Considerations in Managing Multiple Systems Trauma

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Considerations in Managing Multiple Systems Trauma

• Emergency Medical Technician - Basic

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Multi-Systems Trauma

• Dead rescuers cant help anyone
• Survey scene initially on every call
• Be aware of your surroundings

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Multi-Systems Trauma

• The most dramatic injury usually is NOT the most
  dangerous
• Priorities for management
• Airway
• Breathing
• Circulation
• Disability

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Multi-Systems Trauma

• Noisy breathing Obstructed breathing
• But all obstructed breathing is NOT noisy

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Multi-Systems Trauma

• Anticipate airway problems in all patients with
  trauma to
• Head
• Face
• Neck
• Upper Thorax

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Multi-Systems Trauma

• Restlessness, decreased LOC Hypoxia until
  proven otherwise
• Oxygenate, Look for cause

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Multi-Systems Trauma

• Cyanosis is late, unreliable sign of hypoxia
• Dont treat cyanosis, prevent it
• If you even THINK about giving oxygen - GIVE IT!!

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Multi-Systems Trauma

• Oxygen is useless if patient isnt ventilating
• Danger Signs
• Respirations
• Respirations 24
• Decreased tidal volume
• Labored breathing

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Multi-Systems Trauma

• Assist ventilations with O2
• Then look for cause
• If you cant tell whether patient is ventilating
  adequately, he isnt!

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Multi-Systems Trauma

• Restlessness, anxiety
• With pallor, tachycardia, or slow capillary
  refill

SHOCK
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Multi-Systems Trauma

• Anticipate shock in all seriously injured
  patients
• Falling BP Late sign of shock
• Dont treat a falling BP - Prevent It!!

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Multi-Systems Trauma

• If shock present without external bleeding,
  think
• Thoracic or abdominal bleed
• Pelvic fracture
• Multiple long bone fractures
• Tension pneumothorax
• Cardiac tamponade

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Multi-Systems Trauma

• Isolated head trauma does NOT cause decreased BP
  in adults
• Look for injuries of
• Chest
• Abdomen
• Pelvis
• Major long bones

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Multi-Systems Trauma

• Most reliable indicator of severity of injury,
  effectiveness of resuscitation
  Level Of Consciousness
• Think hypoxia, hypoperfusion, hypoglycemia, head
  trauma
  BEFORE
  alcohol, drugs, or personality

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Multi-Systems Trauma

• Neurological findings may rule in spinal injury
• Absence of neurological findings NEVER rules
  out spinal injury
• Key to diagnosis Mechanism

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Multi-Systems Trauma

• If you THINK about immobilizing spine DO IT!!
• If you immobilize part of spine, immobilize WHOLE
  spine

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Multi-Systems Trauma

• Until proven otherwise
• Chest trauma involves heart, great vessels!
• Chest trauma below fourth intercostal space
  involves abdomen!
• Abdominal trauma above umbilicus involves chest!

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Multi-Systems Trauma

• Gunshot wound severity cannot be assessed in
  field
• Until proven otherwise, patient with gunshot
  wound is shot everywhere!

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Multi-Systems Trauma

• Orthopedic injury usually NOT life-threat
• Exceptions
• Pelvic fracture
• Femur fractures
• Assess, treat proximal to distal

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Multi-Systems Trauma

• Extremity trauma Neurovascular
  involvement until proven otherwise
• Assess, record, report
• Pulses
• Capillary refill
• Skin color, temperature
• Motor, sensory function

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Multi-Systems Trauma

• KILLERS are trauma to
• Head
• Chest
• Abdomen

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Multi-Systems Trauma

• When in doubt, SPLINT!
• Dont waste time on individual injuries if ABCs
  compromised
• Securing patient to long board immobilizes entire
  body

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Multi-Systems Trauma

• Use tourniquets only as LAST RESORT
• But dont wait too long

All bleeding stops eventually
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Multi-Systems Trauma

• Avulsed, amputated parts should be
• Kept cool
• Transported with patient
• But dont hold unstable patient in field looking
  for parts

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Multi-Systems Trauma

• If you dont know the diagnosis. . .
• treat the signs and symptoms

Open, clear, maintain airway Maximize
oxygenation, ventilation Maximize perfusion
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Multi-Systems Trauma

• Definitive Treatment Surgeons
  Knife
• Trying to field-stabilize unstable trauma
  Ultimate Stabilization

DEATH
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Multi-Systems Trauma

• Minimum time on scene
• Maximum treatment in route

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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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Multi-Systems Trauma

• The challenge in a crisis is NOT to be
  innovative.
• The challenge is to FOLLOW THE RULES.