Considerations in Managing
Multiple Systems Trauma
Temple College
EMS Professions
ECA
Multi-Systems Trauma
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Dead rescuers can’t help anyone
• Survey scene initially on every call
• Be aware of your surroundings
Multi-Systems Trauma
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The most dramatic injury usually is NOT
the most dangerous
Priorities for management:
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•
•
•
Airway
Breathing
Circulation
Disability
Multi-Systems Trauma
Noisy breathing = Obstructed
breathing
 But all obstructed breathing is NOT
noisy

Multi-Systems Trauma
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Anticipate airway problems in all
patients with trauma to:
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•
•
•
Head
Face
Neck
Upper Thorax
Multi-Systems Trauma
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Restlessness, decreased LOC =
Hypoxia until proven otherwise
Oxygenate, Look for cause
Multi-Systems Trauma
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Cyanosis is late, unreliable sign of
hypoxia
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Don’t treat cyanosis, prevent it
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If you even THINK about giving oxygen
- GIVE IT!!
Multi-Systems Trauma
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Oxygen is useless if patient isn’t ventilating
Danger Signs
• Respirations <10
• Respirations >24
• Decreased tidal volume
• Labored breathing
Multi-Systems Trauma
Assist ventilations with O2
 Then look for cause
 If you can’t tell whether patient is
ventilating adequately, he isn’t!

Multi-Systems Trauma
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Restlessness, anxiety
With pallor, tachycardia, or slow
capillary refill =
SHOCK
Multi-Systems Trauma
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Anticipate shock in all seriously injured
patients
Falling BP = Late sign of shock
Don’t treat a falling BP - Prevent It!!
Multi-Systems Trauma
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If shock present without external
bleeding, think:
•
•
•
•
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Thoracic or abdominal bleed
Pelvic fracture
Multiple long bone fractures
Tension pneumothorax
Cardiac tamponade
Multi-Systems Trauma
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Isolated head trauma does NOT cause
decreased BP in adults
Look for injuries of:
•
•
•
•
Chest
Abdomen
Pelvis
Major long bones
Multi-Systems Trauma
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Most reliable indicator of severity of injury,
effectiveness of resuscitation =
Level Of Consciousness
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Think hypoxia, hypoperfusion, hypoglycemia,
head trauma
BEFORE
alcohol, drugs, or personality
Multi-Systems Trauma
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Neurological findings may “rule in”
spinal injury
Absence of neurological findings
NEVER “rules out” spinal injury
Key to diagnosis = Mechanism
Multi-Systems Trauma
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If you THINK about immobilizing spine
DO IT!!
If you immobilize part of spine,
immobilize WHOLE spine
Multi-Systems Trauma
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Until proven otherwise:
• Chest trauma involves heart, great vessels!
• Chest trauma below fourth intercostal
space involves abdomen!
• Abdominal trauma above umbilicus
involves chest!
Multi-Systems Trauma
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Gunshot wound severity cannot be
assessed in field
Until proven otherwise, patient with
gunshot wound is shot everywhere!
Multi-Systems Trauma
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Orthopedic injury usually NOT life-threat
Exceptions:
• Pelvic fracture
• Femur fractures
Assess, treat proximal to distal
Multi-Systems Trauma
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Extremity trauma =
Neurovascular involvement until proven
otherwise
Assess, record, report:
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•
•
•
Pulses
Capillary refill
Skin color, temperature
Motor, sensory function
Multi-Systems Trauma
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KILLERS are trauma to:
• Head
• Chest
• Abdomen
Multi-Systems Trauma
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When in doubt, SPLINT!
Don’t waste time on individual injuries if
ABC’s compromised
Securing patient to long board
immobilizes entire body
Multi-Systems Trauma
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Avulsed, amputated parts should be:
• Kept cool
• Transported with patient
But don’t hold unstable patient in field
looking for parts
Multi-Systems Trauma
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If you don’t know the diagnosis. . .
treat the signs and symptoms
Open, clear, maintain airway
Maximize oxygenation,
ventilation
Maximize perfusion
Multi-Systems Trauma
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Definitive Treatment =
Surgeon’s Knife
Trying to field-stabilize unstable trauma =
Ultimate Stabilization
DEATH
Multi-Systems Trauma
Minimum time on scene
 Maximum treatment in route

Multi-Systems Trauma
Patient MUST go to facility able to
continue care appropriately
 Closest facility, facility preferred by
family is NOT necessarily most
appropriate
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