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Chapter 10

Chapter 10. Trauma. Trauma Care. Includes: Rapidly identifying injuries Transporting patients to appropriate trauma center for definitive care Providing scene safety Performing trauma assessment in all cases Morbidity and mortality. Newton’s Laws of Motion. Newton’s First Law

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Chapter 10

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  1. Chapter 10 Trauma

  2. Trauma Care • Includes: • Rapidly identifying injuries • Transporting patients to appropriate trauma center for definitive care • Providing scene safety • Performing trauma assessment in all cases • Morbidity and mortality

  3. Newton’s Laws of Motion • Newton’s First Law • “A body in motion remains in motion in a straight line unless acted upon by an outside force.” • Newton’s Second Law • “Acceleration depends on the mass of the object and the force upon it.” • Newton’s Third Law • “To every action, there is an equal and opposite reaction.”

  4. Types of Trauma (1 of 2) • Blunt injuries • Energy exchange between an object and body without breaking skin • Penetrating injuries • External force in which tissue is penetrated by an object

  5. Types of Trauma (2 of 2) • Deceleration injuries • Caused by a sudden stop of body’s forward motion • External force injuries • Caused by forces that violate body tissues • Injury depends on anatomic area, mass, and velocity of foreign object.

  6. Factors That Might Require Trauma Center (1 of 2) • Ejection from automobile • Death in same passenger compartment • Pedestrian thrown or run over, auto–pedestrian injury greater than 5 mph • High-speed automobile crash • Intrusion into passenger compartment of greater than 12” • Major vehicle deformity greater than 20”

  7. Factors That Might Require Trauma Center (2 of 2) • Vehicle rollover with unrestrained passenger • Extrication time greater than 20 minutes • Falls of greater than 20’ • Motorcycle crash at greater than 20 mph or with separation of rider and bike

  8. Triage • Doing the greatest good for the greatest number • Four common triage categories • Immediate (red) • Delayed (yellow) • Minimal (green) • Expectant (black)

  9. Types of Triage (1 of 3) • START triage • Step 1: Identifies walking wounded • Step 2: Assesses nonwalking patients • Step 3: Assesses hemodynamic status by checking radial pulse • Step 4: Assesses neurologic status • JumpSTART triage • Modifies process for pediatric patients under 8 years or weighing less than 100 lb

  10. Types of Triage (2 of 3)

  11. Types of Triage (3 of 3)

  12. Trauma Scoring Systems (1 of 6) • Glasgow Coma Scale (GCS) • Assesses level of consciousness: eye opening, verbal response, motor response • Trauma score • Predicts likelihood of patient survival • Score ranges 1–16 • Includes GCS • Not useful with severe head injuries

  13. Trauma Scoring Systems (2 of 6)

  14. Trauma Scoring Systems (3 of 6) • Revised trauma score • Most commonly used scoring system to determine severity of injury • Measures respiratory rate, systolic blood pressure, GCS score • Abbreviated Injury Scale (AIS) • Ranks severity of injury by reviewing six body regions

  15. Trauma Scoring Systems (4 of 6)

  16. Trauma Scoring Systems (5 of 6) • Injury Severity Score (ISS) • Provides overall score for patients with multiple injuries • Incorporates AIS score • Trauma injury severity score • Calculates survival probability of critically ill or injured patient • Not commonly used in transport setting

  17. Trauma Scoring Systems (6 of 6)

  18. Levels of Trauma Care (1 of 2) • Level I: Provides every aspect of trauma care from prevention through rehabilitation • Level II: Provides initial definitive care • Level III: Provides assessment, resuscitation, emergency care, stabilization • Level IV: Provides advanced trauma life support prior to transfer

  19. Levels of Trauma Care (2 of 2)

  20. General Trauma Management • Involves patients who are very ill and in need of close assessment • Immediate attention directed at the ABCs • Assess placement of the endotracheal tube, presence of breath sounds, capnography waveform • Assess cardiovascular status

  21. Effects of Hypothermia on Trauma Patients

  22. Diagnostic Imaging for Trauma (1 of 2) • Standard radiographs • Structure and landmark verification, placement of anatomic devices, structure symmetry, foreign object identification • Computed tomography • Head injury and bleeding identification, complex fractures • Scan head, c-spine, chest, abdominal-pelvic region

  23. Diagnostic Imaging for Trauma (2 of 2) • Magnetic resonance imaging (MRI) • Identification of abnormalities in trauma • FAST ultrasonography • Identification of abdominal bleeding in trauma; becoming more common in transport • IAP monitoring • Identifies intra-abdominal hypertension

  24. Types of ACS • Primary • Surgical interventions or injuries to abdominal-pelvic region • Secondary • Result of conditions outside abdomen • Recurrent • Recurrence of ACS following initially successful surgical or medical treatment

  25. Anatomy of Thorax

  26. Types of Pneumothorax • Open pneumothorax • Signs: “sucking chest wound,” dyspnea, tachypnea • Simple pneumothorax • Often associated with closed chest injury • Tension pneumothorax • Life-threatening, results from continual influx of air into pleural space

  27. Open Pneumothorax

  28. Tension Pneumothorax

  29. Skill Drill 10-1: Managing an Open Pneumothorax (1 of 2) Immediately close the chest wound, initially with a gloved hand. Maintain an open airway and administer high-flow oxygen. Apply an occlusive dressing, taped down on three sides.

  30. Skill Drill 10-1: Managing an Open Pneumothorax (2 of 2) Initiate a large-bore IV. Monitor oxygen saturation, vital signs, and the cardiac monitor.

  31. Skill Drill 10-2: Needle Decompression of a Tension Pneumothorax (1 of 3) Locate the appropriate site between the second and third rib. Assess the patient Prepare and assemble all necessary equipment.

  32. Skill Drill 10-2: Needle Decompression of a Tension Pneumothorax (2 of 3) Insert the needle at a 90° angle. Cleanse the appropriate area using an aseptic technique. Make a one-way or flutter valve (optional).

  33. Skill Drill 10-2: Needle Decompression of a Tension Pneumothorax (3 of 3) Remove the needle and listen for release of air or look for bubbling in the syringe. Properly dispose of the needle. Secure the catheter in place. Monitor the patient closely.

  34. Hemothorax (1 of 2) • Blood in pleural space • Causes • Hypovolemic shock • Harms lung function • Caused by: • Penetrating and blunt trauma • Tumor

  35. Hemothorax (2 of 2)

  36. Chest Tube Insertion (1 of 2) • Used to remove air, fluid, pus from pleural cavity • Indicated for treatment of: • Pneumothorax, hemopneumothorax, empyema

  37. Chest Tube Insertion (2 of 2)

  38. Skill Drill 10-3: Chest Tube Insertion (1 of 5) Select the appropriate site. Connect the collection device to the distal end of the one-way valve with a rubber band. Cleanse the site with an appropriate aseptic technique.

  39. Skill Drill 10-3: Chest Tube Insertion (2 of 5) Anesthetize the area. Mark the tube for the desired length of insertion. Clamp the distal end of the tube with a large clamp and the proximal end of tube with a curved clamp. Make a transverse incision over the fifth rib at the midaxillary line.

  40. Skill Drill 10-3: Chest Tube Insertion (3 of 5) Tunnel over the fifth rib with a large curved clamp, push through the pleura, spread the clamp, and leave it in place. Grasp the clamp attached to the end of the chest tube and advance it through the space created by the first clamp.

  41. Skill Drill 10-3: Chest Tube Insertion (4 of 5) Remove the clamps and advance the tube to the predetermined mark indicated on the tube. Connect the collection device with the one-way valve. Remove the distal clamp.

  42. Skill Drill 10-3: Chest Tube Insertion (5 of 5) Suture the tube in place and close the wound. Cover the insertion site with an occlusive dressing.

  43. Other Forms of Thoracic Trauma (1 of 5) • Flail chest • Fracture in two or more places to two or more adjacent ribs; may initially go undetected • Pericardial tamponade • Abundance of blood, fluid in pericardium; life-threatening; Beck’s triad indicator; requires emergency pericardiocentesis

  44. Other Forms of Thoracic Trauma (2 of 5)

  45. Other Forms of Thoracic Trauma (3 of 5) • Aortic dissection/transaction • Aortic rupture; most common cause of immediate death in MVCs • Myocardial contusion • Caused by blunt chest trauma; signs similar to acute MI • Diaphragmatic rupture • Caused by both blunt and penetrating trauma

  46. Other Forms of Thoracic Trauma (4 of 5) • Tracheobronchial disruption • Rare, life-threatening; can occur anywhere along tracheobronchial tree • Pulmonary contusion • Tearing, lacerations to lungs can cause bleeding, plasma leakage into alveoli and interstitial spaces

  47. Other Forms of Thoracic Trauma (5 of 5) • Esophageal perforation • Usually caused by penetrating injuries like projectiles • Traumatic asphyxia • Severe, sudden crushing injury to chest and abdomen • Not a form of asphyxia, but patient’s head and neck turn cyanotic

  48. Skill Drill 10-4: Pericardiocentesis (1 of 3) Prepare the equipment and obtain baseline vital signs. Place the patient into a supine position. Premedicate per protocol or on-line medical control. Don a mask, gown, hair cover, and sterile gloves. Cleanse the site and drape the area.

  49. Pericardiocentesis (2 of 3) Identify the needle entry site directly below the xiphoid. Infiltrate the area with 1% lidocaine into the skin and deeper tissues.

  50. Pericardiocentesis (3 of 3) Gently aspirate while inserting the needle. A blood sample can be placed into the collection container and transported with the patient. Insert the needle-on-syringe at the identified entry site at a 30° angle.

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