Trauma Emergencies Head to Toe exam Application of C-Collar KED LSB Long bone injury Joint injury

1. Trauma Emergencies • Head to Toe exam • Application of C-Collar • KED • LSB • Long bone injury • Joint injury • Traction Splint • Bleeding and shock management

2. Bleeding and Shock

3. Circulatory System Responsible for distribution of blood to all parts of the body • Heart • Arteries • Capillaries • Veins • Perfusion • Hypoperfusion • Functions of the blood

4. Heart • Muscular organ that pumps blood, which supply oxygen and nutrients to the cells of the body • Arteries Carry oxygen-rich blood away from the heart • Capillaries Oxygen-rich blood is emptied from arteries into microscopically small capillaries, which supply every cell of the body

5. Veins Carry blood that has been depleted of oxygen and loaded with CO2 and wastes from capillaries • Perfusion Adequate blood throughout, which fills the capillaries and supplies the cells and tissues with oxygen and nutrients

6. Hypoperfusion aka shock Inadequate perfusion of the body’s tissues with oxygen and nutrients Functions of the blood • Transportation of gases • Nutrition • Excretion • Protection • Regulation

7. Bleeding Hemorrhage • Severe bleeding is a major cause of shock • During S A M P L E ask if on blood thinners i.e. coumadin, Plavix

8. External Bleeding • Use standard precautions • Classifications Arterial bleeding Venous bleeding Capillary

9. Severity of external bleeding • Physical size of the patient • Natural response constriction of vessels and clotting restrictive clothing

10. Care • ABCs • Standard precautions • Assess circulation radial pulse skin color temperature and condition

11. Control ; methods • Direct pressure • Elevation • Pressure points • Splinting *sharp ends of broken bones may cause tissue and vascular injury *Stabilizing may prevent further injury

12. Cold packs • PASG • Tourniquet • Blood pressure cuff • Provide O2

13. Special situations involving bleeding Head injury • Do not apply pressure to ears and nose but allow drainage to flow freely Nosebleed • Have pt. sit and lean forward • Direct pressure • Keep calm and quiet • Do not let pt. lean back • If pt. is uncomfortable; recovery position, prepare to suction and manage airway

14. Internal Bleeding • Perform a through history and exam Mechanism of blunt trauma that may cause internal bleeding • Falls • MVA or motorcycle crashes • Auto-pedestrian collisions • Blast injuries

15. Penetrating injuries • Gunshot wounds • Stab wounds • Impaled objects Signs • Injuries to the surface of the body indicative of underlying injuries • Bruising, swelling, or pain over vital organs

16. Painful, swollen, or deformed extremities • Bleeding from mouth, rectum, vagina or other orifice • Vomiting; coffee-ground, bright red • Dark, tarry stools or bright red blood in stools • Signs and symptoms of shock

17. Care • ABCs • O2 • Control external bleeding • Rapid transport

18. Shock Inadequate tissue perfusion Failure of • Pumping of the heart • Supply of blood • Integrity of blood vessels ability to dilate or constrict

19. Types of shock C A N S H R I M P Severity of shock • Compensated • Decompensated • Irreversible

20. Stages • Stage 1: Initial Stage of Shock • The first of the stages of shock is reversible, but there aren't any signs to indicate shock at this stage. Cells begin to change due to issues with perfusion and oxygenation. Perfusion is the method used by veins to deliver blood to capillary beds in body tissues. Without this nutritive blood and an adequate oxygen supply, the cells switch to anaerobic metabolism, producing pyruvic and lactic acid.

21. Stage 2: Compensatory Stage of Shock • During the compensatory stage of shock, the body tries to reverse the results of the initial stage. Physiological, neural, hormonal, and biochemical reactions are employed to correct the imbalances. Hyperventilation is one such mechanism. This causes an increased rate of breathing which, in turn, may help to get more oxygen flowing to the cells and neutralize the newly acidic conditions. • Another mechanism is the catecholamine response. Hypotension, or low blood pressure, due to the reduced volume of blood flow triggers this response. Catecholamines are hormones released by the adrenal glands. These hormones increase heart rate and attempt to increase blood pressure.

22. Compensated Shock • Increased pulse rate • Decreased pulse strength • Cool, clammy skin • Progressing anxiety, restlessness, combativeness • Thirst, weakness, eventual air hunger

23. Stage 3: Progressive Stage of Shock • Decompensated • If the stages of shock progress to the third stage before the initial cause is corrected, damages become more severe and can be irreversible. Cellular function continues to deteriorate, anaerobic metabolism leads to increased metabolic acidosis, and the compensatory mechanisms can no longer maintain the balance required to protect the organs.

24. Decompensated shock • Pulse becomes unpalpable • B/P drops precipitously • Patient becomes unconscious • Respirations slow or cease

25. Stage 4: Refractory Stage of Shock • Irreversible • The stages of shock will eventually lead to the refractory stage if the cause of shock cannot be fixed. At this stage, the organs completely fail and lead to death. It is important to understand the stages of shock in order to recognize and prevent the progression to this final stage.

26. Irreversible shock • Irreversible cell damage • Cell death • Tissue dysfunction • Organ dysfunction • Patient dies

27. Signs and Symptoms of shock • AMS • Pale, cool, clammy skin • Nausea and vomiting • VS changes Pulse; Increased Respirations; Rapid, labored, shallow B/P; Drops {late sign}

28. Thirst • Dilated pupils • Sometimes cyanosis • Pediatric compensation

29. Care • Airway and O2 • Transportation Clock starts at time of injury Limit on-scene time On Scene • ABCs with spinal precautions • Rapid trauma exam • Immobilization • Moving the Pt. to ambulance

30. VS Trending q 5 minutes • Control any external bleeding • Splint any suspected bone or joint injuries • Maintain body heat • Rapid transport • Detailed PE

31. Notify hospital ASAP • Notify medical direction if necessary • Request ALS • If conscious speak calmly, reassuringly