L

Amount of blood in an adult

80 - 90 ml/kg

Amount of blood in a child

Arterial Bleeding

Bright red and spurting, due to high pressure from the heart’s pumping action. This type of bleeding is most difficult to control and can be life-threatening

Venous Bleeding

Dark red and steady flow, as it’s under less pressure than arterial bleeding. Easier to control, but still dangerous

Capillary Bleeding

Slow and oozing, often seen in superficial wounds. Usually stops on its own or is easily controlled.

Steps for controlling bleeding

• Direct Pressure: Apply pressure directly to wound using a sterile dressing or gloved hand

• Elevation: Elevate the injured area above the level of the heart, if possible

• Pressure Dressing: Apply a pressure dressing over the wound to maintain direct pressure

• Tourniquet: If bleeding cannot be controlled with pressure and the injury is on an extremity, apply the tourniquet above the injury site

Apply tourniquet

Do this bleeding control measure if direct pressure fails to control severe bleeding or immediately if there is a massive hemorrhage from an extremity

Applying tourniquet

2-3 inches above wound, avoiding joints. Tighten until bleeding stops and note time of application

Should not be

When should a tourniquet be released

Hemostatic Dressing

Special dressing impregnated with substances that help promote clotting. Used when direct pressure alone is insufficient, often in areas where a tourniquet can not be applied.

Pressure Dressing

A tightly applied dressing that maintains continuous pressure on a wound to control bleeding

Splints

Immobilize fractures and reduce the movement that can aggravate bleeding

Traction Splint

Used for femur fractures to reduce pain and prevent further injury

Pelvic Stabilizer

Reduce bleeding from pelvic fractures by immobilizing the pelvis

Epistaxis treatment

Pinch the nostrils and lean the patient forward. Apply cold pack to bridge of the nose. In some cases, placing gauze pads inside the nostrils may help absorb the blood

Contusion

Bruise caused by damage to small blood vessels under the skin, leading to minor bleeding and discoloration

Hematoma

A more severe injury where a pool of blood forms under the skin or within tissues, often due to more significant trauma and blood vessel damage

Avulsion

Occurs when a flap of skin or tissue is torn away from the body.

Treat an avulsion

• Clean the wound if possible

• Fold the skin flap back to its normal position, if still attached, and cover it with a sterile dressing

• If tissue completely detached, wrap it in sterile gauze, moisten it with saline, and transport it with patient for potential reattachment

Amputated Part

• Wrap part in sterile gauze moistened with saline

• Place it in a plastic bag

• Cool the bag by placing it in another bag or container filled with ice or cold water. Do not place directly on ice

Impaled Object

• Do not remove unless obstructing airway or preventing CPR

• Stabilize object in place with bulky dressings to prevent movement

• Control bleeding around the object using direct pressure without disturbing the object itself

Dressing

Sterile material placed directly on a wound to control bleeding and prevent contamination

Bandage

Material used to secure a dressing in place or immobilize an injured area

Factors that increase bleeding

• Blood-thinning medication (warfarin, aspirin)

• Hypothermia

• Pre-existing medical conditions that impair clotting, such as hemophilia

Clamping/crushing injury

When a body part is trapped under pressure, leading to tissue damage and potential crush syndrome

Crush Syndrome

Release of toxins into circulation when pressure is relieved

Crush Injury Treatments

• Controlling bleeding

• Immobilizing the injured part

• Preventing complications such as crush syndrome by early recognition and rapid transport

Abdominal Evisceration Treatments

• Cover exposed organs with sterile, moist dressing

• Never push organs back in

• Cover moist dressing with occluive dressing to prevent contamination

• Place patient in position of comfort

Air Embolism

Greatest risk from laceration to anterior neck. Air enters the damaged blood vessels and travels to the heart, causing a potentially fatal condition.

Neck laceration treatment

• Apply occlusive dressing

• Use direct pressure to control bleeding

Epidermis

Outermost layer of the skin, which provides a protective barrier and contains no blood vessels or nerves

Dermis

Middle layer of skin where nerves, blood vessels, sweat glands, hair follicles, and sebaceous glands are located

Subcutaneous (Hypodermis)

Deepest layer of skin made of fat and connective tissue that insulates and protects the body. It also contains larger blood vessels and nerves

Protection, Thermoregulation, Sensation

The three functions of the skin

Superficial (First-degree) Burn

Damage: Affects only the epidermis

Signs/symptoms: Redness, pain, and minor swelling. No blisters. Example: sunburn

Partial-Thickness (second-degree) Burn

Damage: Affects the epidermis and part of the dermis

Signs/symptoms: Red, blistered, moist appearance. Intense pain due to nerve involvement

Full-Thickness (third-degree) Burn

Damage: Affects all layers of the skin, potentially reaching muscle and bones

Signs/symptoms: White, charred, or leathery skin. Loss of sensation in the burned area due to nerve destruction, but surrounding areas may still be painful

>10%

Critical burn (BSA, full thickness burns)

>25%

Critical burn (BSA, partial thickness burns)

Face, hands, feet, joints, genitalia

Critical burn areas

Airway Compromise

Greatest concern with inhalation injuries and signs. Due to swelling, burns to the airway, and inhalation of toxic substances like carbon monoxide.

Signs:

• Singed nasal hairs

• Soot around the nose or mouth

• Hoarseness or difficulty breathing

• Coughing up black sputum

• Stridor (high-pitched breathing sound)

Circumferential Burn

Burn that completely encircles a body part. Can restrict circulation or lead to compartment syndrome as swelling increases within the confined space, compressing blood vessels and tissues