Chapter 8 Trauma Emergencies EMR 8-1 1-

Introduction Approximately 20 percent of Emergency Medical Responder (EMR) calls are for trauma An EMR in many cases will not be able to determine the severity of trauma injury An EMR will need to closely monitor for subtle changes in the patient’s status Cont. EMR 8-2 1-

Introduction Trauma patients, particularly ones with more than one body system injured, must be treated aggressively and transported to a trauma center as soon as possible This chapter will provide an overview of classifications, assessment tools, signs and symptoms, critical interventions, and management of various trauma emergencies EMR 8-3 1-

Trauma Assessment and Management Learning Objective 1 Trauma Assessment and Management INITIAL TRAUMA ASSESSMENT AND MANAGEMENT Components of an initial assessment Critical interventions if indicated ASSESSMENT AND MANAGEMENT Baseline vitals Obtain information and use critical thinking skills EMR 8-4

Assessment and Management of Shock Learning Objective 2 Assessment and Management of Shock SHOCK Potentially life-threatening state Hypoperfusion Compensatory measures Organs sacrificed Blood flow to brain maintained EMR 8-5

Assessment and Management of Shock Learning Objective 2 Assessment and Management of Shock TYPES OF SHOCK Hypovolemic shock Cardiogenic shock Neurogenic shock Septic shock Anaphylactic shock EMR 8-6

Assessment and Management of Shock Learning Objective 2 Assessment and Management of Shock ASSESSEMENT TOOLS S—Signs and symptoms A—Allergies M—Current Medications P—Pertinent past medical history L—Last oral intake (food or fluids) E—Events leading up to the current situation EMR 8-7

Assessment and Management of Shock Learning Objective 2 Assessment and Management of Shock SIGNS AND SYMPTOMS Early stages of shock Body tries to compensate for the loss of blood, insufficient blood flow, or deficit of body fluids Later stages of shock Body is unable to continue compensating and shock progresses to a more critical state EMR 8-8

Assessment and Management of Shock Learning Objective 2 Assessment and Management of Shock MANAGEMENT Critical interventions Positioning Supine Fowler’s Continued management EMR 8-9

Managing a Patient with Bleeding Learning Objective 3 Managing a Patient with Bleeding BLEEDING OVERVIEW The average adult has five to six liters of blood volume Bleeding can be external or internal Symptoms of internal bleeding Loss of a significant amount of blood will result in further symptoms of uncompensated shock EMR 8-10

Managing a Patient with Bleeding Learning Objective 3 Managing a Patient with Bleeding THREE TYPES OF BLEEDS Arterial bleed Bleeding from a vein Capillary bleed EMR 8-11

Managing a Patient with Bleeding Learning Objective 3 Managing a Patient with Bleeding EXTERNAL BLEEDING Types of open wounds Management of an external bleed Critical interventions Controlling an external bleed Direct pressure Tourniquet EMR 8-12

Managing a Patient with Bleeding Learning Objective 3 Managing a Patient with Bleeding INTERNAL BLEEDING Types Contusion or ecchymosis Trauma causes Management of internal bleeding Critical interventions EMR 8-13

Treating a Patient with Burns Learning Objective 4 Treating a Patient with Burns BURNS Severity Depth Size Location Source Cont. EMR 8-14

Treating a Patient with Burns Learning Objective 4 Treating a Patient with Burns BURNS Children and infants Have different body proportions Rule of nine formula is not used for them EMR 8-15

Treating a Patient with Burns Learning Objective 4 Treating a Patient with Burns BURN CLASSIFICATIONS Superficial burns Mild sunburn Partial-thickness burns Blisters and swelling on the skin Full-thickness burns Involves all layers of skin EMR 8-16

Treating a Patient with Burns Learning Objective 4 Treating a Patient with Burns ASSESSMENT TOOLS Baseline vitals SAMPLE and OPQRST MANAGEMENT OF BURNS Critical interventions Reassess every five minutes EMR 8-17

Treating a Patient with Burns Learning Objective 4 Treating a Patient with Burns SPECIFIC BURNS Thermal burns Chemical burns Electrical burns Radiation burns EMR 8-18

Treating a Patient with Burns Learning Objective 4 Treating a Patient with Burns RAPID TRANSPORT FOR BURN PATIENTS Burns to the face and neck Life threatening Observe for breathing difficulty Rapid transport Advised for full-thickness burns EMR 8-19

Managing Injuries to the Skull, Face, and Neck Learning Objective 5 Managing Injuries to the Skull, Face, and Neck SKULL FRACTURE Blunt trauma Penetrating injury to the skull Radiography (X-ray) Computed tomography (CT scan) Bruising or discoloration EMR 8-20

Managing Injuries to the Skull, Face, and Neck Learning Objective 5 Managing Injuries to the Skull, Face, and Neck TRAUMATIC BRAIN INJURY (TBI) Contrecoup injury Traumatic brain injury symptoms Categories Types Assessment tools Management of brain injuries EMR 8-21

Managing Injuries to the Skull, Face, and Neck Learning Objective 5 Managing Injuries to the Skull, Face, and Neck FACIAL INJURIES General information Assessment tools Management of facial fractures Management of a nosebleed Management of an ear injury Management of an eye injury EMR 8-22

Managing Injuries to the Skull, Face, and Neck Learning Objective 5 Managing Injuries to the Skull, Face, and Neck NECK INJURIES Stabilize the spine Manage airway and breathing problems If jugular veins or carotid arteries are severed, severe bleeding will result EMR 8-23

Different Types of Chest Trauma Learning Objective 6 Different Types of Chest Trauma CHEST TRAUMA Overview Some injuries can be life threatening Assessment tools Initial assessment DOTS, TIC, SAMPLE, AND OPQRST EMR 8-24

Different Types of Chest Trauma Learning Objective 6 Different Types of Chest Trauma RIB FRACTURES Overview Painful but usually not life threatening Signs and symptoms Management Critical interventions Position of comfort EMR 8-25

Different Types of Chest Trauma Learning Objective 6 Different Types of Chest Trauma PNEUMOTHORAX (COLLAPSED LUNG) Overview Air enters pleural space Spontaneous pneumothorax Tension pneumothorax Open pneumothorax (sucking chest wound) EMR 8-26

Different Types of Chest Trauma Learning Objective 6 Different Types of Chest Trauma HEMOTHORAX Overview Chest cavity Bleeding between lung and chest wall Can be simple or major bleed Signs and symptoms EMR 8-27

Abdominal and Pelvic Cavity Injuries Learning Objective 7 Abdominal and Pelvic Cavity Injuries ABDOMINAL TRAUMA Injuries to the abdomen General symptoms of abdominal injury EMR’s role EMR 8-28

Abdominal and Pelvic Cavity Injuries Learning Objective 7 Abdominal and Pelvic Cavity Injuries SOLID ORGAN TRAUMA Liver injury Spleen injury Pancreas injury Kidney injury HOLLOW ORGAN TRAUMA Extremely serious, patient must be transported to medical facility as soon as possible EMR 8-29

Abdominal and Pelvic Cavity Injuries Learning Objective 7 Abdominal and Pelvic Cavity Injuries GENERAL ASSESSMENT TOOLS Baseline vital signs DRGERM, OPQRST, and SAMPLE GENERAL MANAGEMENT Critical interventions Reassess every five minutes EMR 8-30

Abdominal and Pelvic Cavity Injuries Learning Objective 7 Abdominal and Pelvic Cavity Injuries PELVIC CAVITY TRAUMA Overview Fracture due to blunt trauma can be life threatening Assessment tools Signs and symptoms Management EMR 8-31

Muscle Injuries, Joint Injuries, and Fractures Learning Objective 8 Muscle Injuries, Joint Injuries, and Fractures MUSCLE AND JOINT INJURIES Overview Sprains, strains, and dislocations Types of injuries Assessment tools Signs and symptoms Management EMR 8-32

Muscle Injuries, Joint Injuries, and Fractures Learning Objective 8 Muscle Injuries, Joint Injuries, and Fractures FRACTURES Overview Bone is impacted by force and breaks Closed fracture and open fracture Assessment tools Cont. EMR 8-33

Muscle Injuries, Joint Injuries, and Fractures Learning Objective 8 Muscle Injuries, Joint Injuries, and Fractures FRACTURES Signs and symptoms Management EMR 8-34

Spinal Cord Injuries SPINAL CORD INJURY Learning Objective 9 Overview Severing of spinal cord from force to vertebral column Assessment tools Signs and symptoms Management EMR 8-35

Summary An EMR must be able to recognize different types of trauma in order to access and manage a patient in the best way possible Making a proper assessment, knowing critical interventions, and general management for various trauma situations can help an EMR give appropriate care to patients until they can be transported to a facility for further treatment EMR 8-36 1-