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

Temple College EMS Professions Multi-Systems Trauma l Dead rescuers cant help anyone Survey scene initially on every call Be aware of your surroundings

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

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

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

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

Temple College EMS Professions Multi-Systems Trauma l Cyanosis is late, unreliable sign of hypoxia l Dont treat cyanosis, prevent it l If you even THINK about giving oxygen - GIVE IT!!

Temple College EMS Professions Multi-Systems Trauma l Oxygen is useless if patient isnt ventilating l Danger Signs Respirations <10 Respirations >24 Decreased tidal volume Labored breathing

Temple College EMS Professions Multi-Systems Trauma l Assist ventilations with O 2 l Then look for cause l If you cant tell whether patient is ventilating adequately, he isnt!

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

Temple College EMS Professions Multi-Systems Trauma l Anticipate shock in all seriously injured patients l Falling BP = Late sign of shock l Dont treat a falling BP - Prevent It!!

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

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

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

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

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

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

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

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

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

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

Temple College EMS Professions Multi-Systems Trauma l When in doubt, SPLINT! l Dont waste time on individual injuries if ABCs compromised l Securing patient to long board immobilizes entire body

Temple College EMS Professions Multi-Systems Trauma l Use tourniquets only as LAST RESORT l But dont wait too long All bleeding stops eventually

Temple College EMS Professions Multi-Systems Trauma l Avulsed, amputated parts should be: Kept cool Transported with patient l But dont hold unstable patient in field looking for parts

Temple College EMS Professions Multi-Systems Trauma l If you dont know the diagnosis... l treat the signs and symptoms Open, clear, maintain airway Maximize oxygenation, ventilation Maximize perfusion

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

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

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

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