Podcast
Questions and Answers
What is the primary consideration when performing a scene size-up?
What is the primary consideration when performing a scene size-up?
Which of the following would be considered a high-risk mechanism of injury?
Which of the following would be considered a high-risk mechanism of injury?
What should you do during the primary survey?
What should you do during the primary survey?
What should you assume about an unresponsive patient with trauma?
What should you assume about an unresponsive patient with trauma?
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Why should you avoid inserting an NPA if there is a basil or skull fracture?
Why should you avoid inserting an NPA if there is a basil or skull fracture?
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What should you do to open the airway if spinal injury is indicated?
What should you do to open the airway if spinal injury is indicated?
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What is the primary goal of the primary survey?
What is the primary goal of the primary survey?
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Why should you conduct a primary survey while continuing manual stabilization?
Why should you conduct a primary survey while continuing manual stabilization?
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What is the primary purpose of administering 100% oxygen via non-rebreather to a patient?
What is the primary purpose of administering 100% oxygen via non-rebreather to a patient?
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What is the main focus of the secondary assessment?
What is the main focus of the secondary assessment?
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When should a helmet be removed from a patient?
When should a helmet be removed from a patient?
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What is the primary cause of low back pain?
What is the primary cause of low back pain?
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What is the purpose of the OPQRST assessment?
What is the purpose of the OPQRST assessment?
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What should be done during patient transfers to manage a suspected spinal injury?
What should be done during patient transfers to manage a suspected spinal injury?
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What should be controlled during patient care to prevent further injury?
What should be controlled during patient care to prevent further injury?
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When should CPR be initiated?
When should CPR be initiated?
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Study Notes
Patient Assessment
- Perform scene size-up to ensure safety and decide whether to activate trauma systems and consider backup.
- The decision to immobilize a patient depends on local protocols, but high-risk mechanisms of injury suggest the possibility of spine injury and indicate the need for spinal mobilization restriction.
High-Risk Mechanisms of Injury
- High-velocity crashes (>40 mph) with severe vehicle damage.
- Unrestrained occupant of moderate to high-speed motor vehicle crash.
- Vehicle damage with compartmental intrusion (>12 in) into the patient's seating space.
- Fall of an adult (>20 ft) or a child (>10 ft) or the height (2-3 times their child's height).
- Penetrating trauma near the spine.
- Ejection from a moving vehicle or a motorcycle crash (>20 mph).
- Other high-impact injuries (e.g., auto-pedestrian or auto-bicycle crash >20 mph).
- Accident with a death of occupant in the same passenger compartment.
Uncertain Risk Mechanisms
- Moderate to low-velocity MVCs (motor vehicle crashes).
- Isolated injuries without positive assessment findings.
- Syncopal events (e.g., patient already seated or supine, or assisted by a bystander).
Primary Survey
- Keep manual stabilization in line position.
- Identify patient's level of responsiveness.
- Conduct primary survey while continuing manual stabilization.
- Focus on identifying and managing life-threatening concerns (e.g., external hemorrhage, airway, and breathing).
- Follow the X ABCDE method.
Airway Management
- Evaluate and monitor level of consciousness.
- Ask patient about symptoms and chief complaint.
- Re-evaluate and record observations.
- Assume unresponsive patients with trauma have spinal injury.
- Clear mouth and suction if necessary.
- Open airway using jaw thrust maneuver if spinal injury is indicated.
- Avoid inserting NPA (nasal pharyngeal airway) if basil or skull fracture is suspected or if there is obvious nasal trauma.
Breathing and Ventilation
- Evaluate breathing and ensure adequate oxygenation and ventilation.
- Administer 100% oxygen via non-rebreather if patient is breathing adequately.
- Ventilate patient to maintain end-tidal CO2 >25.
- Initiate CPR if necessary.
- Control external bleeding with direct pressure or pressure dressings.
History Taking
- Investigate chief complaint.
- Obtain medical history and alert for injury-specific signs and symptoms.
- Perform OPQRST (onset, palliation, quality, radiation, severity, timing) and SAMPLE (signs, allergies, medications, past medical history, last oral intake, events).
- Obtain history from friends, family members, or medical identification jewelry and cards if patient is not responsive.
Secondary Assessment
- Complete secondary assessment on-scene or during transport.
- Obtain vital signs and perform physical exam with patient in a neutral position.
- Apply manual stabilization while asking patient not to move.
- Focus on site of injury depending on chief complaint.
- Monitor patient for any changes in level of consciousness, ICP, and GCS score.
Spinal Injury Management
- Treat patients with suspected spinal injury according to local protocols.
- Use a cervical collar or other immobilization device to provide full body spinal immobilization.
- Avoid moving the cervical spine during patient transfers.
- Monitor patient's condition and provide interventions during transport.
Helmet Removal
- Check ABCs and ensure airway is clear and breathing is adequate.
- Assess whether the helmet can be removed without compromising airway or breathing.
- Consider the type of helmet and whether it can be removed safely.
- Remove the helmet if it is a full-face helmet or causing excessive head movement.
- Consult with medical direction before moving the helmet.
Back Pain Management
- Upright posture places a substantial amount of weight on the lumbar spine.
- Most causes of low back pain are idiopathic.
- Pay attention to patient's medications and pain management.
- Consider degenerative disk disease, spinal tumors, and other causes of back pain.
- Provide palliative care in the absence of trauma.
Patient Assessment
- Ensure safety and decide to activate trauma systems and consider backup during scene size-up.
- High-risk mechanisms of injury suggest the possibility of spine injury and indicate the need for spinal mobilization restriction.
High-Risk Mechanisms of Injury
- High-velocity crashes (>40 mph) with severe vehicle damage.
- Unrestrained occupant of moderate to high-speed motor vehicle crash.
- Vehicle damage with compartmental intrusion (>12 in) into the patient's seating space.
- Fall of an adult (>20 ft) or a child (>10 ft) or the height (2-3 times their child's height).
- Penetrating trauma near the spine.
- Ejection from a moving vehicle or a motorcycle crash (>20 mph).
- Other high-impact injuries (e.g., auto-pedestrian or auto-bicycle crash >20 mph).
- Accident with a death of occupant in the same passenger compartment.
Uncertain Risk Mechanisms
- Moderate to low-velocity MVCs (motor vehicle crashes).
- Isolated injuries without positive assessment findings.
- Syncopal events (e.g., patient already seated or supine, or assisted by a bystander).
Primary Survey
- Keep manual stabilization in line position.
- Identify patient's level of responsiveness.
- Conduct primary survey while continuing manual stabilization.
- Focus on identifying and managing life-threatening concerns (e.g., external hemorrhage, airway, and breathing).
- Follow the X ABCDE method.
Airway Management
- Evaluate and monitor level of consciousness.
- Assume unresponsive patients with trauma have spinal injury.
- Clear mouth and suction if necessary.
- Open airway using jaw thrust maneuver if spinal injury is indicated.
- Avoid inserting NPA (nasal pharyngeal airway) if basil or skull fracture is suspected or if there is obvious nasal trauma.
Breathing and Ventilation
- Evaluate breathing and ensure adequate oxygenation and ventilation.
- Administer 100% oxygen via non-rebreather if patient is breathing adequately.
- Ventilate patient to maintain end-tidal CO2 >25.
- Initiate CPR if necessary.
- Control external bleeding with direct pressure or pressure dressings.
History Taking
- Investigate chief complaint.
- Obtain medical history and alert for injury-specific signs and symptoms.
- Perform OPQRST (onset, palliation, quality, radiation, severity, timing) and SAMPLE (signs, allergies, medications, past medical history, last oral intake, events).
- Obtain history from friends, family members, or medical identification jewelry and cards if patient is not responsive.
Secondary Assessment
- Complete secondary assessment on-scene or during transport.
- Obtain vital signs and perform physical exam with patient in a neutral position.
- Apply manual stabilization while asking patient not to move.
- Focus on site of injury depending on chief complaint.
- Monitor patient for any changes in level of consciousness, ICP, and GCS score.
Spinal Injury Management
- Treat patients with suspected spinal injury according to local protocols.
- Use a cervical collar or other immobilization device to provide full body spinal immobilization.
- Avoid moving the cervical spine during patient transfers.
- Monitor patient's condition and provide interventions during transport.
Helmet Removal
- Check ABCs and ensure airway is clear and breathing is adequate.
- Assess whether the helmet can be removed without compromising airway or breathing.
- Consider the type of helmet and whether it can be removed safely.
- Remove the helmet if it is a full-face helmet or causing excessive head movement.
- Consult with medical direction before moving the helmet.
Back Pain Management
- Upright posture places a substantial amount of weight on the lumbar spine.
- Most causes of low back pain are idiopathic.
- Pay attention to patient's medications and pain management.
- Consider degenerative disk disease, spinal tumors, and other causes of back pain.
- Provide palliative care in the absence of trauma.
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Description
Learn about the steps to assess a patient in emergency situations, including scene size-up and identifying high-risk mechanisms of injury. Understand when to immobilize a patient and activate trauma systems.
