illinois emsc1 trauma objectives upon completion of this lecture, you will be better able to:...
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Illinois EMSC 1
Trauma ObjectivesUpon completion of this lecture, you will
be better able to: Discuss how mechanism of injury affects
your evaluation of an injured student Describe special assessment considerations
for injured students of various ages Based on assessment findings, develop and
prioritize a plan of care for selected injuries
Illinois EMSC 7
INJURY SEVERITY FROM FALLS
Fall >10 feet or 3 times the person’s height
Yielding vs. nonyielding surface Body area striking the ground
first
Illinois EMSC 9
CRUSH INJURIES Energy
concentrated in one body area
Usually involves nerves, muscle, bone, and tendons
Illinois EMSC 11
ACCELERATION AND DECELERATION FORCES
Whiplash injury Aortic tear Hepatic artery
tear
Illinois EMSC 15
ASSESSMENT OF THE INJURED STUDENT
Initial assessment Detailed assessment Triage and transport
Illinois EMSC 16
INITIAL ASSESSMENT Airway/Cervical Spine
Control Breathing Circulation Disability (neurological) Expose
Illinois EMSC 17
PURPOSE OF THE INITIAL ASSESSMENT
Identification of LIFE-THREATENING emergencies
Initiation of LIFE-SAVING measures (CPR)
Illinois EMSC 19
AIRWAY INTERVENTIONS
Jaw thrust AVOID HYPEREXTENSION OR FLEXION OF THE NECK
Log roll to side for emesis
Illinois EMSC 20
CERVICAL SPINE STABILIZATION
Place hands on either side of the head
Maintain neck midline
Illinois EMSC 21
BREATHING ASSESSMENT
Look, listen, and feel Observe chest symmetry Note work of breathing Jugular vein distention Tracheal deviation
Illinois EMSC 22
BREATHING INTERVENTIONS
If breathing is absent, begin mouth to mask ventilations
If breathing is shallow or labored, maintain airway control
Illinois EMSC 23
CIRCULATORY ASSESSMENT
Level of consciousness Carotid pulse (absent or present) Capillary refill Skin color Skin temperature Sites of bleeding
Illinois EMSC 24
CIRCULATORY INTERVENTIONS
If pulse is absent, begin CPR
Apply direct pressure to open wounds
Illinois EMSC 25
NEUROLOGICAL ASSESSMENT
Level of consciousness AVPU scale
Awake Verbal response Pain response Unresponsive
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EXPOSE Remove clothing to
observe the chest Observe the chest for bruises,
penetrations, and symmetry Auscultate breath sounds Auscultate heart sounds
Illinois EMSC 29
DETAILED ASSESSMENT Fahrenheit (keep person warm) Get vital signs Head-to-toe assessment Inspect the back
Illinois EMSC 30
HEAD-TO-TOE ASSESSMENT
Palpate the head and face Observe for fluid from the nose
and ears Assess for pupillary response Reassess the mouth Palpate the jaw
Illinois EMSC 33
NECK Palpate for pain or
tenderness Observe for tracheal
deviation Observe for jugular
vein distention Observe for impaled
objects and open wounds
Illinois EMSC 34
CHEST
Auscultate breath sounds in all lobes
Auscultate chest sounds Observe work of breathing Palpate for pain/tenderness
Illinois EMSC 35
ABDOMEN Observe for bruising,
impaled objects, open wounds
Palpate lightly for pain, tenderness, and distention
Observe for guarding
Illinois EMSC 36
PELVIS Apply pressure on pelvis to
determine its stability Perform genitalia exam at
one’s discretion
Illinois EMSC 38
EXTREMITIES Observe for deformities,
impaled objects, open wounds Palpate for pulses, crepitus, or
swelling Determine capillary refill, skin
color, temperature Assess for pain/tenderness
Illinois EMSC 39
INSPECT THE BACK Log roll student with
assistance School nurse must maintain
cervical spine control Inspect and palpate the
back for bruising, impaled objects, pain and tenderness
Illinois EMSC 41
HISTORY SAMPLE
Symptoms Allergies Medications Past history Last meal Events leading to the illness or
injury
Illinois EMSC 42
OTHER CONSIDERATIONS
Stop the assessment if there are changes in the student’s airway, breathing, or circulation
Stabilize impaled objects Apply pressure to open wounds Apply ice to fractures Remove any restrictive clothing
Illinois EMSC 43
TRIAGE DECISIONS EMERGENT (life threatening
injuries) URGENT (fractures, head
injuries) NON-URGENT (minor bruises)
Illinois EMSC 44
EXPECTED OUTCOMES
Maintenance of airway, cervical spine alignment, adequate respiratory effort, adequate circulation to brain and vital organs
Absent or minimal pain, discomfort, and anxiety
Illinois EMSC 46
SELECTED TRAUMA EMERGENCIES
Head injuries Spinal cord injuries Chest injuries Abdominal injuries Musculoskeletal injuries Amputations
Illinois EMSC 47
CONSIDERATIONS IN PEDIATRIC HEAD TRAUMA
Scalp is large and vascular Cranium is thin and pliable Head size is larger in
proportion to body
Illinois EMSC 48
INTERVENTIONS IN HEAD TRAUMA
Continuous monitoring of neurological status pupil size and reactivity LOC body movement
Use direct pressure on open wounds
DO NOT PACK nose or ears if drainage is present!
Illinois EMSC 49
CONSIDERATIONS IN SPINAL TRAUMA Energy forces associated with spinal
trauma (hyperextension, hyperflexion, and axial loading)
Usually occurs during sports or MVC Pediatric spine is malleable and
flexible Pediatric spine is “adult” by age 8 SCIWORA diagnosed in younger
children
Illinois EMSC 51
INTERVENTIONS IN SPINAL TRAUMA
Keep student immobilized or lying down
Use the jaw thrust to keep the airway open
A spinal cord injury should ALWAYS be suspected in a student with a head injury!
Illinois EMSC 52
CONSIDERATIONS IN CHEST TRAUMA
Ribs are cartilaginous, allowing energy to be transferred to the heart and lungs
In younger children, the liver is not protected by the rib cage, making liver injuries common
Illinois EMSC 53
INTERVENTIONS IN CHEST TRAUMA
Keep airway open Initiate mouth to mask
ventilations Stabilize impaled objects Use 3 sided occlusive dressing
for open chest wounds Apply pressure to stop bleeding
wounds
Illinois EMSC 54
CONSIDERATIONS IN ABDOMINAL TRAUMA Most abdominal injuries involve
blunt trauma Abdominal muscles are thin and
weak Abdominal organs are not well
protected Liver and spleen are particularly
susceptible
Illinois EMSC 55
INTERVENTIONS IN ABDOMINAL TRAUMA Maintain the ABC’s with
simultaneous spinal stabilization if spinal injury suspected
Cover open abdominal wounds with a sterile dressing moistened with sterile saline
If abdominal contents have extruded, DO NOT attempt to push them back in
Illinois EMSC 56
CONSIDERATIONS IN MUSCULOSKELETAL TRAUMA Epiphyseal plate area is weaker
and more prone to injury Epiphyseal injuries are of concern
since they may inhibit growth and cause deformity
In children with multiple injuries, musculoskeletal injuries can contribute to hypovolemic shock
Illinois EMSC 57
INTERVENTIONS IN MUSCULOSKELETAL TRAUMA
Apply sterile dressings to any open wounds
Stabilize fracture to prevent further injury
Apply splint as appropriate
Illinois EMSC 58
CONSIDERATIONS IN AMPUTATIONS Emergent Requires EMS Vasoconstriction may occur,
minimizing blood loss It is critical to locate the
amputated part and prepare it for transport with EMS
Illinois EMSC 59
INTERVENTIONS IN AMPUTATIONS Rinse amputated part with saline (if
available), wrap in saline moistened gauze, place in plastic bag and place bag on cold pack, label bag with name, date and time
Apply direct pressure to the site Avoid use of a tourniquet Apply new dressings over old
dressings
Illinois EMSC 61
SPECIAL NEEDS CHILDREN
Assess usual positioning, LOC and ability to communicate
Provide reassurance Follow the same
sequence of care (ABC’s)
Illinois EMSC 62
FOLLOW-UP AFTER TRAUMA
Note changes in student’s school routines
Update school health record
Facilitate care plan development
Illinois EMSC 64
TRAUMA PREVENTION
Encourage safe behaviors
Take legislative actionNote dangerous areas in school
Illinois EMSC 65
SUMMARYInjuries are the leading cause of
death in school-aged children. Appropriate assessment and management of injured students is one of your more important roles.
Track school injuries and use the resulting data as part of your injury prevention efforts.