TRAUMA

STS

2/9/2015

SKULL FRACTURES

Bleeding:

• Loosely cover bleeding site with sterile gauze

• Check for CSF

• Do NOT try to stop blood flow. Why?

• Do NOT insert NPA

• C-spine precautions

• But keep in mind…THEIR SKULL IS FRACTURED…so be careful of how you hold their head

EYE INJURIESForeign objects in eye:

• Irrigate with saline/water (flush medial to lateral)

• Never attempt to remove object from cornea (only remove if object is on eyelid)

• If impaled: stabilize with roller gauze

• If chemical: flush for 20 min

• If thermal burn: cover with burn dressing

Blowout fracture: fracture of orbital bone; googly eyes

• Check PERRL

• Contacts should be kept in eye unless chemical present

• Notify ALS if pt wearing contacts

• TRANSPORT

EPISTAXIS

Bleeding from nose

1. Pinch nose

2. Tilt forward

Do not tilt backwards; if pt swallows blood, may cause pt to vomit suction

3. Apply ice

MOUTH INJURIES• Save loose teeth in container mixed with Pt’s saliva/milk

• If bleeding in mouth is heavy

• Check airway• Turn left-lateral • Prepare to suction

Never stick your hand into someone’s mouth!!

SOFT TISSUE INJURY

Hematoma: pool of blood collects in an area, leading to compartment syndrome

• may be due to blunt injury

Treatment: splint and CMS

OPEN INJURIES

Abrasion:

• clean and apply bandaid/dressing

Avulsion:

• clean and place flap back in right position

• control bleeding

• apply dressing

OPEN INJURIES (CONT.)

Impaled object:

splint and stabilize

When do you remove an impaled object?

If it interferes with CPR/obstructs airway

Gunshot wound:

look for entry and exit wound

control bleeding

provide O2

blanket and shock position if in shock

PNEUMOTHORAX

Air in pleural space

Sucking chest wound: open chest wound allows air into pleural space

• Occlusive dressing

• Tape 3 sides down

• Auscultate every 5 min

• If lung sounds are absent after applying occlusive dressing, ventilate and remove dressing momentarily to relieve pressure

TENSION PNEUMOTHORAX

What’s the difference between this and a sucking chest wound?

• This is caused by a collapsed lung (genetic defect, trauma, etc)

• You cannot ventilate a tension pneumo because it’ll add more air and exacerbate the problem

What is the biggest indicator of a tension pneumo?

• Tracheal deviation

Treatment: TRANSPORT

ABDOMINAL WOUNDS

Evisceration: organ protruding through abdomen

• Soak big trauma dressing in sterile saline solution

• Tape over exposed organ

• DO NOT touch exposed organ

• DO NOT try to pack organs back

AMPUTATIONS

Wrap severed body part in sterile gauze

Place in plastic bag

Chill on ice

• Do NOT allow body part to freeze or come into direct contact with ice

NECK

Jugular vein laceration

• Apply occlusive dressing

• Tape down on 4 sides

• Monitor respirations closely (in case of air embolism)

THERMAL BURNS1st degree: superficial

2nd degree: dermis

3rd degree: full thickness

Treatment:

• Stop burning submerse in cool water/saline

• If severe, apply burn dressing (non-adhesive)

• Treat for shock

• Patients with critical burns lose a lot of fluids

• Rule of Nines

CHEMICAL/ELECTRICAL BURNS

Chemical burn treatment:

• Remove clothing

• For powder chemicals: brush off powder first

• Flush with water for 20 min

Electrical burn treatment:

• Look for entry and exit wounds

• Prepare to perform CPR in case of cardiac arrhythmia

SCENARIO

You get a dispatch call for a 20 y/o male at Doheny Fountain with suspected trauma.