STS 9/30/14Trauma

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 first

3) Flush with water for 20 min

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

DCAPBTLS

• Deformities• Contusions• Abrasions• Punctures• Burns• Tenderness• Lacerations• Swelling

Scenario