Trauma

Life threatening injuries:

Life threatening injuries:

• DCAP-BTLS

• no more than 90 seconds

DCAP-BTLS stand for

• Deformities

• Contusions

• Abrasions

• Punctures/Penetrations

• Burns

• Tenderness

• Lacerations

• Swelling

IC

• Instability

• Crepitus

Glasgow scale

(higher is better)

a tool used to assess a patient's level of consciousness, especially after a brain injury.

Glasgow scale categories

motor response (6)

verbal response (5)

eye response (4)

eye response

motor response

verbal response

Long backboard

spinal restriction for supine patients with trauma injuries

Short backboard (Kendrick)

can be used to extricate seated patient with suspected spinal injury until they can be placed on a long backboard

Rapid exam, when does it occur, what do you do

• After scene size up

• general impression, AVPU, ABCs

AVPU

• A - Alert: The patient is fully awake, aware of their surroundings, and may open their eyes spontaneously.

• V - Verbal: The patient responds to verbal stimuli (such as you calling their name or telling them to wake up) by opening their eyes, speaking, or moving.

• P - Pain: The patient does not respond to a voice, but reacts to a painful stimulus (like pinching a fingernail bed or rubbing their sternum) by groaning or moving.

• U - Unresponsive

ABC

Airway, Breathing, and Circulation

rapid exam body order

top down, ending on back

rapid body exam priorities, elevating extremeties yes or no

• significant trauma with neck/spinal pain, paralysis, neurological deficit, priapism, altered mental status, or intoxication -> apply cervical collar

• then proceed with assessment

• If a patient is not breathing, your attention focuses on providing ventilatory assistance, even if there is major bleeding.

• In cases of life-threatening bleeding, controlling bleeding takes priority over airway and breathing concerns.

• Elevating extremity is controversial- only do if there are no impaled objects, un splinted fractures or risk to other wounds

Spinal Injury

Motion restriction of the neck is imperative for a suspected spinal injury; allowing the neck to remain unsecured or failing to provide a specific stabilization device may lead to further injury of the neck/spine.

If an appropriately sized cervical collar is unavailable, a rolled towel or sheet can be placed around the patient’s head and taped to the backboard. Continuous manual support should be provided.

The proper fit of a cervical collar is essential. It is inappropriate to use a cervical collar that does not fit.

whiplash injuries

Whiplash injuries occur when a patient’s body is propelled forward while their head and neck are left behind

this commonly occurs due to rear-end impacts, particularly when the head/neck is not restrained by an appropriately placed headrest.

Helmets:

should only be removed if

1. it covers full face,

2. allows excessive head movement,

3. makes airway management difficult,

4. prevents adequate spinal motion restriction,

5. patient in cardiac arrest

Shock:

if trauma with cool extremities and tachycardia, assume hemorrhage 

Early: agitation, cool clammy extremities, tachycardia 

Later: weak/absent peripheral pulses, hypotension

shock early signs

agitation, cool clammy extremities, tachycardia 

shock late signs

weak/absent peripheral pulses, hypotension

Clinical shock

at least 25-30% blood volume loss, but large volumes may be lost before clinical manifestations of shock

Blood

• Average blood volume: 6L for men, 5L for women

• 10% loss is well tolerated (tachycardia)

• 20-25% = failure of compensatory mechanisms (hypotension, orthostasis, decreased cardiac output)

• 40% = marked hypotension, decreased cardiac output, lactic acidemia

ICP Increase

Increased intracranial pressure

• unilaterally fixed and dilated pupil 

• abnormal respirations 

• bradycardia 

• widening pulse pressure 

• decreased pulse rate 

• Ataxic Respirations, highly irregular, unpredictable breathing pattern characterized by random, shallow breaths alternating with periods of apnea

Heat exhaustion

is the most common heat emergency.

Hypovolemia, as a result of loss of water and electrolytes from heavy sweating, is a common cause.

Typical signs and symptoms include dizziness, weakness, altered mental status/syncope, nausea/vomiting, headaches, muscle/abdominal cramping, dry tongue, and thirst. -flush skin with water 15-20 minutes

Venous blood

dark red, flows steadily

Arterial blood

bright red, spurts

Avulsion

injury that separates soft tissue layers (between subcutaneous layer and fascia) -separation may be complete, or remaining tissue may hang as a flap -not internal bleeding

Amputation

keep hand in sterile dressing then in dry plastic bag, keep it cool

Evisceration

organs protrude from peritoneum, cover with sterile gauze moistened with sterile saline, secure with occlusive dressing

Subluxation

incomplete dislocation of joint or organ

Contusion

bruise, dermis intact with blood (ecchymosis)

Hematoma

Hematoma

blood collected within damaged tissue or body cavity

Abrasion

wound in superficial skin

Fractures Symptoms

crepitus (grinding), shortened, deformity, false motion

Epidural Hematoma

• Bleeding below skull but above dura mater 

• arterial bleeding 

• increased intracranial pressure 

• sudden LOC 

• brief LOC, wakes up, then LOC

Subdural Hematoma:

• rupture of bridging veins between dura mater and arachnoid membrane

• gradual onset, sudden LOC is rare

• vomiting, pupillary changes, weakness, paralysis, headache, dizziness, nausea, seizures

• after fall/strong deceleration force injury, head trauma in elderly, anticoagulation therapy

• acute symptoms usually develop gradually over 1-2 days after initial

flail chest

• ribs are fractured in two or more places

• causing a section of the chest wall to move independently of the rest of the chest

• extreme chest pain, difficulty breathing, and potentially shortness of breat

High altitude

HAPE, HACE
high-altitude pulmonary edema, a serious condition where fluid builds up in the lungs at high elevations

High-Altitude Cerebral Edema, a severe and life-threatening condition where fluid builds up in the brain at high elevations.

Scuba:

AGE, decompression sickness (bends), descent pains (squeeze)

Arterial Gas Embolism

Pelvic Fracture (most serious)

• Hypotension

• shock, death 

• several liters of blood may drain into pelvic space

• retroperitoneal space 

• may not be visible bleeding until severe blood loss 

• pain at fracture site (iliac crest) 

• pelvic binder, backboard, scoop stretcher

Minor burn

full thickness <2%
partial <15%
superficial <50%

Moderate burn

full thickness 2-10%
partial 15-30%
superficial over 50%

Severe Burn

full thickness that involve hands, feet, face, airway, genitalia, circumferential
full thickness over 10%
partial over 30%
respiratory injury or fractures
for under 5 or over 55 classified moderate = severe

Femoral Shaft Fracture (also serious)

• 500 to 1000mL blood loss 

• hypovolemic shock 

• Traction splints

Air splint

can stabilize injuries below knee or elbow

Splinting hand or wrist

limb supported

hand in position of function

wrist slightly bent down,

finger joints moderately flexed

place soft roller bandage on the palm

Sling and swathe method

immobilizes shoulder and upper arm

shoulder dislocation, acromioclavicular joint separations, clavicle, scapula, humeral fractures

Retinal detachment

retina pulled away from choroid

painless

increase in floaters

flashes of light (photopsia)

curtain, veil across visual field

blurred vision

Cataracts

clouding of lenses

decreased tear production, difficulty distinguishing colors

Macular degeneration

irreversible central vision loss in elderly

smoking, obesity, sun exposure, diet low in omega 3 fatty acids/dark green leafy vegetables

compartment syndrome

within 6-8 hours

a painful condition caused by increased pressure within a muscle compartment, restricting blood flow and potentially damaging tissue

Falls

• Adults: over 20 feet 

• Children: Over 10 feet

Basilar Skull Fracture: 

• high energy trauma to head -general head injury signs: altered mental widening pulse pressure, unreactive pupil, amnesia, seizure, bradycardia, numb tingling extremities, nausea vomiting 

• Specific signs: CSF draining from ears, raccoon eyes (ecchymosis under eyes), Battle sign (ecchymosis behind one ear)

Concussion

• gradually improving mental status, headache, amnesia 

• Nausea, loss of coordination, weakness

Burns types

1. Radiation

2. Thermal

3. Chemical

4. Acidic

Trauma lethal triad:

• Hypothermia

• Coagulopathy

• acidosis

Hypothermia: 

• Early: shivering, rapid breathing, redness, cyanosis, tachypnea 

• Later signs: loss of coordination, muscle stiffness, slowed pulses, confusion/lethargy, coma/unresponsiveness, weak pulse, dysrhythmias, very slow respirations, and cardiac arrest can occur, bradycardia, bradypnea