Considerations in Managing Multiple Systems Trauma


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Temple College EMS Professions Considerations in Managing Multiple Systems Trauma Emergency Medical Technician - Basic


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Temple College EMS Professions Multi-Systems Trauma Dead rescuers can’t help anyone Survey scene initially on every call Be aware of your surroundings


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Temple College EMS Professions Multi-Systems Trauma The most dramatic injury usually is NOT the most dangerous Priorities for management: Airway Breathing Circulation Disability


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Temple College EMS Professions Multi-Systems Trauma Noisy breathing = Obstructed breathing But all obstructed breathing is NOT noisy


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Temple College EMS Professions Multi-Systems Trauma Anticipate airway problems in all patients with trauma to: Head Face Neck Upper Thorax


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Temple College EMS Professions Multi-Systems Trauma Restlessness, decreased LOC = Hypoxia until proven otherwise Oxygenate, Look for cause


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Temple College EMS Professions Multi-Systems Trauma Cyanosis is late, unreliable sign of hypoxia Don’t treat cyanosis, prevent it If you even THINK about giving oxygen - GIVE IT!!


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Temple College EMS Professions Multi-Systems Trauma Oxygen is useless if patient isn’t ventilating Danger Signs Respirations <10 Respirations >24 Decreased tidal volume Labored breathing


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Temple College EMS Professions Multi-Systems Trauma Assist ventilations with O2 Then look for cause If you can’t tell whether patient is ventilating adequately, he isn’t!


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Temple College EMS Professions Multi-Systems Trauma Restlessness, anxiety With pallor, tachycardia, or slow capillary refill = SHOCK


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Temple College EMS Professions Multi-Systems Trauma Anticipate shock in all seriously injured patients Falling BP = Late sign of shock Don’t treat a falling BP - Prevent It!!


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Temple College EMS Professions Multi-Systems Trauma If shock present without external bleeding, think: Thoracic or abdominal bleed Pelvic fracture Multiple long bone fractures Tension pneumothorax Cardiac tamponade


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Temple College EMS Professions Multi-Systems Trauma Isolated head trauma does NOT cause decreased BP in adults Look for injuries of: Chest Abdomen Pelvis Major long bones


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Temple College EMS Professions Multi-Systems Trauma Most reliable indicator of severity of injury, effectiveness of resuscitation = Level Of Consciousness Think hypoxia, hypoperfusion, hypoglycemia, head trauma BEFORE alcohol, drugs, or personality


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Temple College EMS Professions Multi-Systems Trauma Neurological findings may “rule in” spinal injury Absence of neurological findings NEVER “rules out” spinal injury Key to diagnosis = Mechanism


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Temple College EMS Professions Multi-Systems Trauma If you THINK about immobilizing spine DO IT!! If you immobilize part of spine, immobilize WHOLE spine


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Temple College EMS Professions Multi-Systems Trauma Until proven otherwise: Chest trauma involves heart, great vessels! Chest trauma below fourth intercostal space involves abdomen! Abdominal trauma above umbilicus involves chest!


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Temple College EMS Professions Multi-Systems Trauma Gunshot wound severity cannot be assessed in field Until proven otherwise, patient with gunshot wound is shot everywhere!


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Temple College EMS Professions Multi-Systems Trauma Orthopedic injury usually NOT life-threat Exceptions: Pelvic fracture Femur fractures Assess, treat proximal to distal


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Temple College EMS Professions Multi-Systems Trauma Extremity trauma = Neurovascular involvement until proven otherwise Assess, record, report: Pulses Capillary refill Skin color, temperature Motor, sensory function


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Temple College EMS Professions Multi-Systems Trauma KILLERS are trauma to: Head Chest Abdomen


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Temple College EMS Professions Multi-Systems Trauma When in doubt, SPLINT! Don’t waste time on individual injuries if ABC’s compromised Securing patient to long board immobilizes entire body


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Temple College EMS Professions Multi-Systems Trauma Use tourniquets only as LAST RESORT But don’t wait too long All bleeding stops eventually


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Temple College EMS Professions Multi-Systems Trauma Avulsed, amputated parts should be: Kept cool Transported with patient But don’t hold unstable patient in field looking for parts


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Temple College EMS Professions Multi-Systems Trauma If you don’t know the diagnosis. . . treat the signs and symptoms Open, clear, maintain airway Maximize oxygenation, ventilation Maximize perfusion


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Temple College EMS Professions Multi-Systems Trauma Definitive Treatment = Surgeon’s Knife Trying to field-stabilize unstable trauma = Ultimate Stabilization DEATH


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Temple College EMS Professions Multi-Systems Trauma Minimum time on scene Maximum treatment in route


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Temple College EMS Professions Multi-Systems Trauma Patient MUST go to facility able to continue care appropriately Closest facility, facility preferred by family is NOT necessarily most appropriate


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Temple College EMS Professions Multi-Systems Trauma The challenge in a crisis is NOT to be innovative. The challenge is to FOLLOW THE RULES.


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