Prehospital Emergency Care: Trauma Overview PDF

PREHOSPITAL EMERGENCY CARE Kinetics is the branch of mechanics dealing with the movements o0f bodies, understanding Trauma Overview: The Trauma Patient...

PREHOSPITAL EMERGENCY CARE Kinetics is the branch of mechanics dealing with the movements o0f bodies, understanding Trauma Overview: The Trauma Patient kinetics is helpful in understanding MOI and and the Trauma System trauma. Setting the Stage Is the Patient a Priority for Transport? Overview of Lesson Topics Analysis of the mechanism of injury may be crucial o The Kinetics of Trauma element in the decision. o Mechanics of Injury o The Multisystem Trauma Patient THE KINETICS OF TRAUMA o The Golden Period and Platinum 10 minutes o The Trauma System Mass and velocity o Golden Principles of Prehospital Trauma Cara Case Study Introduction 1. EMTs Nina Segall and Scotty Lindquist respond to a report of a person shot in a hunting Kinetic energy accident. After 15-minute response to the - Velocity is the more significant factory in remote area, they meet state police on the determining the amount of kinetic energy. scene. Police confirm that it was a hunting - Estimate the speed of the objects involved accident and all weapons have been secured. o Motor vehicle collisions The patient, a 27-year-old man, was o Penetrating trauma accidentally shot by another hunter with a high Acceleration and deceleration velocity fire. - The law of inertia 2. As the EMTs size up the scene, they see a police o A body at rest will remain at rest, and a body officer holding direct pressure on the patient’s in motion will remain in motion, unless acted thigh. The patient is lying supine on the ground, upon by an outside force. and seems combative and confused. He is pale o A faster change of speed (acceleration or and sweating, despite the cool temperatures. deceleration) results in more force exerted. Energy changes form and direction CASE STUDY - Energy travels in a straight line unless it meets 1. What are the priorities in managing this interference. patient? - Interference with the travel of kinetic energy 2. What information will help the EMTs determine can cause it to change direction and form. the extent of the patient's injuries? Impacts - Three types of impacts in a vehicle collision INTRODUCTION o Energy is absorbed in each impact Trauma makes up a signifcant percentage of the o There can be multiple impacts of each type. calls to which prehospital personnel respond. ▪ Vehicle collision Recognizing the extent of injuy is critical to making ▪ Body collision decisions to giving trauma patients the best chances ▪ Organ collision of suvival. VEHICLE COLLISION THE KINETICS OF TRAUMA - The vehicle strikes an object The mechanism of injury (MOI) is how a person is injured. The scenes of analyzing mechanisms of injury is the kinetics of trauma  o Vehicle telemetry data consistent with a high risk of injury. BODY COLLISION - The occupant continues forward and strikes the inside of the automobile. FRONTAL IMPACT o The occupant is travelling at the same speed as the vehicle. ORGAN COLLISION - The collision continue to move forward and strike the inside of the skull, chest, or abdomen. o With an up – and – over pathway look for injuries to the abdomen, chest, face, head, and neck. MECHANISM OF INJURY MOI provides a suspicion of injury; not an accurate indicator of injury. You must assess the patient for indicators of injury. VEHICLE COLLISION - Have a high suspicion of injury when there is o Death of another vehicle occupant o Altered mental status o Intrusion over 12 inches for the occupant o A deformed Steering wheel indicates site Possible chest or Abdominal Injury. o Ejection from the motor vehicle  REAR – END IMPACT o Initially, the head and neck are whipped back o A properly adjusted headrest and seat belt reduce injury o Subsequent injury can follow an up – and – over or down – and – under pathway. o With a down – and – under pathway look for injuries to the knees, femurs, hips, acetabulum, and spine. EXAMPLES OF MECHANISMS OF INJURY ASSOCIATED WITH FRONTAL IMPACT The Effects of Driver Not Wearing a Seat Belt (a) In a rear impact with an unrestrained occupant, initial movement is backward, causing potential neck injury. (b) The occupant then moves forward, causing impact to the head and chest. Lateral impact Vehicle-pedestrian collision - There may be injuries of the head, neck, chest, - Extent of injury depends on abdomen, pelvis, and extremities - Vehicle speed - Assess whether the patient bore the brunt of - What part of the body is hit the impact - How far the pedestrian was thrown - The surface the pedestrian landed on - The body part that first struck the ground - Injury patterns are different in children and adults Restraints: a cause of hidden injuries - The benefits of restraints outweigh the risks, but they are associated with certain injuries that must be suspected - Injury is more likely if lap belts and shoulder straps are not positioned properly - Air bags are not designed for multiple collisions - Considerations for infants and children - The head and neck are not secured - The head snaps forward, straining the neck - Spinal cord injury can occur, even without injury to the vertebrae - Car seats should be placed in the backseat of the vehicle only Motorcycle collisions Rotational or rollover crash Helmet use is a significant factor in reducing morbidity - Injury patterns are less predictable and mortality - In rollovers there are multiple impacts and Impacts may be head-on or angular, and may involve changes in direction ejection - Multisystem trauma is common - Ejection is common with rollover; crushing Laying the bike down can result in severe abrasions injuries to ejected occupants are common and burns. (Motorcycle collisions can result in multisystem trauma from multiple impacts to the rider) All-terrain vehicles Vehicles are unstable and easily tipped Vehicle collisions are similar to motorcycle collision FALLS - Severity of trauma depends on: Distance Surface Body part impacted first a. Low velocity Knife or similar object A severe fall is Can include defensive slash wounds > 20 feet in an adult The length of the object provides clues to injury > 10 feet or two to three times the height in a b. Medium- and high-velocity injuries child Includes pellets and bullets A. Feet-first falls Shotguns and handguns are generally medium Injuries to lower extremities velocity Injuries to spine High-velocity weapons include rifles Injury to internal organs Damage is determined by the trajectory and the Wrist and elbow injuries may occur dissipation of energy B. Head-first falls Dissipation of energy is affected by o Upper extremity injuries Drag Profile Head and neck injuries Cavitation Chest, spine, and pelvis injuries may occur Fragmentation PENETRATING INJURIES c. Gunshot wounds Kinetic energy predicts the amount of damage 90 percent of fatal wounds involve the head, thorax, Low, medium, or high velocity and abdomen Wounds also occur to the neck and extremities  c) Patient Displacement/Tertiary Injury The blast wind may propel the patient to the ground or against objects, causing further injuries. (d) Patient Exposed to Hazardous Material or Structural Collapse/Quaternary/Quinary Injury The patient may also be Blast injuries exposed to harmful chemicals or toxins or may be injured by Occurs from explosions structural collapse. Each of the phases of an explosion causes specific types of injury CASE STUDY Nina and Scotty ensure that the patient has an open airway and is breathing adequately, and apply oxygen by nonrebreather mask as the police officer continues to apply direct pressure. Nina detects a weak, thready radial pulse that she estimates to be greater than 100 per minute. She performs a rapid secondary assessment, during which she finds an entry wound to the front of the thigh, and an exit wound posteriorly. Meanwhile, Scotty is preparing a long backboard so they can prepare the patient for transport TYPES OF BLAST INJURIES 1. What factors should the EMTs consider in (a) Pressure Wave/Primary Injury determining where the patient should be Air molecules slam into one transported? another, creating a pressure wave THE MULTISYSTEM TRAUMA PATIENT moving outward from the blast center, causing pressure injuries Most trauma patients have a simple or single injury. Multisystem trauma has a high incidence of (b) Blast Wave/Secondary morbidity and mortality Managing immediate life threats and Injury Instantaneous expeditious transport are the appropriate care combustion of the explosive agent creates superheated gases. The resulting pressure blows the bomb casing apart. Pieces of the bomb projectiles can cause secondary injuries by striking the patient.  The Golden Period and Platinum 10 Minutes Trauma in a patient with significant medical history (for example, myocardial infarction, chronic obstructive The best chances of survival from trauma occurs pulmonary disease, and congestive heart failure), >55 when intervention takes place as quickly as years of age, hypothermia, burns, or pregnancy possible The goal is for EMS providers to limit scene time Multisystem trauma to 10 minutes with severely injured patients Open or depressed skull fracture Within the 10-minute scene time, you must assess the patient, manage immediate life Suspected brain injury threats, and prepare the patient for transport Paralysis Table 27-1 Indications for On-Scene Time of 10 Minutes or Less and Rapid Transport The Trauma System Airway occlusion or difficulty in maintaining a patent airway The trauma system exists to provide immediate surgical intervention for critically injured Respiratory rate 29/minute trauma patients Inadequate tidal volume Different levels of trauma centers have different levels of capability Hypoxia This care dramatically reduces the morbidity Respiratory distress, failure, or arrest and mortality of patients requiring immediate surgical intervention Suspected skull fracture Level l -Regional Trauma Center Flail chest Level ll Area Trauma Center Level III -Community Trauma Center Suspected pneumothorax, hemothorax, or tension Level IV -Trauma Facility pneumothorax Pelvic fracture American College of Surgeons Committee on Trauma Two or more proximal long-bone fractures 2022 National Guideline for Field Triage of Injured Crushed or mangled extremity Patients Uncontrolled external hemorrhage A. RED CRITERIA – High risk for serious injury Suspected internal hemorrhage. Signs and symptoms of shock Significant external blood loss with controlled hemorrhage Glasgow Coma Scale score 13 or less Altered mental status Seizure activity Sensory or motor deficit Any penetrating trauma to the head, neck, anterior or posterior chest, abdomen, and above the elbow or knee Amputation of an extremity proximal to the finger  Patients meeting any one of the YELLOW CRITERIA WHO DO NOT MEET RED CRITERIA should be preferentially transported to a trauma center, a available within the geographic constraints of the regional trauma system (need to be the highest-level center) Golden Principles of Prehospital Trauma Care The golden principles of prehospital trauma care apply to all patients who have experienced some type of injury but especially those with multisystem trauma or critical injuries. Special considerations in trauma care: Your personal safety is the highest priority Patients meeting any of the above RED criteria should Airway management and adequate ventilation be transported to the highest-level trauma center and oxygenation are key elements of trauma available within the geographic constraints of the management regional trauma system. Stop significant bleeding B. YELLOW CRITERIA – moderate risk for serious injury Assessment of the trauma patient is conducted in a systematic sequence Rapid transport is essential to survival of severely injured patients A backboard serves to splint fractures in unstable trauma patients Do not develop tunnel vision and become focused on dramatic injuries or patients Case Study Conclusion Nina consults with medical direction concerning their destination for the patient. There is a community trauma center 20 minutes away, and a regional trauma center 70 minutes away. Medical direction advises transport to the community trauma center, where the patient will receive initial stabilization. It is likely that the patient will be transferred to the regional trauma center for definitive treatment. Lesson Summary Assessing the MOI helps predict potential injuries. Mass and velocity are the determinants of kinetic energy. Trauma may be blunt or penetrating High-velocity weapons are particularly prone to producing massive bodily injury Trauma systems exist to allow rapid surgical intervention for severely injured patients.  Trauma triage criteria help determine which patients should be transported to a trauma center.