05 Traumatic Emergencies

8/10/2019 05 Traumatic Emergencies

1/15

TRAUMATIC

EMERGENCIES

ALS Section E 1


2/15

INITIAL TRAUMA CARE TRAUMA

NOTE: Appropriate Body Substance Isolation euip!ent !ust be used on all

trau!a patients"

CRITERIA: All trauma patients

TREATMENT:

1. Perform BTLS primary survey:

a. If loa an !o situation is present:i. Perform only life"#riti#al interventions on s#ene.

ii. Avise re#eivin! fa#ility an transport rapily.

iii. Perform se#onary survey enroute to re#eivin! fa#ility.iv. Perform all ot$er interventions% su#$ as I& insertion% #aria#

monitorin! an PAS' inflation enroute to re#eivin! fa#ility.

v. In all #ases% s#ene time s$oul (e limite to 1) minutes% unless

entrapment e*ists.(. If a loa an !o situation is not present:

i. Continue se#onary survey.

ii. Provie supportive #are as ini#ate.iii. Attempt to limit s#ene time to 1) minutes or less% unless entrapment

e*ists.

+. Conta#t Mei#al Control to report assessment finin!s.,. Air-ay an /0'EN aministration:

a. Apply /0'EN at 1 Lpm (y non"re(reat$er.

(. Perform avan#e air-ay #ontrol measures% as neee.#. Apply pulse o*imeter if availa(le.

2. (tain SAMPLE $istory an vital si!ns3 repeat vital si!ns every to 1)

minutes an relay to re#eivin! fa#ility.

. PAS':a. May (e use if patient #onition -arrants% an no #ontraini#ations are

present.

(. Conta#t Mei#al Control for orers to inflate.#. Refer to PAS' Care 'uieline for pro#eure.

4. Continue reassessment of patient urin! transport:

a. Continuously reassess t$e patient5s level of #ons#iousness usin! t$e'las!o- Coma S#ale.

(. Continuously monitor life"#riti#al interventions an ABC5s.

#. Report any #$an!es in patient #onition to Mei#al Control.

6. Conta#t Mei#al Control.7. If patient nees immeiate intu(ation re8uirin! #ons#ious seation -it$

&ERSE9% refer to CNSCIS SE9ATIN " &ERSE9 proto#ol.

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Re#ised: Au$ust %&&&

ALS Section E +


3/15

GLASGO' COMA SCALE TRAUMA

Indicator Response Score

Eye Openin$ Spontaneous 2

To voi#e ,

To pain +

None 1(erbal Response riente

Confuse 2Inappropriate -ors ,

In#ompre$ensi(le +

None 1

Motor Response (eys #omman 4

Lo#ali;es pain


4/15

AM*UTATION TRAUMA

NOTE: +o not delay transport o, patient to retrie#e an entrapped or lost part"

+o not co!plete partial a!putations"

CRITERIA:

1. Partial or #omplete amputation of a (oy part

TREATMENT:

1. Initial Trauma Care.

+. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er.

,. Bleein! #ontrol.2. I& of LR enroute to re#eivin! fa#ility3 #onsier +)")) mL flui (olus to

maintain SBP (et-een >) ? 1)).

. Treat for s$o#@ if ini#ate.

4. Consier MRPINE SL=ATE m! I&P pus$ as neee for pain #ontrol.May repeat * 1 after 1 minutes as neee.

6. Tissue preservation:

a. Rinse part !ently -it$ normal saline -+O NOT SCRUB..(. . Conta#t Mei#al Control.

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Re#ised: /uly %&&0

ALS Section E 2


5/15

BURNS TRAUMA

NTE: *atients 1it2 unstable #ital si$ns s2ould not routinely recei#e pain!edications"

CRITERIA: Any may (e present

1. In$alation inury

+. Ele#tri#al inury

,. Si!nifi#ant partial or full t$i#@ness (urns

2. C$emi#al e*posure

TREATMENT:

1. Assure s#ene an res#uer safety.

+. Initial Trauma Care.

,. Remove patient from sour#e of (urn% an e*tin!uis$ flames on patient.2. Treat (urn a##orin! to type:

a. T$ermal ? #over -it$ moist ressin!.

(. C$emi#al ? flus$ -it$ -ater or saline (rus$ off any ry #$emi#al firstD.

#. Tar ? #ool -it$ -ater or saline3 o not attempt to remove tar.. Ele#tri#al ? remove from #onta#t -it$ #urrent only if fully traine an

properly e8uippe3 note any se#onary fra#tures or e*it -ouns.

. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er.4. Perform avan#e air-ay #ontrol measures as neee.

6. Monitor.

7. I& of LR3 Consier +) ? )) mL flui (olus to maintain SBP >) ? 1)).

>. Consier MRPINE SL=ATE m! I&P as neee for pain #ontrol. Mayrepeat * 1 after 1 minutes as neeeor #onsier =ENTAN0L 1 m#!@! slo-

I&P over 1"+ minutesD instea of MRPINE. May (e repeate on#e after minutes at 1 m#!@! slo- I&P.

1). (tain (urn $istory:

a. Type of (urn3 #ausative a!ent3 time of (urn.

(. Lo#ation of (urn.#. Estimate e!ree an per#ent surfa#e area (urne.

. Inury environment.

e. SAMPLE $istory.11. Conta#t Mei#al Control.

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1+. If MRPINE anor =ENTAN0L aller!y% #onsier 9EMERL + m! I&

pus$.

Re#ised: /uly %&&0

3ebruary %&44

ALS Section E


6/15

C5EST IN/URIES TRAUMA

CRITERIA:

1. Si!ns an symptoms of serious #$est inury% in#luin!:a. Penetratin! or su#@in! #$est -ouns

(. nsta(le #$est -all se!ment#. Si!ns of (lunt trauma to #$est. Parao*i#al movement

e. Ta#$ypnea or respiratory istress -it$ suspe#te #$est inury

TREATMENT:


+. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er% or B&M as ne#essary.,. Perform avan#e air-ay #ontrol measures as neee.

2. Neele #$est e#ompression% if patient meets (ot$ of t$e follo-in!:

a. Si!ns an symptoms of s$o#@.(. 9e#rease or a(sent (reat$ souns on one sie.

. Immo(ili;ation.

4. Treat any o(vious #$est inuries% as ini#ate:

a. Apply o##lusive ressin! to su#@in! #$est -ouns% leavin! one #orneropen.

(. Support any unsta(le #$est -all se!ments -it$ !au;e or $an.

6. Initiate rapi transport3 reassess vitals 8 minutes.7. Monitor.

>. I& of LR3 #onsier +) ? )) mL flui (olus to maintain SBP >) ? 1)).

1). Conta#t Mei#al Control.

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ALS Section E 4


7/15

3IEL+ TRIAGE TRAUMA

CRITERIA:

1. Multiple inure patients (eyon immeiate #apa(ility.+. Maor EMS In#ient. MEMSID

TREATMENT:

4" Se#ure s#ene an par@ in a safe lo#ation3 ACTI(ATE REGION 0 MCI*LAN"

%" Esta(lis$ In#ient Comman System ICSD3 esi!nate #omman an tria!ese#tors.

6" Count total num(er of patients involve% in#luin! all uninure% ea an

refusals.

7" Rapily #ate!ori;e inure patients usin! METTA' system:

a. Bla#@ ? (vious eat$3 non"(reat$in! patients -it$out spontaneous

respiration after repositionin! air-ay.(. Re ? Immeiate3 life t$reatenin! inuries% respiratory #ompromise% s$o#@

an altere mental status.

#. 0ello- ? 9elaye3 inuries -$i#$ #an -it$stan up to an $our elay

-it$out treatment% fra#tures an (urns.. 'reen ? Am(ulatory3 all -al@in! -oune an uninure patients.

8" Esta(lis$ treatment an loain! areas for -oune patients.

0" Treat an transport a##orin! to priority:a. All re patients s$oul (e transporte as soon as possi(le.

(. 0ello- patients may (e ta@en to treatment area% an transporte as soon as

all re patients $ave (een eva#uate.

#. 'reen patients may (e transporte (y pu(li# transportation or ot$erve$i#les.

9" As#ertain family relations$ips of vi#tims an transport family mem(ers to t$esame $ospital estination if possi(le.

" Lo! patient information an provie upates to In#ient Commaner.

;" Reassi!n patient priorities as neee to e*peite #are% an as patient

#onitions #$an!e.

4&" Conta#t Mei#al Control.

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Re#ised: /anuary %&&0

ALS Section E 6


8/15

5EA+ OR S*INE IN/UR< TRAUMA

CRITERIA: Any may (e present

1. nresponsive or 'CS F 1,

+. Posturin!

,. ne8ual pupils2. Loss of motor or sensory fun#tion. Me#$anism t$at ini#ates potential for inury.

E/CLSIN:

1. SBP F >) ? See s$o#@ proto#ol

TREATMENT:


+. Air-ay an /0'EN at 1 Lpm (y non"re(reat$er.,. If un#ons#ious or semi"#ons#ious% intu(ate as per avan#e air-ay

mana!ement3 if si!ns of elevate intra#ranial pressure posturin!% unilateral

pupil ilation% 'CS7 -it$ $ypertension(ray#ariaD% initiate #ontrolle

ventilation at 12"+) (reat$smin -it$ 1))G o*y!en @eepin! en"tial pC+ at,,",G if availa(le.

2. Immo(ili;e patient an #ontrol (leein!.

. Initiate transport.4. Monitor

6. I& of LR at H&.

7. 0PERTNIC SALINE ,G solutionD at ##@! I& over ,) minutes if si!ns

of elevate intra#ranial pressure present% if availa(le.>. Assessment fa#tors to #onsier:

a. Restlessness may (e a si!n of $ypo*ia.

(. Assume #ervi#al spine inury in all patients -it$ si!nifi#ant $ea inury.#. (serve patient #losely for #$an!es in LC.

. Avoi t$e use of nasal air-ays in patients -it$ suspe#te fa#ial fra#tures.

e. 9o not treat $ypertension in t$e $ea"inure patient.1). Conta#t Mei#al Control.

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11. Consier PAS' for refra#tory $ypotension -it$ suspe#te spinal #or trauma.

Re#ised: October %&&8

No#e!ber %&&0

ALS Section E 7


9/15

*AIN3UL= S'OLLEN OR

+E3ORME+ E>TREMIT. Conta#t Mei#al Control."""""""""""""""""""""""""""""""""""""""

1). If MRPINE or =ENTAN0L aller!y e*ists% #onsier 9EMERL + m! I&

pus$.

Re#ised: /uly %&&0

3ebruary %&44

ALS Section E >


10/15


11/15

TRAUMATIC ARREST TRAUMA

CRITERIA:

1. Pulseless an apnei# trauma patient not meetin! t$e Trau!a 3ield+eat2

+eclaration#riteria refer to t$e Trau!a 3ield +eat2+eclarationproto#olD.

TREATMENT:

1. Assure res#uer safety3 maintain inline sta(ili;ation t$rou!$out

assessment an treatment.

+. Perform avan#e air-ay #ontrol measures3 initiate CPR.,. Immo(ili;e an initiate rapi transport -it$in 1) minutes of

e*tri#ation.

2. Monitor. Esta(lis$ t-o lar!e (ore I&5s of LR:

a. Run -ie open until patient re!ains pulse

(. Maintain SBP 1))"11)4. Aminister EPINEPRINE 1:1)%))) 1m! I& ," minutes until

pulses return or until arrival at $ospital.

6. Treat su(se8uent ysr$yt$mias per appropriate proto#ol.

7. Conta#t Mei#al Control."""""""""""""""""""""""""""""""""""""""""""""""

>. Consier PAS' inflation as ini#ate

1). Mei#al Control may orer Peri#ario#entesis if your servi#e $as t$at #apa(ilityD as per Peri#ario#entesis Care 'uieline.

Re#ised: /anuary %&&%

May %&&7

3ebruary %&44

ALS Section E 11


12/15

TRAUMA 3IEL+ +EAT5 TRAUMA

+ECLARATION

Si!nifi#ant traumati# inury AN+

patient foun pulseless an apnei# NOupon EMS arrivalJ


13/15


14/15

f. ea inury -it$ sei;ure a#tivity% unilaterally ilate pupil% or open

epresse s@ull fra#ture

!. T-o or more pro*imal lon! (one fra#tures$. M&C motor ve$i#le #ras$D -it$ ee#tion

i. 9eat$ of o##upant in same passen!er #ompartment

. =alls O +) ft C$ilren: 1) ft or +" , * $ei!$t of t$e #$ilD@. Separation of rier from motor#y#le

l. Peestrian (i#y#list stru#@ (y ve$i#le an t$ro-n or run overm. &e$i#le rollover -it$ un(elte passen!ers

Treatment:

1. BLS an ILS units s$oul a#tivate a tiere response or aeromei#al transport to

!ain ALS level s@ills for t$e patient if t$ey anti#ipate prolon!e s#ene or transporttime.

+. BLS units -it$out mutual ai rapi tiere response option s$oul transport t$e

patient to t$e nearest lo#al $ospital.,. Consier aeromei#al transport if 8ui#@er an of #lini#al (enefit.

2. Pre"etermine lanin! ;ones s$oul (e utili;e -$enever feasi(le for patient

$anoff to aeromei#al teams. T$e lanin! ;ones s$oul (e availa(le to allaeromei#al transport a!en#ies.

October %&4&

ALS Section E 12


15/15

October %&4&

ALS Section E 1

05 Traumatic Emergencies

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