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 INJURIES
Foreign 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 BURNS
1st degree: superficial
2nd degree: dermis
3rd degree: full thickness
Treatment:
•
Stop burning  submerse in cool
water/saline
•
If severe, apply burn dressing (nonadhesive)
•
Treat for shock
•
•
Patients with critical burns lose a lot of fluids
Rule of Nines
CHEMICAL/ELECTRICA
L 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.