EMR Trauma Management and Operations

Course overview

Objectives Describe the signs and symptoms of a CNS injury Describe field triage and transport criteria Identify components of a culture of safety and ways providers can minimize disease transmission Content CNS Injury 1 Head injuries Open injuries may present with bleeding Closed injury may present with swelling or depression of skull bones Brain injury may lead to altered consciousness with airway and breathing problems 2 Scalp injuries May bleed more than expected because of the large number of blood vessels in the scalp Control bleeding with direct pressure Severe bleeding from the scalp can cause shock in infants and young children 3 Injury to the brain Injury of brain tissue or bleeding inside the skull may increase pressure on the brain Altered mental status 4 Special Management Considerations Maintain airway ventilation oxygenation Primary assessment with manual inline spinal stabilization should be done on scene Monitor the patients mental status Dress and bandage open wound as indicated in the emergency medical care of soft tissue injuries 5 Injuries to the Spine Mechanism of injury Motor vehicle crashes Pedestrian vehicle collisions Falls Blunt trauma Penetrating trauma to head neck or torso Motorcycle crashes Hangings Springboard or platform diving accidents Unresponsive trauma patients Signs and symptoms Tenderness in the area of injury Pain associated with moving Do not ask the patient to move to try to find a pain response Do not move the patient to test for a pain response Pain independent of movement or palpation Numbness weakness or tingling in the arms or legs Unable to feel or move below the suspected level of injury Loss of feeling or movement in the upper or lower extremities Difficulty breathing or shallow breathing Loss of bladder and or bowel control If the patient can walk move and feel arms and legs it does not rule out the possibility of injury to the bones of the spine or to the spinal cord 2 Assessing the patient with a possible spine injury Responsive patient Manually stabilize head and neck in the position found Mechanism of injury Questions to ask Does your neck or back hurt What happened Where does it hurt Can you move your hands and feet Can you feel me touching your fingers Can you feel me touching your toes Unresponsive patient Maintain airway Assist ventilation if inadequate Administer oxygen Stabilize head and neck manually in the position found Obtain information from others at the scene to determine mechanism of injury and patients mental status before the Emergency Medical Responders arrival Complications Inadequate breathing effort Paralysis 2 Special management consideration Establish and maintain manual stabilization Maintain constant manual stabilization May be released when additional EMS resources have applied a cervical collar and properly secured the patients torso and head to a backboard Primary assessment Whenever possible airway control should be done without moving the patients head Whenever possible artificial ventilation should be done without moving the head Assess pulse movement and feeling in all extremities Trauma Triage 3 National Trauma Triage Protocol Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage MMWR 2008 58 RR 1 1 35 cdc gov fieldtriage contains the National Trauma Triage Protocols and additional instructional materials Hand Hygiene and PPE 1 Exposure to Diseases Spread Through Blood or Body Fluids or by Respiratory Droplets Are Best Prevented by the Use of Standard Precautions 2 Standard Precautions Hand hygiene The most important measure to prevent the spread of infection Wash your hands after gloves are removed Hand cleansing Soap and water Alcohol based hand rub Cleanse hands with soap and dry hands thoroughly Cleanse hands and other exposed skin immediately if they are exposed to contaminants such as blood and body fluids or after