Emergency Medical Transport and Shock Management

Abdominal/GU Trauma

• Anatomy and Physiology of the Abdomen
  • GLASSS-P ( RUQ, RLQ, LLQ, LUQ)
  • Diaphragm (thoracic cavity, 4th and 5th intercostal space, 12th rib)
  • Peritoneal cavity (upper and lower areas, contents)
  • Retroperitoneal cavity (area posterior to peritoneal lining, contents)
  • Pelvis (iliac vessels, organs, and structures)
  • Solid and hollow organs (liver, spleen, pancreas, kidneys, etc.)
• Signs and Symptoms of a GI Bleed
  • Hematuria (dark brown or bright red)
  • Upper GI bleed (coffee ground emesis)
  • Lower GI bleed (bright red blood)
  • Distention, tenderness, and Cullen sign (ecchymosis around the umbilicus)
  • Grey-Turner sign (ecchymosis of the flank)
• Signs and Symptoms of a Ruptured Diaphragm
  • Abdominal pain, acute respiratory distress
  • Decreased breath sounds, abdominal sounds in the chest
  • Subcutaneous emphysema, sunken abdomen, associated injuries
  • Right-sided diaphragmatic tear (liver injury)
  • Left-sided diaphragmatic tear (spleen injury)

Bleeding

• Anatomy and Physiology of Hemorrhagic Shock
  • Internal and external bleeding
  • Blunt or penetrating injuries to vessels or organs
  • Long bone or pelvic fractures
  • Multisystem injury
• Indication for Fluid Resuscitation
  • Internal hemorrhage ( fluid bolus of 250 ml of normal saline or lactated ringers)
  • Hemorrhagic shock (fluid bolus of 250 ml, titrate to systolic BP of 80-90 mmHg)
• Signs and Symptoms of Hemorrhagic Shock
  • Initial stage (low circulating blood volume with minimal signs of hypoperfusion)
  • Compensated shock (agitation, anxiety, restlessness, etc.)
  • Decompensated shock (altered mental status, hypotension, etc.)

Chest Trauma

• Identification of Beck's Triad
  • Cardiac tamponade (excessive fluid in the pericardial sac)
  • Beck's Triad (muffled heart tones, hypotension, JVD)
• Signs and Symptoms of a Cardiac Contusion
  • Local tissue contusion and hemorrhage
  • Edema, sharp retrosternal chest pain
  • EKG changes (sinus tachycardia, A-Fib, etc.)
• Signs and Symptoms of a Pneumothorax
  • Small pneumothorax (mild dyspnea, pleuritic chest pain)
  • Large pneumothorax (increasing dyspnea, respiratory compromise, hypoxia)
  • Open pneumothorax (defect in the chest wall, sucking chest wound)

Cranial Trauma

• Pathophysiology of a Traumatic Brain Injury
  • Primary brain injury (injury to the brain and its associated structures)
  • Secondary brain injury (consequence of primary injury, abnormal processes)
• Signs and Symptoms of a Traumatic Brain Injury
  • Pupillary abnormalities (anisocoria, sluggish or nonreactive pupils)
  • Period of unconsciousness, confusion, or disorientation
  • Repeatedly asking the same questions (perseveration)
  • Amnesia, combativeness, or other abnormal behavior
  • Numbness or tingling in the extremities
  • Loss of sensation and/or motor function
  • Focal neurologic deficits
  • Seizures
  • Cushing triad (hypertension, bradycardia, irregular or erratic respirations)

Facial, Neck, and Spinal Trauma

• Anatomy and Physiology of the Head
  • 28 bones make up the cranium and face
  • Base of the skull (ethmoid, sphenoid, occipital, frontal, temporal)
  • Brain (cerebrum, cerebellum, brainstem, meninges)
• Signs and Symptoms of Spinal Cord Injuries
  • Paresthesia, paralysis, temp-sensation numbness
  • Spinal shock (flaccid paralysis, flaccid sphincters, absent reflexes)
  • Neurogenic shock (hypotensive, bradycardiac, skin warm, flushed, and dry)
  • Neurons deficits (paralysis of small bowel, paralytic ileus)

Multisystem Trauma

• Calculating Mechanism of Injury
  • Use trauma triage guidelines
  • Falls, ejection from a vehicle, etc.
• Complications of a Crush Injury
  • Rhabdomyolysis (muscle tissue becomes ischemic and dies)
  • Electrolyte imbalances and acidosis
  • Renal dysfunction leading to electrolyte abnormalities
  • Renal failure
• Complications of Hypovolemia
  • Electrolyte imbalances
  • Compensated shock (agitation, anxiety, restlessness, etc.)
  • Decompensated shock (altered mental status, hypotension, etc.)

Test your knowledge of emergency medical transport criteria, shock management, and associated complications. Covers crush injuries, compensated shock, supine hypotensive syndrome, and cardiogenic shock.