Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Trauma and Trauma Systems
Chapter 1
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Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Trauma:
A physical injury or wound caused by external force or violence
Trauma is the leading killer of persons under age 44 in the United States.
150,000 Trauma deaths each year in the US
44,000 Deaths from MVA trauma
38,000 Deaths from gunshot wound trauma
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Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Penetrating Trauma:
An injury caused by an object breaking the skin and penetrating the
body.
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Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Blunt Trauma:
An injury caused by the collision of an object with the body in which
the object does not enter the body
Life threatening problems, such as internal bleeding, may occur with only
subtle signs and symptoms.
When assessing a trauma patient, look beyond the obvious injuries for
evidence that suggests a life-threatening condition.
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Serious Trauma:
Is a surgical disease; its proper care is immediate surgical
intervention to repair internal hemorrhage sites.
Only 10% of trauma injuries pose a serious threat to life
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Modern Trauma Systems:
Include three levels of trauma center, each with an increased ability
and commitment to providing trauma care.
Level I - Regional Trauma Center
Level II – Area Trauma Center
Level III – Community Trauma Center
Level IV – Trauma Facility
* Highway Safety Act of 1966
* Trauma Care Systems and Planning and Development Act of 1990
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Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Trauma Center:
A hospital that has the capability of caring for acutely injured
patients; trauma centers must meet strict criteria to use this
designation.
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Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Trauma Triage Criteria:
Guidelines to aid prehospital personnel in determining which trauma
patients require urgent transportation to a trauma center.
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Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Mechanism of Injury:
The process and forces that cause trauma.
Consideration of the mechanism of injury begins during the scene
sizeup.
The mechanism of injury should be reconsidered as the first step
of the focused history and physical exam for trauma patients.
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Index of Suspicion:
The anticipation of injury to a body region, organ or structure based
on analysis of the mechanism of injury.
If you have any reason to suspect that the patient has sustained
serious internal injury, move to enter him or her into the trauma
system.
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Golden Hour:
The 60-minute period after a severe injury; it is the maximum
acceptable time between injury and initiation of surgery for the
seriously injured trauma patient.
Initial patient assessment, emergency stabilization, patient
packaging and initiation of transport should ideally take less than
10 minutes.
In applying trauma triage criteria, it is best to err on the side of
precaution.
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Volume 4 – Chapter 1 (Trauma & Trauma Systems)
Trauma Triage Criteria for Immediate Transport:
Mechanism of Injury:
Falls greater than 20 feet (3x height)
Pedestrian/bicyclist vs. auto collisions
Motorcycle impact greater than 20 mph
Ejection from a vehicle
Severe vehicle impact (+40mph, 12” intrusion, 20”
deformation)
Rollover w/ serious impact
Death of another occupant
Extrication time greater than 20 minutes
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Trauma Triage Criteria for Immediate Transport:
Significant MOI with Infants & Children:
Falls greater than 10 feet (3x height)
Bicyclist vs. auto collisions
Vehicle collision at medium speed
Vehicle collision with unrestrained infant/child
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Trauma Triage Criteria for Immediate Transport:
Physical Findings:
Revised Trauma Score 29
Pulse 120
2 or more proximal bone fractures
Flail Chest
Pelvic fractures
Limb paralysis
Burns to more than 15% of body surface area
Burns to face or airway
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