L3 Suspension-Blast-Ballistics Trauma Management PDF

Support The Management Of Trauma In The Emergency And Urgent Care Setting Component 8 Suspension trauma Hanging trauma Blast injuries Ballistic injuries  Suspension, Hanging, Blast and Ballistics - Component 8 Subjects covered durin...

Support The Management Of Trauma In The Emergency And Urgent Care Setting Component 8 Suspension trauma Hanging trauma Blast injuries Ballistic injuries  Suspension, Hanging, Blast and Ballistics - Component 8 Subjects covered during this training session may evoke memories of incidents that you have witnessed or been involved in. If you have any concerns then please discuss them with your Course Director/staff at the education centre. Support is available to all staff, more information is available on The Pulse LINC Emergency on Call – 0207 922 7539 Staff Counselling Referral Line – 0800 0214 155 MIND Blue Light Infoline – 0300 123 3393 TRiM Assessment- Information available via the Pulse Wellbeing Hub – 0203 162 7554 © Department of Clinical Education & 2 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Suspension Trauma © Department of Clinical Education & 3 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Suspension Trauma What is it? “A casualty who is experiencing pre-syncopal symptoms or who is unconscious whilst suspended in a harness..” They “should be rescued as soon as is safely possible.” © Department of Clinical Education & 4 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Suspension Trauma The pathophysiology: “Lower extremity venous circulation is exclusively dependent on muscle contraction.. When suspended and immobile, a "cascading" event can occur almost immediately. © Department of Clinical Education & 5 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Suspension Trauma ‘Suspension cascade’ Victim can’t escape vertical position with legs dangling 3-6 mins - venous pooling begins unless legs are moving 6-12 mins - obstruction of venous returns worsens as harness compresses femoral veins. Harness and abdominal pressure compresses inferior vena cava Loss of consciuosness follows © Department of Clinical Education & 6 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Suspension Trauma: Management “..standard UK first aid guidance of ABC management” “If the rescuer is unable to immediately release a conscious casualty from a suspended position, elevation of the legs by the casualty or rescuer where safely possible may prolong tolerance of suspension” They “should be rescued as soon as is safely possible” © Department of Clinical Education & 7 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Suspension Trauma Any Questions? © Department of Clinical Education & 8 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Hanging © Department of Clinical Education & 9 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Hanging Hanging is the most common method of suicide accounting for 61% of all suicides in those aged 10 years and over. Hanging may be accidental or deliberate, or fully or partially supported. Hanging may also be defined as a short drop or a log drop A short drop is where death is caused by asphyxia due to compression of the airway and blood vessels in the neck. A long drop is where death is caused as a result of a fracture-dislocation of the upper cervical vertebrae. There is no definition of the height required for either drop and the approximately height should be noted and handed over to receiving staff. © Department of Clinical Education & 10 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Hanging Management : Undertake a dynamic risk assessment Identify if there are signs of life or the need for resuscitation Remove (and if necessary cut) ligatures Call for help at an early stage Move the patient to an appropriate position for assessment & management (considering C spine care) The airway should take priorities over C spine management if required Airway management may be difficult, due to the potential for airway injury and swelling. © Department of Clinical Education & 11 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Hanging Management : If No CPR is commenced, where possible staff should not disturbed the scene to assist the police with their investigations. Post ROSC Care Be aware that patients are likely to be hypoxic and agitated and may need specialist on screen care. The possibility of spine or spinal cord injury should also be considered. © Department of Clinical Education & 12 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Hanging Remember- Welfare All staff may be effected by this type of incident, either in the short or longer term. Staff should have access to wellbeing services and a post-incident debrief. Bystander, witnesses and families may also need signposting to support services as well. © Department of Clinical Education & Standards 13 Suspension, Hanging, Blast and Ballistics – Component 8 Hanging Any Questions ? © Department of Clinical Education & Standards 14 Suspension, Hanging, Blast and Ballistics – Component 8 Blast Injuries © Department of Clinical Education & 15 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Blast Injuries Warfare/terrorism Industrial/residential Gas leaks Factories, commercial sites Fuel refineries Transport © Department of Clinical Education & 16 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Blast Injuries Catagory Cause Possible Injuries Primary Blast shock Wave Gas containing organs damaged Secondary Flying fragments/debris Lacerations and fractures to entire body Tertiary Blast wave propels patient Penetrating Injuries against objects Quaternary Other explosion related Blunt and Crush injuries injury and illnesses Quinary Resulting from additives Burns such as bacteria and radiation © Department of Clinical Education & 17 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Blast Injuries Any Questions? © Department of Clinical Education & 18 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Penetrating Trauma © Department of Clinical Education & 19 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Penetrating trauma Stab wounds Gunshot wounds © Department of Clinical Education & 20 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Stab Wounds Low velocity – Stab wounds are low energy penetrating trauma Multiple wounds from a single weapon © Department of Clinical Education & 21 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Stab wounds Knife, scissors and ice picks are common weapons Injury is often limited to depth and area of penetration May leave only small external injury with significant inside damage © Department of Clinical Education & 22 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Stab wounds © Department of Clinical Education & 23 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Gunshot wounds Higher velocity weapons deliver much more energy into the patient. They leave a permanent cavity in the body and also create a temporary cavity when the projectile enters the body © Department of Clinical Education & 24 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Gunshot wounds High velocity weapons – High energy projectile enters the body Creates much more potential for injury Projectile pathway is often erratic © Department of Clinical Education & 25 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Gunshot wounds Cavitation- Permanent cavity formed by the pathway of the projectile Temporary cavitation is relative to the energy that comes with the projectile The greater the energy - the greater the temporary cavity produced Has the same effect as an explosion inside the body Creates a large exit wound in comparison to entrance wound © Department of Clinical Education & 26 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Gunshot wounds Ricochet- Bullet does not always follow a straight path Increases tissue damage Pathway becomes erratic If no exit wound then all of the kinetic energy has been transferred to the body © Department of Clinical Education & 27 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Gunshot wounds Entry and exit wounds- Entrance wound is often the size of the projectile Exit wound can be considerably larger and not always in an expected place © Department of Clinical Education & 28 Standards Suspension, Hanging, Blast and Ballistics – Component 8 © Department of Clinical Education & 29 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Gunshot wounds © Department of Clinical Education & 30 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Things to Consider Scene safety Weapon type Anatomic structures along potential projectile path Crime scene Patient care is top priority Kinetic energy © Department of Clinical Education & 31 Standards Suspension, Hanging, Blast and Ballistics – Component 8 Any Questions? © Department of Clinical Education & 32 Standards