STS: Trauma February 9, 2016

Initial Assessment C-spine Vitals based on importance Treat obvious injuries first Rapid trauma DCAPBTLS -Think before you get on scene: what’s most important? -Deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations, and swelling

Skull Injury Bleeding: Loosely cover site with sterile gauze Check for CSF Do NOT try to stop blood flow Do NOT insert NPA C-spine precautions What is CSF? Clear, odorless liquid that protects the brain and spinal cord Where do we check for CSF? Ears and nose Contraindication for NPA: head injury, infants less than 1 year Contraindication for OPA: pt with gag reflex

Eye Injury Foreign objects: Irrigate with saline (medial to lateral) Don’t attempt to remove object from cornea If impaled? If chemical? If thermal? If impaled? Stabilize with roller gauze If chemical? Flush for 20 min If thermal? Cover with burn dressing

Eye Injury cont. Blowout Fracture: Check PERRL Contacts should be kept in eye unless chemical present Notify ALS if pt wear contacts Treatment: TRANSPORT What is a blowout fracture? Fracture of orbital bone, googly eyes

Nose/Neck Injury Epistaxis: Pinch nose Tilt forward Apply Ice Jugular Vein Laceration: 1. Apply occlusive dressing 2. Tape down on 4 sides 3. Monitor respirations closely Who knows why we apply ice? Constricts the blood vessels and helps stop the bleeding Ice is nice Want to avoid embolism

Mouth Injury Loose teeth: Save in container of pt saliva or milk Bleeding: Check airway Turn left-lateral Prepare to suction -but who has milk, just try to collect pieces if possible

Soft Tissue Injury Hematoma: May be due to blunt injury Treatment: splint and CMS What is a hematoma? It’s when a pool of blood collects in an area of the body leading to compartment syndrome

Open Injury Abrasion: Clean and apply bandaid/dressing Avulsion: Clean and place flap back in place Control bleeding Apply dressing What is an abrasion? Area damaged by something scraping or wearing away -treat with saline or alcohol wipes What is an avulsion? Area damaged by skin that was pulled away or torn away -most likely saline

Open Injury Cont’d Impaled object: Splint and stabilize When do you remove an impaled object? Gunshot wound: Look for entry and exit wound Control bleeding Provide O2 Check for shock When do you remove an impaled object? Only if it interferes with CPR/airway Shock: blanket and shock position: legs elevated 6” above heart

Pneumothorax Sucking Chest Wound: Occlusive dressing Tape 3 sides down Auscultate every 5 min - What do you do if lung sounds are absent? What do you do if lung sounds are absent? Ventilate and remove dressing momentarily to relieve pressure → burp the dressing -tape, tape, tape, auscultate

Tension Pneumothorax Tension pneumo vs. sucking chest wound Caused by collapsed lung Can’t ventilate tension pneumo because it’ll add air and exacerbate the problem Biggest indicator? - Treatment: TRANSPORT ASAP Biggest indicator? Tracheal deviation

Abdominal Wounds Evisceration: Soak big trauma dressing in sterile saline Tape over exposed organ Do NOT touch exposed organ Do NOT try to pack organs back What is an evisceration? Organs protruding from the abdomen [tell story about evisceration]

Amputations Amputation: 1. Wrap body part in sterile gauze 2. Place in plastic bag 3. Chill on ice - Do NOT allow body part to freeze or come into direct contact with ice -not likely to occur -don’t want to ruin cells, keep part viable for reattachment if possible

Thermal Burns 1st degree: superficial 2nd degree: dermis 3rd degree: full thickness Stop burning – submerse in water/saline If severe, apply burn dressing (non-adhesive) Treat for shock Rule of Nines (adult/pediatric) What are the rule of nines? Adult: 18% front, 18% back, 9% arm, 9% arm, 18% leg, 18% leg, 9% head, 1% groin Pediatric: 18% front, 18% back, 9% arm, 9% arm, 14% leg, 14% leg, 18% head, 1% groin

Chemical/Electrical Burns Chemical Burn: 1. Remove clothing 2. For powder chemicals, brush off powder first 3. Flush with water for 20 min Electrical Burn: 1. Look for entry and exit wounds 2. Prepare to perform CPR (cardiac arrhythmia) -Also not likely to happen here -Like eyes, flush for 20 -Since electrical, likely to mess with sinus rhythm

Practice Scenario 22 y/o Pt. bleeding on R elbow during a football tailgate Dispatch: 22 y/o Pt. bleeding on R elbow during Fountain Run Pt sitting against a wall A&Ox3 Negative head, neck, back pain C/C: bloody R elbow Lost footing and fell while trying to climb up onto Traveler   S: abrasion (R elbow), after rapid → avulsion (L hand), abrasion (R knee) A: Penicillin, latex, peanuts M: Adderol P: ADHD L: Taco bell, milkshake, when prompted → 3 shots, 30 minutes ago B: 130/85 E: PERRL L: clear bilaterally L: A&Ox3 S: normal, warm, diaphoretic R: 20 P: 110 P: 95 Rapid trauma using DCAPBTLS Clean abrasions/avulsion, bandage, ensure check CMS for avulsion AMA