Trauma

Course Overview

  • Course Title: Emergency Care RES 242

  • Instructor: Michael Zahab RRT

Objectives

  • Review trauma definition and role: Understand the significance of trauma and the responsibilities of emergency care providers.

  • Understand levels of trauma: Familiarity with various trauma levels in medical facilities.

  • Learn types of trauma: Differentiate between the various trauma types encountered in emergency settings.

  • Patient examination in ED: Master the examination process for trauma patients.

  • Golden hour & lethal triad: Definition and implications for patient outcomes.

  • Examination components: Knowledge of the 7 essential items in trauma examination.

  • Trauma scoring tools: Understanding different scoring methodologies.

  • Body response to trauma: Insight into the physiological responses post-trauma.

What is Trauma?

  • Definition: Injury to living tissue caused by an external source.

  • Types of Trauma:

    • Blunt Trauma: Injuries without penetration; examples include contusions, rib fractures, and hemothorax.

    • Penetrating Trauma: Results from objects piercing the skin, such as stab wounds and gunshot wounds.

    • Crushing Injuries: Result from sustained pressure over time, damaging soft tissue and circulatory function.

    • Gunshot Wounds

      • Factors influencing damage:

        • Velocity of the bullet.

        • Secondary effects such as cavitation and the mushroom effect.

      Falls

      • Statistics:

        • Cause approximately 16,000 deaths annually; known as the second leading cause of accidental death.

        • Assess factors: fall distance, body position upon impact, and landing surface.

Levels of Trauma

  • Level 1: Provides total care for the severest injuries; staffed by trauma surgeons and neurosurgeons.

  • Trauma Center Levels:

    • Level I: Comprehensive treatment.

    • Level II: Ability to provide initial care and stabilize trauma patients.

    • Level III: General care, limited to minor injuries.

    • Level IV: Provides stabilization and transfer.

  • Specialized Facilities: Includes pediatric trauma centers and burn centers.

Trauma Room Organization

  • Roles include: ER attending, ER resident, trauma attending, surgical residents, & multiple RNs.

Types of Injuries

Blunt Trauma / Shear Force

  • Definition: Injury from compression and speed change; skin remains intact.

  • Common Injuries:

    • Contusions

    • Hemothorax

    • Rib fractures

    • Pneumothorax

Crushing Injuries

  • Description: Result from prolonged force, leading to soft tissue damage and impaired circulation.

Penetrating Traumas

  • Definition: Injuries caused by penetrating objects; potential for serious tissue damage.

  • Examples: Stab wounds and gunshot wounds which may cause complications like infection and blood loss.

Examination Considerations

Examination Phase

  • Scene Assessment: Determine the need for patient triage and conduct a thorough examination.

  • Examination Areas:

    • Head

    • Neck

    • Chest

    • Abdomen

    • Back

    • Extremities

    • Vital signs every 5-30 minutes.

Golden Hour

  • Significance: The initial 60 minutes post-injury are critical for outcomes; rapid assessment and intervention are necessary to prevent worsening conditions.

Trauma Evaluation and Responses

Correcting Hypothermia

  • Maintaining body temperature is vital for blood clotting and patient stabilization.

Lethal Triad Components

  • Acidosis: Often occurs in trauma patients, leading to poor tissue perfusion and metabolic changes.

Airway Management

  • Importance of managing the airway and identifying conditions like hemothorax; chest tube insertion may be required.

Tension Pneumothorax Management

  • Immediate treatment involves needle decompression at the second rib space within the mid-clavicular line.

Examination Steps

Triage

  • Protocols for handling mass casualty incidents, utilizing RPM (Respiration, Pulse, Mental Status) for rapid assessment.

Head and Neck Assessments

  • Assess neurological response, examining for any injuries, CSF leakage, and signs of possible cervical spine injuries.

Chest and Abdominal Exams

  • Inspect for signs of trauma including bruises, lacerations, and abnormal sounds.

Extremity Observation

  • Evaluate for motion, strength, deformities, and pulses to check for circulation and nerve function.

Trauma Scoring Tools

  • AVPU Scale: Assess consciousness (Alert, Responds to Voice, Pain, Unresponsive).

  • Abbreviated Injury Scale (AIS): Scoring injuries by body region.

  • Injury Severity Score (ISS): Rapid scoring method, greater scores imply worse outcomes.

Next Steps in Trauma Care

  • Prioritize oxygenation, frequent re-examinations, vital signs monitoring, and watch for systemic changes or complications.

Key Trauma Takeaways

  • Level 1 Trauma Centers: Most comprehensive care.

  • Organized Chaos in Trauma Rooms: Efficient teamwork is critical.

  • Importance of the Golden Hour: Initial 60 minutes crucial for outcomes.

  • Thorough Trauma Examination: Ensure all parts are assessed systematically.

  • Blood Loss Monitoring: Recognize signs of internal or external bleeding.