STS 2/18/14Trauma

Skull fractures• Bleeding:– Loosely cover bleeding site with sterile

gauze (look for CSF)– DO NOT attempt to stop blood flow

• DO NOT insert nasopharyngeal airway

• Suspect C-spine

Eye injuries• Foreign objects in eye:– Irrigate with saline/water (flush middle of eye

to outside corner)– Never attempt to remove object from cornea

(only remove if object is on eyelid)– Impaled

• stabilize with roller gauze– Chemical in eye

• flush with saline/water for 20 min– Thermal burn

• cover with burn dressing

• Blowout fracture– Fracture of orbit bone– Googly eyes

• Check PERL• Contacts should be kept in eye– Unless chemical in eye– Notify ALS/Tx if Pt wearing contacts

• Get to hospital ASAP

Epistaxis• Bleeding from nose• Tx:

1) Pinch nose2) Tilt forward

- Do not tilt backwards - If Pt swallows blood,

may cause Pt to vomit suction

3) Apply ice

Mouth injuries• Teeth dislodged– Save teeth in

container mixed with Pt’s saliva/milk

• If bleeding in mouth is heavy– Check airway– Prepare to suctionNever stick your hand into someone’s mouth!

Soft tissue injury• Hematoma– Pool of blood collects in

an area compartment syndrome

– May be due to blunt injury

Tx: splint and CMS

Open injuries• Abrasion

– Superficial damage no deeper than epidermis

– Tx: clean and apply bandaid/dressing

• Avulsion– Flap ripped away, still

attached– Tx:

• Clean and place flap back in right position

• Control bleeding• Apply dressing

• Penetrating wound (impaled)– Tx:• Splint and stabilize impaled object• DO NOT remove object unless

– Interferes with CPR– Obstruction of airway

• Gunshot wound (GSW)– Look for entry and exit wound (document)– Tx:• Control bleeding• Provide O2 accordingly• Blanket and shock position if in shock

Pneumothorax• Air in pleural space

– Lung may collapse within seconds• Sucking chest wound

– Open chest wound allows air into pleural space

– Tx:• Occlusive dressing• Tape 3 sides down allow air out

when pressure builds• Lung sounds every 5 min• If lung sounds absent after applying

occlusive dressing ventilate, remove dressing momentarily

Abdominal wounds• Evisceration– Organ protruding

through abdomen– Tx:• Soak big trauma dressing

in sterile saline solution, tape over exposed organ• DO NOT touch exposed

organ (infection)

Amputations

• Wrap severed body part in sterile gauze

• Place in plastic bag (zip loc)• Chill with ice– DO NOT allow body part to freeze or

come into direct contact with ice

Neck• Jugular vein injury– Tx:• Occlusive dressing• Tape down on 4 sides• Monitor respirations

closely (in case of air embolism)

Thermal Burns1st degree

superficial

2nd degreedermis

3rd degree full thickness

Tx:- Stop burning submerse in cool water/saline- If severe, apply burn dressing (non-adhesive)

Treat for shockPt’s with critical burns lose a lot a

fluids

Chemical burnsTx:1) Remove clothing2) For powder chemicals:

brush off powder first3) Flush with water for 20 min

Electrical burns• Look for entry and exit wounds• Prepare to perform CPR– Cardiac arrhythmia

Scenario