1. STS: Trauma
September 21, 2016

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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]

14. 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

15. 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

16. 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

17. 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