Chapter 33
Trauma Overview
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
33-1
Objectives
33-2
Reconsidering the Mechanism of Injury
• Perform a scene size-up and primary survey
• Reconsider the mechanism of injury (MOI)
– MOI is the way in which an injury occurs,
as well as the forces involved in producing
the injury
– Reevaluating the MOI is necessary to rule
out the possibility of a more significant
MOI than initially suspected or identified
during the scene size-up.
– Index of suspicion
33-3
Factors to Consider
In a Motor Vehicle Crash
•
•
•
•
•
•
•
•
Rate of speed
Seatbelt use
Impact site
Amount of intrusion
Airbag deployment
Vehicle size
Condition of steering wheel
Condition of windshield
33-4
Significant Mechanism of Injury
•
•
•
•
•
•
•
Golden hour
Limit scene time to 10 minutes
Perform a primary survey
Follow with a rapid trauma assessment
Move quickly and efficiently
Consider the need for ALS personnel
Consider immediate transport
33-5
Significant Mechanisms of Injury
• Penetrating injury to
the head, neck, or
torso
• Penetrating injury to
the extremities
above the elbow or
knee
• Flail chest
• Combination trauma
with burns
• Two or more
proximal long-bone
fractures
• Pelvic fractures
• Open or depressed
skull fracture
• Paralysis
• Amputation above
the wrist or ankle
• Major burns
33-6
MOI – Not Significant
• Perform a primary survey
• Begin the secondary survey with an
assessment of the injured body part
(focused physical exam)
– Examine other areas of the body as
needed
33-7
Significant Mechanism of Injury
• Perform a rapid trauma assessment when:
– A significant mechanism of injury exists
– Additional injuries are suspected
– A critical injury is found during the focused
physical examination
– A previously stable patient with no significant
mechanism of injury becomes unstable during the
focused physical examination
– After providing any emergency intervention
33-8
Significant Mechanism of Injury
• Spinal precautions as soon as practical
based on MOI
• Primary survey
– Airway
– Breathing
– Circulation
– Disability
– Expose
33-9
Significant Mechanism of Injury
• Rapid trauma assessment
– Reassess mental status
– Assess
•
•
•
•
•
•
•
•
Head
Neck
Chest
Abdomen
Pelvis
Lower extremities
Upper extremities
Back
– Compare one side of the body to the other
33-10
Revised Trauma Score (RTS)
• Scoring system used to predict the likelihood
of serious injury or death following trauma
• Calculated from a combination of results
from three categories
A. Respiratory rate
B. Systolic blood pressure
C. Glasgow Coma Scale
33-11
Transport of the Priority Trauma Patient
• Consider the following:
– Distance to the nearest Trauma Center
– Availability of ground versus air
ambulances
– Time of day (traffic conditions)
– Weather
33-12
Trauma Patient Considerations
• If no significant mechanism of injury
– Perform a focused trauma assessment
• Assess the injured area for DCAP-BTLS
• Assess vital signs
• Obtain a SAMPLE history
– Provide emergency care based on the type
and severity of the injury
33-13
Key Point
• If the patient appeared
stable at the end of the
primary survey, but
becomes unstable
during the secondary
survey, expedite
patient transport to the
closest appropriate
medical facility.
33-14
Questions?
33-15