1 / 68

Trauma Assessment

Trauma Assessment. February 2014 Continuing Education Silver Cross Hospital EMS System Erika Ball, RN, BSN. Objectives. Review of mechanisms of injury. Understanding extremity trauma and amputation; prehospital treatment and protocol review.

farren
Download Presentation

Trauma Assessment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Trauma Assessment February 2014 Continuing Education Silver Cross Hospital EMS System Erika Ball, RN, BSN

  2. Objectives • Review of mechanisms of injury. • Understanding extremity trauma and amputation; prehospital treatment and protocol review. • Care of the patient with chest and abdominal trauma. Review of structures and potential complications associated with injury. • Review of SMO Code 72 for Decompression of Tension Pneumothorax

  3. Phases of Trauma • Pre-event • Injury prevention • Not usually accidental • Event • Interact with people, demonstrate professional attributes • Act as mentor, demonstrate good safety practices Aehlert, 2011

  4. Phases of Trauma • Post-event • Optimal patient care • Appropriate clinical decisions • Treat patient • Continues until patient delivery to ED, complete report Aehlert, 2011

  5. Trauma Systems • Parts • Injury prevention • Prehospital care • Emergency department care • Interfacility transport (if needed) • Definitive care • Trauma critical care • Rehabilitation • Data collection, trauma registry Aehlert, 2011

  6. Trauma Systems • Trauma center • Categories • Level I • Regional resource center • Specialized services (Burn ICU) • Level II • Comprehensive trauma care • Not all resources in level I are immediately available • Research not essential component Aehlert, 2011

  7. Trauma Systems • Trauma center • Categories • Critical access • Communities without level I or II • Provide evaluation, resuscitation, operative intervention for stabilization • Non-designated • Rural, remote areas • Provides initial stabilization, transfer to level I Aehlert, 2011

  8. Trauma Systems • Transport considerations • Time • Single most important factor • Golden period • Do not sacrifice care for speed • Platinum 10 minutes • Most appropriate facility may not be closest Aehlert, 2011

  9. Trauma Systems • Transport considerations • Ground transportation • Use if “reasonable” time • Generally within 30 minutes • Protocols may alter time frame Aehlert, 2011

  10. Trauma Systems • Transport considerations • Aeromedical transportation • When time critical to patient condition • Scene times extended from extrication • Road, traffic conditions seriously delay access to definitive care • Critical care personnel above ground ambulance training needed Aehlert, 2011

  11. Trauma Assessment Process • Scene Size-Up • Primary Survey • Decision for transport, A B C interventions • Reassessment and continued exam ITLS, 2008, 6th ed.

  12. Scene Size-Up • PPE • Scene safety • Triage/ number of patients (need for START Triage?) • Help and equipment needs assessment • Determine Mechanism of Injury

  13. Mechanism of injury:Common Trauma Injuries • Blunt • MVC • Pedestrian motion injuries • Bicycle • Falls • Penetrating • Firearms, shrapnel, posts • Burns • Remember: these are considered trauma! • Drowning What are the predictive injury patterns associated with these incidents?

  14. What are the mechanisms? Look at the impact locations: Front-end Side “quarter panel” = potential for rotational injuries Rear-end Rollover Crush (under a semi) BLUNT TRAUMA • Motor Vehicle Collision • MVC

  15. Blunt Trauma: MVC • Machine collision • Body collision • Organ collision ITLS, 2008 (6th ed.)

  16. Blunt Trauma: MVC • Vehicle collisions • Frontal (head-on) impact • Down-and-under pathway • Occupant continues forward • Moves downward in seat • Knee – primary impact point • Tibia – Dislocated knee, torn ligaments, knee joint dislocation • Popliteal artery lies behind knee, possible blood clot • Femur impact – Fracture, hip dislocation, pelvic fracture, acetabular fracture, blood clots, vascular injury • Injuries may be subtle

  17. Blunt Trauma: MVC • Side Impact: • Head injuries • Cervical spine injury • Pneumothorax/ hemothorax/ tension pneumo • Splenic or liver injury • Pelvic injuries • Extremity injury • Aortic Laceration • Rotational Injury • C-spine injury • Vascular tears

  18. Blunt Trauma: MVC This horizontally oriented skull fracture was a result of a side impact when the side of the driver's head impacted a tree as the vehicle slid to a stop against the tree.

  19. MVC: What mechanisms of force would injure the spleen?Side, Steering wheel, restrained passenger,unrestrained hitting seat or dashboard Spleen injuryPatient has B/P of 70/palp with no rigid abdomen or distension…

  20. Note the AMOUNT of blood that lurks within a spleen injury…(you may need to click play)

  21. Blunt Pelvic Injury

  22. What else is BLUNT trauma? • Baseball bats, sports injuries • Fall from height • Ejection from moving vehicles (motorcycle, ATV, horses, bicycles, snowmobiles)

  23. Blunt Trauma: Pedestrian • Causes fractures of long bones [arms and legs], and causes fractures of spine, pelvis, and vertebrae • Often causes internal injuries that may be severe • Commonly causes head injuries in adults and children • Pneumothorax common in this injury • Two mechanisms of injury: • Vehicle hitting body • Secondary injuries from impact with ground

  24. Pedestrian

  25. Pedestrian Trauma • Look for the impact locations on the vehicle. • The height of the person can also immensely affect the patient’s injury patterns (for example, children are lower at bumper level). • Be aware if the vehicle stopped, or did it continue in it’s path causing tertiary crush injuries?

  26. Bicycle Injuries • Similar to pedestrian versus auto, have several potential impact sites and multiple system injuries • Did they have a helmet on? • Speeds of bicycle? • Were they struck by a vehicle? • Surface of landing? • Did they hit anything during fall? (trees, signposts, other bicyclists)

  27. Blunt Trauma: Falls • Vertical deceleration • You must determine the following: • Distance the person fell • What part of the body they landed on (head, feet first, back) • Did they strike anything on the way down? • What surface did they land on? • All of these are determinants for their injury patterns ITLS, 2008, 6th ed.

  28. Trauma: Penetrating Injuries • High or low velocity • Firearms are high velocity • Determine all wounds involved • NEVER document ballistics as “entry” or “exit” ALWAYS document as “Wound #1” “Wound #2” etc. • You could inadvertently place the location of a murder suspect and cause them to be released…

  29. Penetrating Injury: GSW • There are shock waves with a bullet, damages surrounding tissue • Causes more damage to solid organs: kidney, liver, spleen. • Not always a straight line in the body- may hit bone and change direction • Head, thorax, or abdomen should be transported IMMEDIATELY. Focus on ABC’s, trauma assessment, then transport. ITLS, 2008, 6th ed.

  30. Where are thepotential injuries? Intestines/ bowel Vena cava and Aorta Mesenteric Artery (the artery that supplies blood to intestines) Solid organs: kidneys, liver, pancreas, spleen Base of lung Pelvis and spine

  31. Penetrating Trauma:Impalement • Basic reminders: • Leave object in place with exception to occlusion of the airway • Stabilize object for transport • The severity of the situation is relative to size, force, and location of object.

  32. Note the tourniquet…

  33. Transport decisions… Is the airway clear?

  34. Trauma : A Short Burn Care Review • Remember: burns are a trauma! • Transport to a trauma center • Be aggressive with airway control • Assessment for soot on face, nose, and hands.

  35. Burns • Basic review of burn care: • Determine severity • Begin trauma assessment • AIRWAY! AIRWAY! AIRWAY! • Breathing • Circulation • Remove burning source • Cool burn with clean water, (dry if >20% BSA) no longer than two minutes to avoid hypothermia • Patient is at risk for hypothermia, use precautions ITLS, 2008, 6th ed.

  36. Trauma:A Short Drowning Review • 150 ml is all it takes to cause profound hypoxia (ITLS, 2008) • Rapid evaluation and management of ABC’s • C-spine considerations • Rapid initiation of CPR • Cold water does not indicate death, remember “warm and dead”

  37. Trauma Assessment Review

  38. So here we go… head-to-toe

  39. Airway/C-spine • While repositioning airway/doing airway assessment, maintain c-cpine. • Delegate someone to do this or hold c-spine so the primary assessor can do the head-to-toe Trauma Nurse Core Curriculum (TNCC), 2011

  40. ASSESS AVPU • Alert • Verbal • Pain • Unresponsive

  41. Airway: Patent or non-Patent? • Readjust the airway • Do they need suction: teeth, blood, vomit? • Are they maintaining an airway or do you need to get an adjunct or intubate? • Make these decisions then move to… Trauma Nurse Core Curriculum (TNCC), 2011

  42. Breathing • Are they breathing? • No? Begin assisted ventilations • Yes? Assess the rate and quality. • Is the rate under 12? ASSIST VENTILATIONS • Is the rate over 30? Suspect shock and make load-and-go decision. • Quality. Are they shallow or abnormal? • Yes? ASSIST VENTILATIONS All of these are within normal limits, place on NRB and move to… Trauma Nurse Core Curriculum (TNCC), 2011

  43. CIRCULATION • Do they have a pulse? • No? Begin CPR • Yes? Note rate, skin color, and any hemorrhaging. • Hemorrhaging or bleeding profusely? • Yes? Control bleeding • No? Assess skin and need for fluid bolus • Keep in mind the need to start 2 large-bore IV or IO while enroute to Trauma center • If circulation is addressed, move to… Trauma Nurse Core Curriculum (TNCC), 2011

  44. Trauma Assessment • Head injury? • Contusions, lacerations? • Does the patient have facial injury? • If yes, do NOT use nasopharyngeal airway. • Signs of facial fractures, CSF from the nose or ears, blood from the ears Trauma Nurse Core Curriculum (TNCC), 2011

  45. Trauma Assessment • Neck wounds? • Stepoff on the posterior cervical spine? Trachea assessment… midline? • Place patient in Cervical collar Trauma Nurse Core Curriculum (TNCC), 2011

  46. Trauma Assessment • Chest injury? • Wounds, gunshots, penetrations, bruising (seatbelt?) • Flail chest • Sucking chest wound? • Treatment? • 3 sided occlusive dressing • Muffled heart tones? Tamponade? • Tension pneumothorax? Decompression Trauma Nurse Core Curriculum (TNCC), 2011

  47. Sucking chest wound(you may need to click play)

  48. Assessment Finding:Beck’s Triad • In cardiac tamponade a narrow pulse pressure is regularly observed. • The cardiologist, Claude Beck, who was a Professor of Cardiovascular Surgery first identified the triad of medical signs which was later termed “Beck’s Triad.” • Beck’s Triad (in basic terms): • 1. Distended Neck Veins; • 2. Muffled Heart Sounds; • 3. Hypotension. http://www.emergencymedicalparamedic.com/what-is-becks-triad/

  49. Assessment Finding:Tension Pneumothorax • Created from blunt or penetrating trauma. • “Collapsed” lung that causes an increase in pressure in the chest (intrathoracic pressure) • This pressure pushes on the vena cava, restricting the blood return to the heart. • Also creates pressure on intact lung, making the situation worse ITLS, 2008, 6th ed.

  50. Assessment Finding:Tension Pneumothorax • Symptoms of tension pneumothorax: • Dyspnea (difficulty breathing) • Absent lung sounds on affected side • Anxiety (because of decreased O2) • Tachypnea • JVD (distended neck veins) • Respiratory distress and cyanosis • Loss of radial pulse • Tracheal deviation (often a late sign of this condition) ITLS, 2008, 6th ed.

More Related