Basic Trauma Emergencies Response

BASIC TRAUMA EMERGENCIES

Metropolitan Manila Development Authority

Public Safety Office

TOPICS

1 Body Substance Isolation

2 Mechanism of Injury

3 Sample Dressing/Bandages

4 Patient Assessment

5 Bleeding and Shock

6 Soft Tissues & Muskulo-Skeletal Injuries

7 Splinting

8 Injuries to the Spine

Body Substance Isolation

Assumes all body fluids present a possible risk for infection

Protective equipment Latex or vinyl gloves should always be

worn

Eye protection

Mask

Gown

Turnout gear

Scene Safety

Park in a safe area. Speak with law

enforcement first if present.

The safety of you and your partner comes first!

Next concern is the safety of patient(s) and bystanders.

Request additional resources if needed to make scene safe.

Mechanism of Injury

Helps determine the possible

extent of injuries on trauma

patients

Evaluate:

Amount of force applied to body

Length of time force was applied

Area of the body involved

The Importance of MOI/NOI

Guides preparation for care to patient

Suggests equipment that will be needed

Prepares for further assessment

Fundamentals of assessment are same whether emergency appears to be related to trauma or medical cause.

C-Spine Immobilization

Consider early during assessment.

Do not move without immobilization.

Err on the side of caution.

Significant Mechanism of Injury

Ejection from vehicle

Death in passenger

compartment

Fall greater than 15'-

20'

Vehicle rollover

High-speed collision

Vehicle-pedestrian collision

Motorcycle crash

Unresponsiveness or altered mental status

Penetrating trauma to the head, chest, or abdomen

Patient Assessment Process

Patient Assessment Plan SCENE SIZE UP INITIAL

ASSESSMENT

PHYSICAL

EXAM.

PATIENT

HISTORY

ON GOING

ASSESSMENT

PATIENTS

HAND OFF

What is the current

situation?

MOI/NOI Observe for hazards

General

impression

DCAP-BTLS/

DOTS

SAMPLE Repeat Initial

Assessment

Patient age and

sex

Where is it going?

What are the possibilities?

Responsiveness Head Signs &

Symptoms

Repeat physical

assessment

Chief complaint

How do I control it?

What are the resources needed?

Airway Neck Allergies Reassess treatment

and intervention

Level of

responsiveness

Breathing Chest & Back Medications Calm and reassure

the patient

Airway status

Circulation Abdomen Past History Breathing status

Patient Status

Update

Pelvis Last Oral

Intake

Physical exam

findings

Extremities SAMPLE

History

Vital Signs

Event Treatment

DRESSING

PURPOSE

1) cover the wound

2) help control bleeding

3) prevent additional contamination

KIND OF DRESSING

Occlusive dressing wax or plastic material;

creates an airtight seal

for an open abdominal,

chest and large neck

injuries

KIND OF DRESSING Gauze pad dressing

KIND OF DRESSING Universal or multi-trauma dressing bulky dressing

used in large areas like abdominal wounds

BANDAGES

(Used to hold a dressing in place)

Kinds of dressing:

a. Roller Bandage

b. Triangular Bandage

HAEMORRHAGE AND SHOCK

HAEMORRHAGE - the loss of blood from

the body. It can be external and internal.

EXTERNAL BLEEDING

severity of sudden loss of blood that are serious:

adult - more than 1000 cc (1 liter) children 500 cc (1/2 liter)

infant 100 to 200 cc

EXTERNAL BLEEDING

Types of External Bleeding:

1. Arterial bright red;spurting blood from a wound

in a damaged artery; rich in oxygen; difficult to

control due to high pressure in the

arteries; patients blood pressure decrease, the spurting may also decrease

2. Venous - dark red blood that flows steadily from

a wound in a severe damage vein, steady flow,

usually easier to control because of less pressure.

3. Capillary dark red,slowly oozing blood usually

indicate damaged capillaries, easy to control,

often clots spontaneously.

INTERNAL BLEEDING

It is not visible and seldom obvious and can result to

severe blood loss with rapid progression of shock

and even death.

SOURCES: injured or damaged internal organs and

fracture extremities especially femur, hip and pelvis

CAUSE: Blunt trauma, abnormal clotting within the

body, result of certain fractures especially pelvic

fracture.

SEVERITY: depends on the patients overall condition, age, other medical condition and the

source of internal bleeding

INTERNAL BLEEDING

Signs and Symptoms:

Pain, tenderness, swelling or discoloration of

suspected site or injury

Bleeding from the mouth, rectum, vagina other

orifice

Vomiting bright red blood or like color of dark

coffee grounds

Dark, tarry stools or stools with bright red

blood

Tender, rigid and/or distended abdomen

INTERNAL HAEMORRHAGE (Bleeding)

LATE SIGNS AND SYMTOMS

Anxiety, restlessness, combativeness or altered mental

status

Weakness, faintness or dizziness

Thirst

Shallow, rapid breathing

Rapid, weak pulse

Pale, cool, clammy skin

Capillary refill greater that 2 seconds (in infants and

children under 6 only)

Dropping blood pressure

Dilated pupils that are sluggish in responding to light

Nausea and vomiting

INTERNAL HAEMORRHAGE

CLOSED FRACTURE OF FEMUR can cause one (1) liter blood loss

LACERATION TO THE LIVER OR SPLEEN can cause severe loss of blood potentially fatal

METHODS OF CONTROLLING EXTERNAL

BLEEDING

1. Direct Pressure

- Place clean cloth over the injured site and apply

fingertip pressure directly to the point of bleeding

- If does not stop, remove the dressing and apply

direct pressure with your fingertips to the point of

bleeding

2. Elevation

- Elevate the arm or leg above the level of the heart to slow the flow of blood and aid in clotting.

- If extremity is painful, swollen or deformed

indicating fracture or joint injury, do not elevate the

extremity

METHODS OF CONTROLLING EXTERNAL

BLEEDING

3. Pressure Points

- For bleeding in the upper extremity, use the brachial pressure points

- For bleeding in the lower extremity, use femoral

pressure points using the heel of the hand

4. Tourniquet methods

- last resort when all other methods to control bleeding have failed but can cause damage to nerves

and blood vessels. It can result to the loss of an

extremity.

SHOCK- failure of the circulatory system to provide adequate blood supply throughout the body (inadequate

tissue perfusion).

CAUSES OF SHOCK

- Inability of the heart to pump enough blood through

the organs

- Severe loss of blood; insufficient blood in the system

- Excessive dilation of blood vessels. Blood volume

will be insufficient to fill them and shock will develop

SIGNS OF SHOCK

Breathing: Shallow and rapid

Pulse: Rapid and Weak

Skin: Pale, cool and clammy

Face: Pale, often with blue

color(cyanosis) in the

lips, tongue, and ear lobes

Eyes: Lacklustre, pupils dilated

SYMPTOMS OF SHOCK

Nausea and possible vomiting

Thirst

Weakness

Vertigo a dizzy confused state of mind

Uneasiness and fear some patients these symptoms can be the first sign of shock.

PRE-HOSPITAL TREATMENT FOR

SHOCK

Maintain open airway

Prevent further loss of blood (by using direct

pressure, elevations and pressure points)

Elevate the lower extremities 20-30 cm only if

there are no suspected spinal, neck, chest or

abdominal injuries.

Keep the patient warm, but not overheat.

Provide care for specific injuries.

Transport immediately to nearest hospital.

Soft-Tissue Injuries

SOFT TISSUE INJURIES can be categorized as :

1. Close wound skin did not breaks

2. Open wound skin breaks

3. Single or multiple combination of open and closed wound

CLOSED WOUND

Injury beneath the unbroken skin

Can be severe with damage to internal

organs

Caused by impact with a blunt/hard object

How to recognized closed wound:

Swelling

Tenderness

Discoloration

Possible deformity

Contusion

KIND OF CLOSED WOUND

Hematoma

KIND OF CLOSED WOUND

Crushing Injury

Occurs when a

great amount of

force is applied to

the body

PRE-HOSPITAL TREATMENT FOR CLOSED WOUND

Apply :

R Rest (immobilize)

I - Ice (reduce swelling)

C - Compress (apply bandage)

E - Elevate (the injured extremity)

S - Splinting (reduce pain & swelling)

Monitor for the rapid change of vital signs that might indicate internal bleeding

Treat for Shock

Immediately transport to hospital as soon as possible

OPEN WOUND

Skin breaks on which the patient is at risk

for contamination, which may lead to

infection.

KINDS OF OPEN WOUND

ABRASION(gasgas)

KIND OF OPEN WOUND

Laceration (laslas)

KIND OF OPEN WOUND

Avulsion (tuklap)

KIND OF OPEN WOUND

Amputation (putol)

KIND OF OPEN WOUND

PENETRATION/PUNCTURE(tusok)

KIND OF OPEN WOUND

CRUSH INJURY

Gunshot Wounds

Gunshot wounds have unique characteristics

Abdominal Wounds

Open wound in

abdomen may

expose organs.

Organ protruding

through abdomen

is called an

evisceration.

BLEEDING FROM THE NOSE, EARS, MOUTH

CAUSES:

skull injury

facial trauma

digital trauma (nose picking)

sinusitis and other respiratory tract

infections

hypertension (high blood pressure)

Face and Scalp Injuries

Soft-tissue injuries to the face and scalp are common.

Wounds to the face and scalp bleed profusely.

Impaled Object

PRE-HOSPITAL TREATMENT FOR OPEN WOUNDS

FOR ABRASION

- clean the surface of the wound

- if with bleeding, apply dressing & bandage

FOR LACERATION


- apply dressing & bandage

- if possible, close the open wound

FOR AVULSION


- return skin flap to original position

- control bleeding (direct pressure, apply dressing)

- elevate & immobilize injured part

PRE-HOSPITAL TREATMENT

FOR AMPUTATION

use universal precautions & secure the scene

clean the wound

immobilize partial amputation with bulky

dressing and splint.

Wrap complete amputation in dry sterile

dressing and place in bag.

Put bag in cool container filled with ice. Don not

let the object freeze!

Transport severed part with patient.


FOR ABDOMINAL INJURIES

- use universal precautions and secure the scene

- do not touch the abdominal organs or try to

replace the exposed organs.

- cover the exposed organs with clean cloth or

sterile dressing

- cover the dressing with occlusive dressing

and with more bulky dressing


FOR INJURIES TO NECK use universal precautions and secure the scene

apply slight to moderate pressure on the bleeding with an occlusive dressing

tape down the edges of the dressing to form an airtight seal

never apply pressure to both sides of the neck at the same time

place the patient on the left side

if without spinal injury, place the patient on 15 degree incline with head over, if possible

if an object is impaled in the neck, stabilize it in place with bulky dressing. Do not remove it.

Treat for shock.

Penetrating Injuries of the Neck (2 of 2)

Secure the dressing

in place with roller

gauze, adding more

dressing if needed.

Wrap gauze around

and under patients

shoulder.

MUSCULOSKELETAL INJURIES

FRACTURE

Closed Fracture the overlying skin is intact. Proper splinting

helps prevent closed fracture

from becoming open fracture.

Open fracture skin has been broken or torn either from the

inside by the injured bone or

from the outside by the object

that caused the penetrating

wound with the associated bone

injury. It is serious because of

risk of contamination or

infection.


SIGNS AND SYMTOMS

1. Deformity or angulations

2. Pain & tenderness upon palpation or movement

3. Crepitus (lumalangitngit) sound or feeling of broken

bone ends rubbing together

4. Swelling (pamamaga)

5. Bruising or discoloration

6. Exposed bone ends

7. Joint locked in position reduces motor ability or

reduced ability to articulate a joint

8. Numbness or paralysis may occur distal to site of injury caused by bone pressing on a nerve



R - REST (immobilize)

I - ICE (reduce swelling)

C - Compress (Apply bandage)

E - Elevate the injured part

S - Splinting

PRE-HOSPITAL TREATMENT FOR SKULL

INJURY

1. Do not attempt to stop the flow of blood which

could create pressure inside the skull causing

even more damage

2. Place a loose dressing around the area to collect

the drainage

3. Cover the wound to prevent infection

4. Immediately transport to hospital

EPISTAXIS OR NOSE BLEED (cause by injury, disease or environment)

FOR TREATMENT: 1. Place the patient in a sitting position

2. Have him or her lean forward

3. Apply direct pressure by pinching the fleshy portion of the nostrils together

4. Keep the patient calm and still as possible (rest)

5. Do not remove object inside the nose if there is.

6. Check for clear fluids(cerebrospinal fluid) which may indicate a skull fracture.

7. Do not pack the nose.

SPLINTING

BASIS FOR SPLINTING

Reasons:

1. Prevent movement of any fragments, bone ends or

dislocated joints (reduce farther injury)

2. Reduce pain & minimize the ff common complications from

bone to joint injuries:

a. Damage to muscles, nerves & blood vessels

b. Conversion of a closed deformed extremity(by

breaking through the skin)

c. Restriction of blood flow as a result of bone ends or

dislocations

d. Excessive bleeding from tissue damage caused by

movements of bone ends

3. To prevent closed fracture from becoming an open fracture

4. To minimize blood loss or shock.

SPLINTING EQUIPMENT

RIGID SPLINT made of wood, aluminum wire, plastic, cardboard or compressed wood fibers

PRESSURE SPLINT is an air splint. It is soft and pliable before being inflated but rigid once they are applied and

filled with air.

IMPROVISED SPLINT - made of cardboard box, cane, ironing board, rolled-up magazine, umbrella,

broom handle and any other similar object

SLING and SWATHE two triangular bandages used to hold an injured arm in place against the body

SLING SPLINT SLING AND SWATHE

GENERAL RULES FOR SPLINTING

Always communicate your plans with your patient if possible.

Before immobilizing an injured extremity, expose and control bleeding.

Always cut away clothing around the injury site before immobilizing the joint. Remove all jewelry from the site and below it.

Assess P.M.S. (pulse, motor function and sensation)

Do not attempt to push protruding bone ends back into place.

Pad a splint before applying it.

If joint is injured, immobilize it and the bones above and below.

Dislocation of the Shoulder

Most commonly dislocated

large joint

Usually dislocates anteriorly

Is difficult to immobilize

Splint the joint with a pillow or towel between the arm and

the chest wall.

Apply a sling and a swathe.

Clavicle and Scapula Injuries

Splint with a sling and swathe.

Fractures of the Humerus

Occurs either proximally, in the mid-shaft, or distally at the elbow.

Splint with sling and swathe, supplemented with a padded board splint.

Elbow Injuries

Fractures and dislocations often occur around the elbow.

Injuries to nerves and blood vessels common.

Assess neurovascular function carefully

Splint as you have found it.

Fractures of the Forearm (

Usually involves both radius and ulna

Use a padded board, air, vacuum, or pillow splint.

Injuries to the Wrist and Hand

Injuries of Knee Ligaments

Splint in position found.

Support with pillows.

Injuries to the Tibia and

Fibula

Stabilize with a padded

rigid long leg splint or

an air splint that

extends from the foot

to upper thigh.

Foot Stabilization

A pillow splint can provide excellent stabilization of

the foot.

SPINAL COLUMN is the principal support system of the body. It is made up of thirty three

irregular shape bones called vertebrae. It is

bound firmly together by strong ligaments.

Between each two vertebrae is a fluid-filled

pad of tough cartilage called disc that act as

shock absorber.

Parts of spinal column

Cervical vertebrae

Thoracic vertebrae

Lumbar vertebrae

7 cervical

12 thoracic

5 lumbar

5 fused sacral

4 fused (coccyx)

disc

Spinal

cord

Spinal cord carries

messages from

the brain to the

various parts of

the body

through nerve.

Five Parts of Spinal Column

CERVICAL SPINE first seven vertebrae that can be found in the neck, most mobile and delicate

THORACIC SPINE twelve vertebrae below the cervical vertebrae that comprises the upper back

LUMBAR SPINE next five vertebrae that form the lower back

SACRAL SPINE next five vertebrae that are fused together and form the rigid posterior portion of the

pelvis

COCCYX (tailbone) four fused vertebrae that form the lower end of the spine.

COMMON MECHANISM OF SPINE INJURY

COMPRESSION when the eight of the body is driven against the head. This is common in falls, diving accidents, motor vehicle crashes, or other accidents where a person impacts an object head first.

FLEXION where there is severe forward movement of the head in which the chin meets the chest or when the torso is excessively curled forward.

EXTENTION where there is severe backward movement of the head in which is stretched or when the torso is severely arched forward.

ROTATION when there is lateral movement of the head or spine beyond its normal rotation.

COMMON MECHANISM OF SPINE INJURY

LATERAL BENDING when the body is bent severely from the side

DISTRACTION when the vertebrae and spinal cord are stretched and pulled apart. This is common in

hanging.

PENETRATION when there is injury from gunshots, stabbing or other types of penetrating trauma case

involving spinal column.

SIGNS AND SYMPTOMS OF POSSIBLE SPINAL INJURY

1. Pain unprovoked pain in the area of injury, along the spine and in lower legs

2. Tenderness gentle touch of area may increase pain

3. Deformity abnormal bend or bony prominence (rare)

4. Soft tissue injury head, neck, face (indicate cervical spine injury), injury to the shoulders, back and abdomen (indicate thoracic or lumbar spine injury), injury to extremities (indicate lumbar or sacral-spine injury)

5. Paralysis inability to move or inability to feel sensation in some part of the body (indicate spinal fracture with cord injury)

6. Painful movement movement increase pain. Never try to move injured part.

7. Also: loss of bowel or bladder control, priapism, impaired breathing

BASIC TOOLS FOR IMMOBILIZATION

1. CERVICAL SPINE IMMOBILIZATION COLLAR use to prevent the head from moving and to reduce the compression of the cervical spine during movement and transport of the patient. This should be applied by two rescuers.

2. FULL BODY SPINAL IMMOBILIZATION DEVICE - to provide stabilization and immobilization of the head, neck, torso, pelvis and extremities

3. SHORT IMMOBILIZATION DEVICE provide stabilization and immobilization to the head, neck and torso. This is commonly used to immobilize non-critical sitting patients with suspected spine injury.


1. PPE

2. Establish manual in-line spinal stabilization

immediately upon making contact with the patient

3. When performing initial assessment, open and

maintain the airway with the jaw-thrust manuever

4. Assess the pulse, motor function and sensation in

all extremities

5. Assess the cervical region and the neck before

applying the cervical spine immobilization collar

6. Apply cervical spine immobilization collar

7. Immobilize the patient to a long board

8. Reassess, record and document all information

about the patient

9. Transport the patient to hospital.

THANK YOU VERY MUCH

Basic Trauma Emergencies Response

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