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.)