Emt Multi-Trauma

Considerations in Managing Multiple Systems Trauma Emergency Medical Technician Basic Temple College EMS Professions Multi-Systems Trauma  Dead rescuers can’t help anyone • Survey scene initially on every call • Be aware of your surroundings Temple College EMS Professions Multi-Systems Trauma   The most dramatic injury usually is NOT the most dangerous Priorities for management: • • • • Airway Breathing Circulation Disability Temple College EMS Professions Multi-Systems Trauma Noisy breathing = Obstructed breathing  But all obstructed breathing is NOT noisy  Temple College EMS Professions Multi-Systems Trauma  Anticipate airway problems in all patients with trauma to: • • • • Head Face Neck Upper Thorax Temple College EMS Professions Multi-Systems Trauma   Restlessness, decreased LOC = Hypoxia until proven otherwise Oxygenate, Look for cause Temple College EMS Professions Multi-Systems Trauma  Cyanosis is late, unreliable sign of hypoxia   Don’t treat cyanosis, prevent it If you even THINK about giving oxygen - GIVE IT!! Temple College EMS Professions Multi-Systems Trauma   Oxygen is useless if patient isn’t ventilating Danger Signs • Respirations <10 • Respirations >24 • Decreased tidal volume • Labored breathing Temple College EMS Professions Multi-Systems Trauma Assist ventilations with O2  Then look for cause  If you can’t tell whether patient is ventilating adequately, he isn’t!  Temple College EMS Professions Multi-Systems Trauma   Restlessness, anxiety With pallor, tachycardia, or slow capillary refill = SHOCK Temple College EMS Professions Multi-Systems Trauma    Anticipate shock in all seriously injured patients Falling BP = Late sign of shock Don’t treat a falling BP - Prevent It!! Temple College EMS Professions Multi-Systems Trauma  If shock present without external bleeding, think: • • • • • Thoracic or abdominal bleed Pelvic fracture Multiple long bone fractures Tension pneumothorax Cardiac tamponade Temple College EMS Professions Multi-Systems Trauma   Isolated head trauma does NOT cause decreased BP in adults Look for injuries of: • • • • Chest Abdomen Pelvis Major long bones Temple College EMS Professions Multi-Systems Trauma  Most reliable indicator of severity of injury, effectiveness of resuscitation = Level Of Consciousness Think hypoxia, hypoperfusion, hypoglycemia, head trauma BEFORE alcohol, drugs, or personality Temple College EMS Professions  Multi-Systems Trauma   Neurological findings may “rule in” spinal injury Absence of neurological findings NEVER “rules out” spinal injury  Key to diagnosis = Mechanism Temple College EMS Professions Multi-Systems Trauma   If you THINK about immobilizing spine DO IT!! If you immobilize part of spine, immobilize WHOLE spine Temple College EMS Professions Multi-Systems Trauma  Until proven otherwise: • Chest trauma involves heart, great vessels! • Chest trauma below fourth intercostal space involves abdomen! • Abdominal trauma above umbilicus involves chest! Temple College EMS Professions Multi-Systems Trauma   Gunshot wound severity cannot be assessed in field Until proven otherwise, patient with gunshot wound is shot everywhere! Temple College EMS Professions Multi-Systems Trauma    Orthopedic injury usually NOT life-threat Exceptions: • Pelvic fracture • Femur fractures Assess, treat proximal to distal Temple College EMS Professions Multi-Systems Trauma   Extremity trauma = Neurovascular involvement until proven otherwise Assess, record, report: • • • • Pulses Capillary refill Skin color, temperature Motor, sensory function Temple College EMS Professions Multi-Systems Trauma  KILLERS are trauma to: • Head • Chest • Abdomen Temple College EMS Professions Multi-Systems Trauma    When in doubt, SPLINT! Don’t waste time on individual injuries if ABC’s compromised Securing patient to long board immobilizes entire body Temple College EMS Professions Multi-Systems Trauma   Use tourniquets only as LAST RESORT But don’t wait too long All bleeding stops eventually Temple College EMS Professions Multi-Systems Trauma   Avulsed, amputated parts should be: • Kept cool • Transported with patient But don’t hold unstable patient in field looking for parts Temple College EMS Professions Multi-Systems Trauma   If you don’t know the diagnosis. . . treat the signs and symptoms Open, clear, maintain airway Maximize oxygenation, ventilation Maximize perfusion Temple College EMS Professions Multi-Systems Trauma   Definitive Treatment = Surgeon’s Knife Trying to field-stabilize unstable trauma = Ultimate Stabilization DEATH Temple College EMS Professions Multi-Systems Trauma Minimum time on scene  Maximum treatment in route  Temple College EMS Professions Multi-Systems Trauma Patient MUST go to facility able to continue care appropriately  Closest facility, facility preferred by family is NOT necessarily most appropriate  Temple College EMS Professions Multi-Systems Trauma challenge in a crisis is NOT to be innovative.  The challenge is to FOLLOW THE RULES.  The Temple College EMS Professions