Trauma, Bleeding, Head/Chest/Abdominal Injuries, Pneumothorax, Hemothorax, Tamponade, Flail Chest, Pelvic & Femur Fractures.

First major priority on a trauma call

Scene safety, mechanism of injury assessment, primary survey, and immediate correction of life-threatening problems.

Importance of mechanism of injury in trauma

It helps predict the type and severity of injuries that may be present.

Trauma mechanisms expected to understand according to AEMCA syllabus

Motor vehicle collisions, falls, penetrating injuries, impaled objects, blast injuries, crush injuries, rapid deceleration injuries, and assault injuries.

Action after primary survey in a trauma patient

Perform a rapid trauma survey, unless otherwise directed by the Standards.

Areas checked for life-threatening injuries during rapid trauma assessment

Head, anterior and posterior chest, abdomen, pelvis, and femurs.

Breathing assessment during primary survey

Chest wall movement, air movement at the apices and bases, respiratory distress, cyanosis, tracheal deviation, subcutaneous emphysema, JVD, and need for SpO2 monitoring.

Circulation assessment during primary survey

Radial or carotid pulse, gross bleeding, and need for immediate cardiac monitoring or defibrillation.

Estimate during significant bleeding

The amount of blood loss.

Factors to estimate blood loss

Duration of hemorrhage, rate of flow, presence of clots, amount of blood-soaked material, and quantity of blood vomited.

Management of an impaled object

Do not remove it; stabilize it in place with bulky dressings or bandages.

When to remove an impaled object according to BLS PCS

If it compromises the airway or interferes with CPR after attempts to change hand position.

Findings looked for at a traumatic injury site

Contusions, colour changes, cyanosis, contamination, lacerations, abrasions, asymmetrical movement, penetrations, protruding objects or organs, swelling, sucking wounds, subcutaneous emphysema, distension, deformity, dried blood, and diaphoresis.

Findings assessed by palpation at an injury site

Tenderness, instability, crepitus, swelling, subcutaneous emphysema, and deformity.

When to perform a complete secondary trauma survey

For obvious or suspected major or multiple trauma.

BLS PCS splinting priorities

Spine first, then pelvis, femurs, lower legs, and upper limbs.

Definition of hemorrhagic shock

Shock caused by significant blood loss.

Why uncontrolled hemorrhage is a major trauma priority

It can rapidly reduce circulating blood volume and cause shock and death.

Major potential sites of life-threatening internal bleeding

Chest, abdomen, pelvis or retroperitoneum, and major extremity injuries.

Management of major external hemorrhage

Control the bleeding according to the applicable BLS standard while treating other immediate life threats.

Medication for severe traumatic hemorrhage

Tranexamic acid or TXA.

Transport considerations for TXA

TXA should not delay transport.

Important potential threats in a chest injury

Tension pneumothorax, hemothorax, cardiac tamponade, myocardial contusion, pulmonary contusion, spinal cord injury, and flail chest.

Assessment in chest injury

Lung sounds for air entry and adventitious sounds.

Assessment in penetrating chest injury

Entry and exit wounds, tracheal deviation, JVD, and possible airway or vascular penetration such as frothy or foamy hemoptysis or a sucking chest wound.

Definition of open or sucking chest wound

An open chest injury that allows communication between the atmosphere and the chest cavity.

Management of open or sucking chest wound according to BLS PCS

Seal it with a commercial occlusive dressing with a one-way valve, or if unavailable use an occlusive dressing taped on three sides.

Size of dressing over open chest wound

Large enough to cover the entire wound and extend several centimetres beyond the edges.

Complication monitored after sealing an open chest wound

Tension pneumothorax.

Action if tension pneumothorax develops after sealing chest wound

Release and/or replace the occlusive dressing.

Change indicating development of tension pneumothorax

Rapid deterioration in cardiorespiratory status.

Definition of pneumothorax

A condition involving air within the pleural space.

Major life-threatening form of pneumothorax emphasized in Standards

Tension pneumothorax.

Danger of tension pneumothorax

It can rapidly cause severe respiratory and circulatory deterioration.

Breath sound finding with tension pneumothorax under ALS directive

Absent or severely diminished breath sounds on the affected side.

Circulatory finding associated with ALS Tension Pneumothorax Medical Directive

Hypotension or VSA.

Other findings raising concern for serious chest injury

Tracheal deviation, JVD, subcutaneous emphysema, unequal air entry, respiratory distress, and rapid cardiovascular deterioration.

Advanced treatment for tension pneumothorax by ACP

Needle thoracostomy.

Preferred adult needle thoracostomy location in ALS PCS 5.4

The 4th intercostal space at the anterior axillary line.

Alternate needle thoracostomy location listed

The 2nd intercostal space at the midclavicular line.

Ventilation of patient with suspected pneumothorax

Use a lower tidal volume and rate of delivery to reduce the risk of worsening intrathoracic pressure.

Positioning of conscious chest injury patient without SMR indication

Sitting or semi-sitting.

Potential problems to prepare for in chest injury patient

Tension pneumothorax, cardiac tamponade, cardiac dysrhythmias, and hemoptysis.

Definition of hemothorax

A chest injury involving blood within the pleural space.

BLS Chest Injury Standard detailed list for hemothorax signs

No, it identifies hemothorax as a life-threatening chest injury but does not provide a complete manifestation list.

Definition of cardiac tamponade

A life-threatening chest condition listed in the BLS Chest Injury Standard.

Full classic sign set for cardiac tamponade in BLS excerpt

No, it identifies cardiac tamponade as a major threat but does not provide a full diagnostic sign list.

Definition of flail chest in BLS standards

A form of chest wall instability or deformity that is considered a serious anatomical trauma criterion.

Significance of flail chest for trauma triage

Chest wall instability or deformity such as flail chest is listed as an anatomical criterion in the Field Trauma Triage Standard.

Definition of pulmonary contusion

A serious chest injury specifically listed as a potential life or function threat in the BLS Chest Injury Standard.

Definition of myocardial contusion

A traumatic injury to the heart muscle listed as a serious chest injury threat.

Definition of hemoptysis

Coughing or bringing up blood from the respiratory tract.

Significance of frothy or foamy hemoptysis after penetrating chest trauma

Possible airway or vascular penetration and significant thoracic injury.

Major threats in abdominal or pelvic trauma

Rupture, perforation, laceration, or hemorrhage involving organs or vessels and possible spinal cord injury.

AEMCA syllabus expectation on blunt vs penetrating abdominal injury

Understand how the patterns of organ damage differ and what consequences may result.

Abdominal structures identified as sources of severe hemorrhage by AEMCA

Major abdominal organs and structures capable of acute intra-abdominal bleeding.

Definition of retroperitoneal bleeding

Bleeding into the retroperitoneal space, identified as an important source of internal hemorrhage.

Danger of abdominal trauma with no external bleeding

Serious organ or vessel injury may cause significant internal hemorrhage.

Definition of abdominal evisceration

Protrusion of abdominal organs, such as intestines, through an open wound.

Management of eviscerated intestines

No, do not push them back into the abdomen.

Management of abdominal evisceration according to BLS PCS

Cover exposed intestines with moist, sterile, large bulky dressings.

Understanding of abdominal evisceration management under syllabus

Rationale for using moist sterile dressings and an occlusive covering.

Management for clinically unstable pelvic fracture

Attempt to stabilize the pelvis with a circumferential sheet wrap or commercial pelvic stabilization device.

Securing a patient with suspected unstable pelvic fracture

Secure the patient to a spinal board or adjustable break-away stretcher as directed by the BLS PCS.

Location where immobilization straps should NOT be placed in pelvic fracture

Directly over the injured pelvic area.

Management of legs in pelvic fracture

Secure and immobilize the lower limbs to help prevent additional pelvic injury.

Concern with pelvic trauma

The pelvis can be associated with major internal hemorrhage and is a high-priority area for trauma assessment and stabilization.

Anatomical criterion in Field Trauma Triage for pelvic fractures

Yes.

High-risk anatomical trauma criteria for extremity injuries

Two or more proximal long-bone fractures, crushed or mangled extremities, pulseless extremities, and amputations proximal to the wrist or ankle.

Assessment before and after splinting an extremity

Distal circulation, sensation, and movement.

General splinting approach for joint injuries

Splint as found.

Consideration with absent distal pulse or severely angulated fracture

Apply gentle traction, but if resistance or severe pain occurs, splint as found.

General splinting for open or closed femur fractures

With a traction splint unless the limb is partially amputated.

Action before moving a patient with fractured femur or tibia when appropriate

Stabilize the injured leg by securing it to the uninjured leg before transfer to a board or adjustable break-away stretcher.

Preferred side for log rolling a patient with femur or tibia fracture

The uninjured side when possible.

Importance of femur fractures in trauma

They are high-priority long-bone injuries and are placed ahead of lower leg and upper limb injuries in the BLS splinting priority list.

Frequency of reassessment for compromised distal neurovascular status

Approximately every 10 minutes.

Management of grossly contaminated open fracture

Irrigate with saline or sterile water.

Management of exposed bone ends in open fracture

Cover them with moist sterile dressings and/or padding.

SBP criterion for Field Trauma Triage physiological

Systolic blood pressure less than 90 mmHg.

Adult respiratory rate findings meeting Field Trauma Triage criterion

Less than 10 or 30 or more breaths per minute, or the need for ventilatory support.

Neurological physiological criterion in Field Trauma Triage

The patient does not follow commands.

Major anatomical injuries raising concern in Field Trauma Triage

Penetrating injuries to the head, neck, torso or proximal extremities, chest wall instability, two or more proximal long-bone fractures, crushed or pulseless extremities, proximal amputations, pelvic fractures, open or depressed skull fracture, and paralysis.

Field Trauma Triage mechanism criterion for adult fall height

A fall of 6 metres or more.

Field Trauma Triage mechanism criterion for child fall height

A fall of 3 metres or more or approximately two to three times the child's height.

Significant impact vehicle speed for pedestrians or bicyclists under Field Trauma Triage

30 km/h or greater.

Motorcycle crash speed listed as a Field Trauma Triage mechanism criterion

30 km/h or greater.

Older adult consideration in Field Trauma Triage

Risk of injury and death increases after age 55.

SBP representing shock in a patient older than 65 according to Field Trauma Triage

SBP less than 110 mmHg.

Pregnancy consideration listed under special Field Trauma Triage criteria

Pregnancy of 20 weeks or greater.

Transport decision for major trauma patient meeting physiological or anatomical criteria

Transport directly to the Lead Trauma Hospital or regionally designated equivalent according to the Field Trauma Triage Standard.

Transport decision if airway cannot be secured or survival is unlikely

Transport to the closest emergency department unless otherwise specified by the Field Trauma Triage Standard.

Overall AEMCA trauma approach

Ensure scene safety, identify the mechanism of injury, perform the primary survey, correct immediate life threats, perform a rapid trauma survey, control hemorrhage, manage airway and breathing problems, stabilize major injuries, determine trauma destination, and reassess frequently.

Key trauma order to remember for AEMCA

Life threats first, then rapid trauma survey, hemorrhage and ventilation control, major injury stabilization, transport decision, and continuous reassessment.