1. Illinois EMSC1 Trauma Objectives Upon completion of this lecture, you will be better able to: Discuss how mechanism of injury affects your evaluation of an injured student Describe special assessment considerations for injured students of various ages Based on assessment findings, develop and prioritize a plan of care for selected injuries

2. Illinois EMSC2 TRAUMA

3. Illinois EMSC3 MECHANISM OF INJURY Kinetic Thermal Electrical Chemical Radiant Asphyxiation

4. Illinois EMSC4 KINETIC ENERGY FORCES BLUNT CRUSH ACCELERATION/DECELERATION PENETRATING

5. Illinois EMSC5

6. 6

7. 7 INJURY SEVERITY FROM FALLS Fall >10 feet or 3 times the person’s height Yielding vs. nonyielding surface Body area striking the ground first

8. Illinois EMSC8

9. 9 CRUSH INJURIES Energy concentrated in one body area Usually involves nerves, muscle, bone, and tendons

10. Illinois EMSC10

11. Illinois EMSC11 ACCELERATION AND DECELERATION FORCES Whiplash injury Aortic tear Hepatic artery tear

12. Illinois EMSC12

13. Illinois EMSC13 PENETRATING INJURIES High velocity Guns Low velocity Knives, pencils

14. Illinois EMSC14 BALLISTICS Caliber Tumble Yaw Fragmentation Cavitation Range Weapon

15. Illinois EMSC15 ASSESSMENT OF THE INJURED STUDENT Initial assessment Detailed assessment Triage and transport

16. Illinois EMSC16 INITIAL ASSESSMENT Airway/Cervical Spine Control Breathing Circulation Disability (neurological) Expose

17. Illinois EMSC17 PURPOSE OF THE INITIAL ASSESSMENT Identification of LIFE-THREATENING emergencies Initiation of LIFE-SAVING measures (CPR)

18. Illinois EMSC18 AIRWAY ASSESSMENT Stridor Debris in oropharynx Airway obstruction

19. Illinois EMSC19 AIRWAY INTERVENTIONS Jaw thrust AVOID HYPEREXTENSION OR FLEXION OF THE NECK Log roll to side for emesis

20. Illinois EMSC20 CERVICAL SPINE STABILIZATION Place hands on either side of the head Maintain neck midline

21. Illinois EMSC21 BREATHING ASSESSMENT Look, listen, and feel Observe chest symmetry Note work of breathing Jugular vein distention Tracheal deviation

22. Illinois EMSC22 BREATHING INTERVENTIONS If breathing is absent, begin mouth to mask ventilations If breathing is shallow or labored, maintain airway control

23. Illinois EMSC23 CIRCULATORY ASSESSMENT Level of consciousness Carotid pulse (absent or present) Capillary refill Skin color Skin temperature Sites of bleeding

24. Illinois EMSC24 CIRCULATORY INTERVENTIONS If pulse is absent, begin CPR Apply direct pressure to open wounds

25. Illinois EMSC25 NEUROLOGICAL ASSESSMENT Level of consciousness AVPU scale Awake Verbal response Pain response Unresponsive

26. Illinois EMSC26

27. Illinois EMSC27 NEUROLOGICAL INTERVENTIONS Provide reassurance Tell student what is happening

28. Illinois EMSC28 EXPOSE Remove clothing to observe the chest Observe the chest for bruises, penetrations, and symmetry Auscultate breath sounds Auscultate heart sounds

29. Illinois EMSC29 DETAILED ASSESSMENT Fahrenheit (keep person warm) Get vital signs Head-to-toe assessment Inspect the back

30. Illinois EMSC30 HEAD-TO-TOE ASSESSMENT Palpate the head and face Observe for fluid from the nose and ears Assess for pupillary response Reassess the mouth Palpate the jaw

31. Illinois EMSC31 BATTLE’S SIGN

32. Illinois EMSC32 RACCOON EYES

33. Illinois EMSC33 NECK Palpate for pain or tenderness Observe for tracheal deviation Observe for jugular vein distention Observe for impaled objects and open wounds

34. Illinois EMSC34 CHEST Auscultate breath sounds in all lobes Auscultate chest sounds Observe work of breathing Palpate for pain/tenderness

35. Illinois EMSC35 ABDOMEN Observe for bruising, impaled objects, open wounds Palpate lightly for pain, tenderness, and distention Observe for guarding

36. Illinois EMSC36 PELVIS Apply pressure on pelvis to determine its stability Perform genitalia exam at one’s discretion

37. Illinois EMSC37

38. Illinois EMSC38 EXTREMITIES Observe for deformities, impaled objects, open wounds Palpate for pulses, crepitus, or swelling Determine capillary refill, skin color, temperature Assess for pain/tenderness

39. Illinois EMSC39 INSPECT THE BACK Log roll student with assistance School nurse must maintain cervical spine control Inspect and palpate the back for bruising, impaled objects, pain and tenderness

40. Illinois EMSC40

41. Illinois EMSC41 HISTORY SAMPLE Symptoms Allergies Medications Past history Last meal Events leading to the illness or injury

42. Illinois EMSC42 OTHER CONSIDERATIONS Stop the assessment if there are changes in the student’s airway, breathing, or circulation Stabilize impaled objects Apply pressure to open wounds Apply ice to fractures Remove any restrictive clothing

43. Illinois EMSC43 TRIAGE DECISIONS EMERGENT (life threatening injuries) URGENT (fractures, head injuries) NON-URGENT (minor bruises)

44. Illinois EMSC44 EXPECTED OUTCOMES Maintenance of airway, cervical spine alignment, adequate respiratory effort, adequate circulation to brain and vital organs Absent or minimal pain, discomfort, and anxiety

45. Illinois EMSC45 DOCUMENTATION School health record Prehospital providers

46. Illinois EMSC46 SELECTED TRAUMA EMERGENCIES Head injuries Spinal cord injuries Chest injuries Abdominal injuries Musculoskeletal injuries Amputations

47. Illinois EMSC47 CONSIDERATIONS IN PEDIATRIC HEAD TRAUMA Scalp is large and vascular Cranium is thin and pliable Head size is larger in proportion to body

48. Illinois EMSC48 INTERVENTIONS IN HEAD TRAUMA Continuous monitoring of neurological status pupil size and reactivity LOC body movement Use direct pressure on open wounds DO NOT PACK nose or ears if drainage is present!

49. Illinois EMSC49 CONSIDERATIONS IN SPINAL TRAUMA Energy forces associated with spinal trauma (hyperextension, hyperflexion, and axial loading) Usually occurs during sports or MVC Pediatric spine is malleable and flexible Pediatric spine is “adult” by age 8 SCIWORA diagnosed in younger children

50. Illinois EMSC50

51. Illinois EMSC51 INTERVENTIONS IN SPINAL TRAUMA Keep student immobilized or lying down Use the jaw thrust to keep the airway open A spinal cord injury should ALWAYS be suspected in a student with a head injury!

52. Illinois EMSC52 CONSIDERATIONS IN CHEST TRAUMA Ribs are cartilaginous, allowing energy to be transferred to the heart and lungs In younger children, the liver is not protected by the rib cage, making liver injuries common

53. Illinois EMSC53 INTERVENTIONS IN CHEST TRAUMA Keep airway open Initiate mouth to mask ventilations Stabilize impaled objects Use 3 sided occlusive dressing for open chest wounds Apply pressure to stop bleeding wounds

54. Illinois EMSC54 CONSIDERATIONS IN ABDOMINAL TRAUMA Most abdominal injuries involve blunt trauma Abdominal muscles are thin and weak Abdominal organs are not well protected Liver and spleen are particularly susceptible

55. Illinois EMSC55 INTERVENTIONS IN ABDOMINAL TRAUMA Maintain the ABC’s with simultaneous spinal stabilization if spinal injury suspected Cover open abdominal wounds with a sterile dressing moistened with sterile saline If abdominal contents have extruded, DO NOT attempt to push them back in

56. Illinois EMSC56 CONSIDERATIONS IN MUSCULOSKELETAL TRAUMA Epiphyseal plate area is weaker and more prone to injury Epiphyseal injuries are of concern since they may inhibit growth and cause deformity In children with multiple injuries, musculoskeletal injuries can contribute to hypovolemic shock

57. Illinois EMSC57 INTERVENTIONS IN MUSCULOSKELETAL TRAUMA Apply sterile dressings to any open wounds Stabilize fracture to prevent further injury Apply splint as appropriate

58. Illinois EMSC58 CONSIDERATIONS IN AMPUTATIONS Emergent Requires EMS Vasoconstriction may occur, minimizing blood loss It is critical to locate the amputated part and prepare it for transport with EMS

59. Illinois EMSC59 INTERVENTIONS IN AMPUTATIONS Rinse amputated part with saline (if available), wrap in saline moistened gauze, place in plastic bag and place bag on cold pack, label bag with name, date and time Apply direct pressure to the site Avoid use of a tourniquet Apply new dressings over old dressings

60. Illinois EMSC60

61. Illinois EMSC61 SPECIAL NEEDS CHILDREN Assess usual positioning, LOC and ability to communicate Provide reassurance Follow the same sequence of care (ABC’s)

62. Illinois EMSC62 FOLLOW-UP AFTER TRAUMA Note changes in student’s school routines Update school health record Facilitate care plan development

63. Illinois EMSC63

64. Illinois EMSC64 TRAUMA PREVENTION Encourage safe behaviors Take legislative action Note dangerous areas in school

65. Illinois EMSC65 SUMMARY Injuries are the leading cause of death in school-aged children. Appropriate assessment and management of injured students is one of your more important roles. Track school injuries and use the resulting data as part of your injury prevention efforts.

66. Illinois EMSC66

67. Illinois EMSC67 ANY QUESTIONS??