EMS 25: Trauma Overview

Traumatic injury

Occurs when body tissues are exposed to energy levels beyond their tolerance

Mechanism of injury (MOI)

The way a traumatic injury occurred and how energy was transferred to the body

Blunt trauma

Force to the body causing injury without penetrating the soft tissues; often causes hidden internal injuries

Common causes of blunt trauma

Motor vehicle crashes and falls

Penetrating trauma

Injury caused by an object piercing and penetrating the body's surface

Vehicle crash assessment

Determine the MOI by evaluating vehicle damage, restraint systems, and contact points inside the vehicle

Three collisions in a motor vehicle crash

Vehicle collision, occupant collision, and internal organ collision

First collision

The vehicle strikes another object

Second collision

The occupant strikes the inside of the vehicle

Third collision

Internal organs strike the inside of the body cavity

Coup-contrecoup injury

Brain injury caused when the brain strikes one side of the skull and rebounds to the opposite side

Supplemental restraint system

Seat belts and airbags that reduce injury severity

Contact points

Areas where the patient struck the interior of the vehicle, helping identify possible injuries

Rear-end collision injuries

Whiplash injuries caused by rapid extension and flexion of the neck

Lateral collision injuries

May cause lateral whiplash, rib fractures, pelvic fractures, abdominal injuries, chest injuries, and lower extremity fractures on the impacted side

Rollover collision

Highest life-threatening risk is complete or partial ejection

Car-versus-pedestrian assessment

Determine vehicle speed, whether the patient was thrown, landing surface, and whether the patient was dragged or pinned beneath the vehicle

Spinal injury assumption

Presume spinal column or spinal cord injury in significant trauma until ruled out at the hospital

Significant fall

Fall greater than 20 feet (6 meters)

Fall assessment

Determine height, landing surface, body part struck first, and direction of energy transfer

Landing on feet

May transmit force to the spine while producing fewer internal injuries

Projectile path

May be unpredictable after penetrating trauma

Cavitation

Temporary cavity created by a projectile that damages tissue beyond the projectile's diameter

Projectile injuries

Internal damage is often much larger than the entrance wound

Signs of airway trauma

Noisy or labored breathing, facial or neck swelling, altered gag reflex, low GCS, decreased SpO₂, rapid weak pulse, hypotension

Index of suspicion for neck trauma

Airway obstruction from bleeding, swelling, or foreign bodies

Signs of significant chest trauma

Chest pain, dyspnea, increased respiratory rate, asymmetric chest movement, subcutaneous emphysema, JVD, weak pulse, hypotension

Index of suspicion for chest trauma

Pulmonary contusion, cardiac contusion, pneumothorax, hemothorax, and rib fractures

Pneumothorax

Air in the pleural space causing partial or complete lung collapse

Hemothorax

Blood in the pleural space

Subcutaneous emphysema

Air trapped beneath the skin producing a crackling sensation on palpation

Jugular vein distention (JVD)

Bulging neck veins that may indicate increased intrathoracic pressure

Signs of serious head injury

Loss of consciousness, altered mental status, inability to recall events, combative behavior, headache, nausea, vomiting, inability to maintain the airway, decreasing GCS

Index of suspicion for head injury

Bruising or bleeding around the brain causing increased intracranial pressure

Signs of spinal injury

Severe neck or back pain, numbness, tingling, weakness, or inability to move extremities

Primary blast injury

Damage caused directly by the blast pressure wave

Secondary blast injury

Injury caused by flying debris

Tertiary blast injury

Victim is thrown by the force of the explosion

Quaternary blast injury

Burns, toxic inhalation injuries, and crush injuries

Organs most susceptible to blast injuries

Middle ear, lungs, and gastrointestinal tract

Pulmonary blast injury

Lung injury caused by exposure to a blast pressure wave

Arterial air embolism

Air entering the arterial circulation causing vision changes, altered consciousness, or other neurologic deficits

Golden principles of trauma care

Ensure scene safety, determine MOI, treat life threats first, and transport rapidly

Life-threatening priorities in trauma

Control hemorrhage, support the airway, treat shock, stabilize the spine when indicated

Maximum trauma scene time

Less than 10 minutes

Secondary assessment in trauma

Obtain a SAMPLE history and perform a secondary assessment after life threats are managed, usually during transport

Neck trauma assessment

Inspect for DCAP-BTLS, airway compromise, expanding hematoma, fractures, or air embolism

Chest trauma assessment

Evaluate for injuries involving the lungs, heart, and great vessels

Open chest wound

Life-threatening injury requiring immediate treatment to prevent shock and death

Indications for rapid trauma transport

Dangerous MOI, decreased level of consciousness, or threats to airway, breathing, or circulation

Level I trauma center

Provides every aspect of trauma care, including all surgical specialties

Level II trauma center

Provides initial definitive trauma care but may transfer highly specialized cases

Level III trauma center

Provides assessment, resuscitation, emergency care, stabilization, and transfer when necessary

Level IV trauma center

Provides advanced trauma life support, stabilization, and transfer from remote areas

Indications for air medical transport

Remote location, prolonged extrication, unavailable ALS, multiple trauma patients, or mass-casualty incident

Air EMS staffing

Critical care nurses and paramedics