JCCC EMT Trauma (EMS 132)

the area inside skull

cranial vault

how many cranial and spinal nerves

12 cranial

31 spinal

how many vertebrae do we have

33

how many injuries are there in there to a head trauma

2

primary - the blow itself (coup-contrecoup)

secondary- the after effects (Swelling)

concussion 

least severe head injury

no physical damage, but interrupts normal brain function

concussion, headache, and memory loss, N/V, dizzy

loss of consciousness is not always the case

the two types of memory loss

retro amnesia and antero amnesia

contusion

a bruise on the brain- worse than concussion

think more severe concussion s/s

epidural hematoma 

blood between skull and dura mater

arterial bleeding in epidural space will result in rapidly progressing symptoms

usually goes “unconscious>conscious>unconscious 

DAI

diffuse axonal injury

shearing stretching or tearing of nerve fibers from rapid accel. or. decel. of nerve fibers from falls, SBS, and falls

subdural hematoma

blood beneath dura mater but outside brain

most common TBI

usually after falls or injuries with strong decel forces

usually veinous bleeding so more gradual progression

fluctuating LOC and slurred speech

subarachnoid hemorrhage

bleeding subarachnoid space where CSF is

causes: rupture of aneurysm and trauma

usually results in death

another exp ? for decreased LOC

any recent head trauma

intracranial hematoma

basically a hem. stroke

increased ICP- what does it do

The MAP stays the same, so the perfusion to the brain decreases.

compresses the tissues in brain

tissues pushed out the foramen magnum

this causes cushing’s triad bc the brain stem is being damaged

what is cushing’s triad

htn

bradycardia

abnormal resp. 

SBS main s/s

lethargy

decreased appetite

behavior changes in general

the two signs of basal skull fracture

raccoon eyes and battle sign

general head injury s/s

AMS

N/V

seizure

cushings triad 

combative behavior

repetitive ?s

Dizzy

amnesia

CSF leaking

behavior change

blown pupils

posturing

facial trauma s/s that aren’t obvious

limited ocular movement (a fractured bone snags the muscle)

facial assym.

malocclusion (bad bite)

diplopia (double vision)

are alkali eye burns or acid worse

alkali

blow out orbital fracture

direct blow causes eye to push on thin base plate and fractures it.

s/s

flattened face

periorbital swelling

diplopia

inopthalmos (sunken eye)

impaired ocular movement

globe trauma in eye

an injury to the eyeball itself

pain

pupil irregularity

blood 

blurry vision

hyphema

blood in anterior chamber of eye

hyphema

what do the vertabrae connect by

ligaments called disks

types of spinal cord injuries

extension

flexion

distraction compression

the higher up the spinal cord injury…..

the more body is effected

neurogenic shock

the area below the injury no longer can connect to the sympathetic NS so no vasoconstriction.

They are not cool pale and clammy usually and will have a slow pulse bc of no sympathecic response

head injury treatment

continuous ETCO2

c-spine

BP monitoring

Administer high-flow oxygen via NRB (non-rebreather) as a precaution against

unanticipated deterioration, keep SPO2 from falling below 90%

Target Etco2 level of 40

Moist sterile dressing to any potential open skull wound

Severe head injury – Elevate head of bed 30 degrees

chemical eye burns how long to irrigate

20 mins

thermal/light eye burns care

cover eyes with moist sterile dressing 

conjunctivia

the membrane that lines eyelids and covers surface of eye

cornea

transparent tissue layer infront of pupil and iris

the iris

the muscle that dilates and constricts pupils

lens

transparent part of eye through which images are focused on retina

retina

the light sensitive area at back of eye that sends signals to brain

sclera

white fibrous portion of eye

What should you do before caring for evisceration

Primary and physical exam

If ear or nose cartilage is showing you should

Cover with moist sterile dressing

how many sets of ribs do we have

12

pulmonary contusion

bruise of lung tissue

damaged tissue cant perform 

fluid ends up in alveoli 

may hear crackles

give 02 if needed

can lead to ARDS

ARDS

acute resp distress syndrome

lungs get irritated after injury (secondary drowning, trauma, smoke inhalation, etc…)

blunt myocardial injury

can lead to arrythmias

chest pain

SOB

cardio/obstruc. shock

when bluntbtrauma to chest causes cardiac arrest

commotio cordis

leads to v-fib

traumatic asphyxia- what? s/s?

chest gets crushed and pushes blood to head and rest of body

bluish red to bluish black skin on head, neck, upper thorax

massive subconjunctival hemorrhage

def of flail chest. Care?

2 or more ribs broken in 2 or more places

BVM internal splinting

cardiac tamponade s/s

hypotension/narrowing pulse pressure, muffled heart sounds, JVD- becks triad

irregular pulse, chest pain

Trauma to male genitalia

Wrap contents in moist dressing

Stop bleeding with direct pressure

Put ice on scrotum

Ask “can you urinate”

rule of 9s

TBSA is calculated only based on percent of second- and third-degree burns – First

degree/superficial burns are not included in this calculation

classification: red/white, moist, burns with blisters 

partial thickness

complications with burns

dehydration/fluid shift 

loose thermoregulation 

infection

swelling/compartment syndrome- circumferential burns 

airway

what could happen if there is a burn around the chest

compartment syndrome. They cant breathe 

what places/types are considered critical burns

hands, feet, face, genitalia, butt, thighs, major joints

circumferential 

over 15%

any respiratory 

burn care

Stop the burning

Remove clothing (if not stuck to the patient)

Remove jewelry

Leave blisters intact

(No water bc of heat loss)

Minimize burn wound contamination

Cover burns with dry dressing or clean sheet (seperate fingers and toes)

Do not apply gels or ointments

Monitor SPO2, EtCO2 and cardiac monitor

High flow supplemental oxygen for all burn patients rescued from an enclosed space

Prevent systemic heat loss and keep the patient warm

for small burns (basic red cross first aid, not EMS)

run under cold water for 20 mins

cover with clean dressing

consider burn ointment if no hospital needed 

escharotomy

they cut the chest so it can expand and breathe again

electrical burns considerations

remember reverse triage

can cause more internal injuries

which skeleton? skull, ribs, spine, sternum

axial skeleton

which skeleton? extremities, pelvis, scapula

appendicular skeleton

a femur fracture can loose about _____ of blood

1-2 liters

a pelvic injury can loose ____ of blood

all of it

dislocations considerations

May spontaneously reduce

may cause a fracture of adjoining bone

sprain

excessive twisting causes ligaments and tendons to stretch and tear

strain

overworking, stretching, or exertion

can cause a snap sound upon tearing

when to use a traction splint

when its an isolated, closed, midshaft femur fracture

shoulder injury splinting

sling and swath with padding between arm and chest

anterior hip dislocation

rotated outward (lateral) may be shorter

posterior hip dislocation 

knee is usually bent and leg rotated inward

orthopedic trauma care

Expose (and remove jewelry)

palpate

inspect

cover and dress open wounds

PMS

is PMS there? No- gently try one time to put angulated body part back in proper place.

• Tell the pt before you do this. Ask them to tell you if there is any resistance, unbearable pain, or crunching sounds

Apply splint

PMS

Ice

elevate it

Recheck PMS and 6 Ps every 5 minutes

if open fracture, cover bone with moist dressing.

MARCH

Massive hemorrhage

• body sweep for holes and blood

Airway

• Open and self-maintained?

Respiratory

• Rate- adequate or not?

• Sounds

• Patency and tracheal deviation

• Oximetry

• 02

• Etco2

Circulation

• strength and quality of pulses 

• skin

• note low bp by feeling pulses

Head injury/hypothermia

• cover with blanket

• PMS all extremities 

• AVPU

• Pupils

Triage/Transport

MVC significant MOI cues

death of occupant

rotation or flip

severe deformity or intrusion

ejection

how many collisions in MVC

3

car to object

body to car

organs to body

frontal collisions common injuries

extremities

internal organs

chest

head

Rear end collisions common injuries

whiplash injuries (body goes forward while head stays back)

coup-contrecoup

Lateral crashes common injuries

very common cause of death

lateral whiplash

pelvic injury

rib injury

rollover crashes common injuries

ejection

hit by objects inside

car vs motorcycle common injuries

bilateral femur fractures 

crush injury from bike

abrasions

Falls exp ?s and considerations

how high

what surface

what body part

what was the cause

more than 2-3x body height is significant 

internal injuries pose the greatest threat

children usually fall on their heads

GSW considerations

bullet may ricochet

fragmentation may increase injury

the path the bullet takes is called

trajectory

high velocity weapons can cause ________. What is it?

cavitation- bullet generates pressure waves damaging nearby tissues that may be distant from bullets path

the two time standards for trauma

platinum ten and golden hour

In major MOI situations with broken bones, you should…

use the back board as a splint, then go back as time permits

GCS

when to call for air medical

MCI

Need ALS with no ground ALS available

extended period required for extrication

When you cant get out (locked down highway)

level 1 trauma center

every aspect of trauma at all times

rehab to prevention

level 2 trauma center 

surgical specialties available in < 30 min 

capable of definitive care for all trauma pts

level 3 and 4 trauma centers

3- prompt resus and stabilization

4- provide ALS before transport to higher level

Johnson county level 1 trauma centers

Childrens mercy

research medical center

st lukes hospital- plaza

KU medical center

Stroke centers in Johnson county

Advent health shawnee mission and OP- p

OPR- p

research med center- c

st lukes hospital plaza- C

KU med- C

SMR

indicated when:

AMS with trauma- manual

neuro deficits (pms)- manual

midline pain- manual or verbal

evidence of intox- manaul

other severe or distracting injuries- manual or verbal

cant communicate (language)- manual

major MOI- manual or verbal

DO NOT USE C COLLAR when penetrating injury neck

only do manual when AMS, cant communicate, or movement deficits

self extricate unless worsen injuries, AMS, or neuro deficits

pts should not stay on backboard unless

• used as splint

• unstable pts and you dont have time

index of suspicion

awareness that unseen lifethreatening injuries may exist

trauma exp ?s and observations: MVC

spider web

airbags

# of cars

how fast

break on?

car off?

seatbelts

exterior damage (intrusion)

steering wheel damage

what angle did they get hi from

what was the cause? Medical?

headrest position?

big objects that could hit someone inside

trauma exp ?s and observations: GSW

how many shots heard

how many holes

type of gun

how long ago did it happen

trauma exp ?s and observations: bike injury/crash

helmet look like

how far away from bike?

how did they fall?

bleeding exp ?s

beta blockers?

blood thinners?

alcohol?

hemophilia? 

age?

what 2 things are most important with trauma secondary assessments

the story and the physical exam

you should always give _____ for shock regardless of _____

02, SP02

the 6 p’s

what does it go with and what are they

compartment syndrome/blocked blood flow

Pain, Paresthesia, Paralysis, Pallor, Pulselessness, and Poikilothermia

ALS assist: fluid resuscitation considerations

we aim for permissive hypotension- dont turn them to coolaid but dont let them die

pediatrics need continuous infusion

geriatrics have higher BP needs

OB pts need to be within normal so that fetus stays perfused (mom shunts when hypoperfused)

bandaging care

wrap distal to proximal

dont cover fingers or toes unless they are injured

watch for 6 ps

for closed soft injuries, you should

compare both sides with the following

range of motion (ROM)

bear weight?

PMS

swelling

remove jewelry if swelling