principles of trauma care (2)

PRINCIPLES OF PRINCIPLES OF TRAUMA CARETRAUMA CARE

CELSO M. FIDEL, MD, FPCS, CELSO M. FIDEL, MD, FPCS, FPSGSFPSGS

Diplomate Philippine Board of Diplomate Philippine Board of SurgerySurgery

LOVE your LOVE your CALLING with CALLING with

PASSIONPASSION..It is the It is the

MEANING of MEANING of your LIFEyour LIFE

RodinRodin

Vehicular AccidentVehicular Accident

Smash up CarsSmash up Cars

Truck involved in the MishapTruck involved in the Mishap

On the spot reportingOn the spot reporting

Initial Assessment used to identify and Initial Assessment used to identify and

treat conditions treat conditions that posethat pose as immediate as immediate

treat to patient’s life. treat to patient’s life.

Survey the scene; make sure that it’s Survey the scene; make sure that it’s

safesafe

Check for responsiveness by gentlyCheck for responsiveness by gently

shaking the patient’s shoulders and shaking the patient’s shoulders and

asking himasking him” ARE YOU OKEY’?” ARE YOU OKEY’?

Primary Survey

4 Levels of Responsiveness4 Levels of Responsiveness

1.1. ALERT- ALERT- awake, follows command, oriented as awake, follows command, oriented as to time, place and personto time, place and person

2. 2. Verbal-Verbal- speaks only when spoken to speaks only when spoken to

3.3. Pain- Pain- respond only to painful stimulus respond only to painful stimulus

4. 4. UnresponsiveUnresponsive- does not respond to any - does not respond to any stimulus; eye closed; does not have any verbal stimulus; eye closed; does not have any verbal output; does not flinch when pain is applied.output; does not flinch when pain is applied.

Primary Survey

WHAT DO YOU INITIALLY DO TO ANWHAT DO YOU INITIALLY DO TO AN

INJURED PATIENT?INJURED PATIENT?

A. ENSURE ADEQUATE AIRWAYA. ENSURE ADEQUATE AIRWAY

B. BREATHINGB. BREATHING

C. CIRCULATION AND HEMORRHAGE C. CIRCULATION AND HEMORRHAGE

CONTROLCONTROL

D. DISABILITY( NEUROLOGIC STATUS)D. DISABILITY( NEUROLOGIC STATUS)

E. EXPOSURE OF THE PATIENT/ E. EXPOSURE OF THE PATIENT/

ENVIRONMENTAL FACTORS(COMPLETELYENVIRONMENTAL FACTORS(COMPLETELY

UNDRESS THE PATIENT)UNDRESS THE PATIENT)

Primary Survey

A, B, C’s of Basic Life SupportA, B, C’s of Basic Life Support


Responsive patient- if patient can speak the Responsive patient- if patient can speak the

airway is airway is not obstructednot obstructed.. Unresponsive patient- needs aggressive Unresponsive patient- needs aggressive

airway maintenance immediately; make airway maintenance immediately; make

sure airway is open and patient is breathing sure airway is open and patient is breathing

adequately.adequately. Trauma patient- establish adequate airway Trauma patient- establish adequate airway

and cervical spine control. Apply cervical and cervical spine control. Apply cervical

collar if needed.collar if needed.

Primary Survey

AIRWAY PATENCYAIRWAY PATENCY


Airway Obstruction ManagementAirway Obstruction Management

Advantages of Advantages of OROTRACHEALOROTRACHEAL intubation intubation

direct visualization of the vocal cordsdirect visualization of the vocal cords

ability to use larger diameter ability to use larger diameter

endotracheal tubesendotracheal tubes

applicability to apneic patientsapplicability to apneic patients

Operative Intervention>Operative Intervention>CRICOTHYROIDOTOMYCRICOTHYROIDOTOMY

only tubes < 6mm can be insertedonly tubes < 6mm can be inserted

Primary Survey


Airway Obstruction ManagementAirway Obstruction Management Snoring and gurgling soundSnoring and gurgling sound implies implies partialpartial

. . PHARYNGEAL OCCLUSIONPHARYNGEAL OCCLUSION; ; HoarsenessHoarseness implies implies

LARYNGEAL OBSTRUCTIONLARYNGEAL OBSTRUCTION.. Nasotracheal intubation- for patients breathing Nasotracheal intubation- for patients breathing

spontaneously.spontaneously. Orotracheal intubation- for cervical spine injuries Orotracheal intubation- for cervical spine injuries

provided manual in-line cervical immobilization provided manual in-line cervical immobilization is is

maintained.maintained.

Primary Survey

REMOVAL of FOREIGN BODIESREMOVAL of FOREIGN BODIES

HOW DO WE MAINTAIN THE AIRWAY AND HOW DO WE MAINTAIN THE AIRWAY AND SAFEGUARD THE CERVICAL SPINE?SAFEGUARD THE CERVICAL SPINE?

Crash Helmet should be left in place until a crossCrash Helmet should be left in place until a cross

table x-Ray has been done and the cervical spinetable x-Ray has been done and the cervical spine

cleared of any injury.cleared of any injury.

Orotracheal or nasotracheal airway can be helpfulOrotracheal or nasotracheal airway can be helpful

Needle or Surgical Cricothyroidotomy is an easy, Needle or Surgical Cricothyroidotomy is an easy,

fast and safe access to the airway.fast and safe access to the airway.

Endo tracheal Intubation; best airway maintenanceEndo tracheal Intubation; best airway maintenance

device.device.

Primary Survey

celso m. fidel

HOW DO WE MAINTAIN THE AIRWAY AND HOW DO WE MAINTAIN THE AIRWAY AND SAFEGUARD THE CERVICAL SPINE?SAFEGUARD THE CERVICAL SPINE?

Keep airway patent w/o compromising spine Keep airway patent w/o compromising spine injury.injury. The AIRWAY must be cleared of blood, looseThe AIRWAY must be cleared of blood, loose teeth and dentures, or foreign bodies.teeth and dentures, or foreign bodies. Do the Do the JAW THRUSTJAW THRUST maneuver maneuver w/o hyperextension w/o hyperextension

of the head.( grasping the angles of the of the head.( grasping the angles of the lower jaw and displacing the mandible lower jaw and displacing the mandible forward)forward) Strap forehead of the victim on the stretcher Strap forehead of the victim on the stretcher or any board used to immobilize the or any board used to immobilize the patient with sandbags on both sides of the patient with sandbags on both sides of the head.head.

Primary Survey

Methods of Opening AirwayMethods of Opening Airway

B. B. HOW DO WE ASSESS BREATHING?HOW DO WE ASSESS BREATHING? Assess for adequacy of ventilation and Assess for adequacy of ventilation and maximum gaseous exchange.maximum gaseous exchange. PATENCYPATENCY of the of the AIRWAY AIRWAY does does NOTNOT mean mean thatthat VENTILATION VENTILATION is adequate.is adequate. Expose and examine the chest for rate & Expose and examine the chest for rate & depth.depth. Inspect and palpate the neck and chest for Inspect and palpate the neck and chest for evidence of external trauma, fractures, evidence of external trauma, fractures, tracheal deviation & disparity, subcutaneoustracheal deviation & disparity, subcutaneous emphysema, emphysema, lack oflack of movementmovement of hemithorax of hemithorax Percuss for hyperresonance and dullnessPercuss for hyperresonance and dullness

Responsive patient- if patient can speakResponsive patient- if patient can speak

the airway is not obstructedthe airway is not obstructedUnresponsive patient- needs aggressiveUnresponsive patient- needs aggressive

airway maintenance immediately; makeairway maintenance immediately; make sure airway is open and patient is sure airway is open and patient is breathing adequatelybreathing adequately

Trauma patient- establish adequate air-Trauma patient- establish adequate airway and cervical spine control. Applyway and cervical spine control. Apply cervical collar if neededcervical collar if needed

Primary Survey

B. BREATHINGB. BREATHING ADEQUATE BREATHINGADEQUATE BREATHING full rise and fall of chestfull rise and fall of chest early breathingearly breathing normal respiratory rate 12-20/min normal respiratory rate 12-20/min

INADEQUATE BREATHINGINADEQUATE BREATHING insufficient rise and fall of the chest insufficient rise and fall of the chest increased respiratory rateincreased respiratory rate cyanosis of the skin, lips and nail bedscyanosis of the skin, lips and nail beds mental status changesmental status changes inadequate respiratory rate inadequate respiratory rate

Primary Survey

celso m. fidel

Feeling for BreathingFeeling for Breathing

B. BREATHINGB. BREATHING Remember Remember cyanosiscyanosis is a late sign, and should is a late sign, and should not be relied upon to determine inadequacy not be relied upon to determine inadequacy of ventilationof ventilation Measurement of Measurement of end tidal CO2end tidal CO2 is the most is the most sensitive sensitive indicatorindicator of adequacy of ventilation. of adequacy of ventilation.

Causes of inadequacy of ventilationCauses of inadequacy of ventilation Tension pneumothoraxTension pneumothorax Open pneumothoraxOpen pneumothorax Flail chest/ pulmonary contusion Flail chest/ pulmonary contusion

Primary Survey

B. BREATHINGB. BREATHING ManagementManagement Commence 100% oxygen; Patients with Commence 100% oxygen; Patients with inadequate ventilation may require assisted inadequate ventilation may require assisted ventilation ventilation Suction secretionsSuction secretions Tension/open pneumothorax managementTension/open pneumothorax management Open pneumothorax should be closed by Open pneumothorax should be closed by plastic wrap, sealing only 3 sides plastic wrap, sealing only 3 sides Taping of an examining glove with one Taping of an examining glove with one finger cut will allow the same.finger cut will allow the same.

Primary Survey

Mouth to Mouth ResuscitationMouth to Mouth Resuscitation

Tension/ Open Pneumothorax mgt. cont’dTension/ Open Pneumothorax mgt. cont’d If a sealed dressing must be done; CTT If a sealed dressing must be done; CTT must be done at a distant site.must be done at a distant site. Another maneuver is to seal the open Another maneuver is to seal the open wound w/ vaselinized gauze. If not wound w/ vaselinized gauze. If not capable of doing CTT a large bore needle capable of doing CTT a large bore needle ( 14 or 16) or a vascular cannula should ( 14 or 16) or a vascular cannula should be placed at MCL 2be placed at MCL 2ndnd intercostal space. intercostal space. This should be connected IV tubing This should be connected IV tubing dipped in a bowl of water. dipped in a bowl of water. Patient who is Patient who is AGITATEDAGITATED in the absence of in the absence of head injury –head injury – HYPOXIAHYPOXIA.. In the presence of Head injury R/O hypoxiaIn the presence of Head injury R/O hypoxia as the cause of agitation.as the cause of agitation.

Primary Survey

C. C. HOW DO WE ASSESS CIRCULATION ?HOW DO WE ASSESS CIRCULATION ? Not only controlling hemorrhage but, also Not only controlling hemorrhage but, also restoring adequate perfusion.restoring adequate perfusion. Skin perfusion( color, temperature, moisture,Skin perfusion( color, temperature, moisture, capillary return). capillary return). “BLANCH TEST”“BLANCH TEST” Responsive PATIENT; Pulse rate, quality, and Responsive PATIENT; Pulse rate, quality, and regularity)regularity) Appreciable pulse>> At least 80 mmHg Appreciable pulse>> At least 80 mmHg SystolicSystolic Femoral pulse >>> At least 70 mmHg. Femoral pulse >>> At least 70 mmHg. SystolicSystolic Carotid Pulse >>> “ “ 60 “ “ Carotid Pulse >>> “ “ 60 “ “

..

Primary Survey

C. HOW DO WE ASSESS CIRCULATION ?C. HOW DO WE ASSESS CIRCULATION ? Irregular suggest ; Irregular suggest ; cardiac abnormalitycardiac abnormality threading meansthreading means HYPOXIA HYPOXIA; cardiac rate ; cardiac rate and rhythm; Check BP if possible. and rhythm; Check BP if possible. Mental Status .Check consciousness level. In Mental Status .Check consciousness level. In the absence of head injury a fall in level the absence of head injury a fall in level signifies>>>signifies>>>Diminished cerebral perfusionDiminished cerebral perfusion Unresponsive patient- check Unresponsive patient- check carotid pulsecarotid pulse;; Present if systolic pressure is 60 mm Hg. Present if systolic pressure is 60 mm Hg. Determine rate of external hemorrhage.Determine rate of external hemorrhage.

Primary Survey

CIRCULATIONCIRCULATION

WHAT ARE THE PRIORITIES OF HYPOVOLEMIC SHOCK?WHAT ARE THE PRIORITIES OF HYPOVOLEMIC SHOCK? Gain access to the circulationGain access to the circulation Rapidly transfuse fluids or volume expandersRapidly transfuse fluids or volume expanders

Obtain blood samples and send for Obtain blood samples and send for BASELINE studies such as hematocrit, BASELINE studies such as hematocrit, typing and cross matching.typing and cross matching.

Replace Blood lossReplace Blood loss Stop the BleedingStop the Bleeding

Primary Survey

C. CIRCULATION & CONTROL OF C. CIRCULATION & CONTROL OF HEMORRHAGEHEMORRHAGE Management:Management: Control external hemorrhage by direct Control external hemorrhage by direct pressure; No tourniquets/hemostats.pressure; No tourniquets/hemostats.

Insert 2 large intravenous cathetersInsert 2 large intravenous catheters Draw blood for CBC, blood typing, cross Draw blood for CBC, blood typing, cross matching, chemistries; arterial blood for matching, chemistries; arterial blood for blood gases.blood gases.

Rapid crystalloid infusion with warmed Rapid crystalloid infusion with warmed Ringer’s Lactate solution.Ringer’s Lactate solution.

Primary Survey

C. CIRCULATION & CONTROL OF C. CIRCULATION & CONTROL OF HEMORRHAGEHEMORRHAGE

Management:Management:

Apply pneumatic splintApply pneumatic splint Begin cardiac monitoringBegin cardiac monitoring

Insert an indwelling catheter and Insert an indwelling catheter and nasogastric tube unless contraindicatednasogastric tube unless contraindicated Prevent hypothermiaPrevent hypothermia

Primary Survey

CARDIOPULMONARY RESUSCITATIONCARDIOPULMONARY RESUSCITATION

Primary Survey

D. DISABILITY (DO BRIEF NEURO- D. DISABILITY (DO BRIEF NEURO-

LOGIC EXAMINATIONS)LOGIC EXAMINATIONS)

Determine level of consciousnessDetermine level of consciousness

A – AlertA – Alert

V – Vocal stimuli responseV – Vocal stimuli response

Can he speak?Can he speak?

Does he make sense?Does he make sense?

P – Pain stimuli responseP – Pain stimuli response

U- UnresponsiveU- Unresponsive

Primary Survey

Check PupilsCheck Pupils

size; evidence of inequalitysize; evidence of inequality

reactionreaction

response to lightresponse to light

Sensory- can feel in all parts of body?Sensory- can feel in all parts of body?

Motor- can move all limbs?Motor- can move all limbs?

WHEN TO TRANSFER TO TRAUMA CENTER?

TRAUMA SCORINGTRAUMA SCORING

For appropriate TriageFor appropriate Triage

Hospital TransferHospital Transfer

Assurance of quality CareAssurance of quality Care

PEDIATRIC TRAUMA SCALEPEDIATRIC TRAUMA SCALE

SizeSize

AirwayAirway

Systolic Blood PressureSystolic Blood Pressure

> 20 kgs +2 10-20 kgs +1 < 10 kgs 1 NORMAL +2

MAINTAINABLE +1

NOT MAINTAINABLE -1

> 90 mm Hg +2

50-90 mm Hg +1< than 50 mm Hg -1

>>>>TRAUMA SCORINGTRAUMA SCORING

PEDIATRIC Trauma Scale>> In the PEDIATRIC Trauma Scale>> In the absence of proper size BP cuff, absence of proper size BP cuff, Assess BP by assigning theseAssess BP by assigning these

values:values: Pulse palpable at Wrist>>>>>+2Pulse palpable at Wrist>>>>>+2

Pulse palpable at Groin>>>>> +1Pulse palpable at Groin>>>>> +1

Pulse not Palpable>>>>>>>>>>> -1Pulse not Palpable>>>>>>>>>>> -1


>>>>TRAUMA SCORINGTRAUMA SCORING Central Nervous System StatusCentral Nervous System Status Awake>>>>> +2Awake>>>>> +2 Partially Conscious or unconscious> +1Partially Conscious or unconscious> +1 Comatous or Decerebrate >>>>>>>>> -1Comatous or Decerebrate >>>>>>>>> -1

Open WoundsOpen Wounds None >>+2 Minor>>> +1 Major -1None >>+2 Minor>>> +1 Major -1 OthersOthers Skeletal Injury +2 Closed Fracture +1 Skeletal Injury +2 Closed Fracture +1

Open/Multiple Fracture -1Open/Multiple Fracture -1

SCORE 6-14 IF < 9 CRITERION FOR DIRECT TRANSPORT SCORE 6-14 IF < 9 CRITERION FOR DIRECT TRANSPORT Trauma Ctr. Trauma Ctr.


>>TRAUMA SCORING>>TRAUMA SCORING


ADULT TRAUMA SCORE1.SYSTOLIC BLOOD PRESSURE 3. Glasgow Coma Scale 4.EYE OPENING

> 89 4 13-16 4 Spontaneous 4

76-89 3 9-12 3 Opens on Command or

50-75 2 6-8 2 verbal stimuli 3

1-49 1 4-5 1 Response to pain 2

0 0 Nil 1

2. RESPIRATORY RATE 5. MOTOR RESPONSE 6. VERBAL

10-29 4 Obeys Command 6 Conscious, Coherent 5

> 29 3 Localizes Pain 5 Disoriented/Incoherent 4

6-9 2 Withdraws to Pain 4 Inappropriate Words 3

1-5 1 Abnormal Flexion 3 Incomprehensible Sounds 2

0 0 Abnormal Extension 2 Nil 1

IF THE PATIENT HAS A SCORE < 11 CRITERION for direct transport into a TERTIARY HOSPITAL OR

A TRAUMA CENTER.

WHAT ARE NECESSARY DURING TRANSFER?WHAT ARE NECESSARY DURING TRANSFER? Cervical Spine must be protectedCervical Spine must be protected Airway is maintained and breathing supportedAirway is maintained and breathing supported

Infusion must be started to support circulation Infusion must be started to support circulation

if necessary.if necessary. Control of external bleeding & immobilization Control of external bleeding & immobilization of the spine and fractures must be attained.of the spine and fractures must be attained.

Locally, the best vehicle for transport in the Locally, the best vehicle for transport in the lieu of an ambulance is the jeepney.lieu of an ambulance is the jeepney. The best backboard support is the backseat of The best backboard support is the backseat of the of the jeepney too.the of the jeepney too.


SECONDARY SURVEY

What are the Important pointsWhat are the Important points in the in the

HISTORY of TRAUMA VICTIMS?HISTORY of TRAUMA VICTIMS?

Systematic EvaluationSystematic Evaluation

S- Signs and symptomsS- Signs and symptoms

A- AllergiesA- Allergies

M- Medications takenM- Medications taken

P- Pertinent HistoryP- Pertinent History

L- Last meal takenL- Last meal taken

E- Events preceeding the injuryE- Events preceeding the injury

SECONDARY SURVEY

Physical Examinations Physical Examinations

Look for signs of injuryLook for signs of injury

D- DeformitiesD- Deformities

O- Open injuriesO- Open injuries

T- TendernessT- Tenderness

S- SwellingS- Swelling

SECONDARY SURVEY

Physical Examinations –Head to ToePhysical Examinations –Head to Toe

Examination of the HeadExamination of the Head

A. Scalp and SkullA. Scalp and Skull ;Look for signs of injury ;Look for signs of injury


O- Open injuriesO- Open injuries



SECONDARY SURVEY

A. Scalp and SkullA. Scalp and Skull

Brisk bleeding= rapid suture closureBrisk bleeding= rapid suture closure

Nasopharyngeal bleeding= FrenchNasopharyngeal bleeding= French

20 foley catheter20 foley catheter

Ecchymosis about the ear (Ecchymosis about the ear (battle signbattle sign); or ); or

about the eyesabout the eyes ( (raccoon eyesraccoon eyes)= presumptive )= presumptive

evidence of evidence of BASAL SKULL FRACTUREBASAL SKULL FRACTURE

SECONDARY SURVEY

B. PupilsB. Pupils

SymmetrySymmetry

ReactivityReactivity

SizeSize

C. Ears and NoseC. Ears and Nose

Blood or Fluid from openingBlood or Fluid from opening

SECONDARY SURVEY

D. MouthD. Mouth


O- Open InjuriesO- Open Injuries



F- Foreign Bodies F- Foreign Bodies

SECONDARY SURVEY

A.A. Examination of the NeckExamination of the Neck D- DeformitiesD- Deformities

O- Open InjuriesO- Open Injuries



B. Cervical VertebraeB. Cervical Vertebrae

DeformitiesDeformities

Palpate for step-up DeformitiesPalpate for step-up Deformities

SECONDARY SURVEY

Examination of the ChestExamination of the Chest; Check for; Check for

Symmetry of ExpansionSymmetry of Expansion

Breath SoundsBreath Sounds

AbrasionsAbrasions

Subcutaneous EmphysemaSubcutaneous Emphysema

Open WoundsOpen Wounds

Rib or Clavicular FractureRib or Clavicular Fracture

SECONDARY SURVEY

Examination of the AbdomenExamination of the Abdomen

A. InspectionA. Inspection Deformities; Abdominal DistensionDeformities; Abdominal Distension

Open InjuriesOpen Injuries

Protruding OrgansProtruding Organs

Swelling & DiscolorationSwelling & Discoloration

SECONDARY SURVEY

B. PalpationB. Palpation

Rigidity ( Hardness)Rigidity ( Hardness)

TendernessTenderness

MassesMasses

C. AuscultationC. Auscultation

Listen for bowel soundsListen for bowel sounds

SECONDARY SURVEY

Diagnostic Aids for the Abdomen Diagnostic Aids for the Abdomen

Diagnostic Peritoneal LavageDiagnostic Peritoneal Lavage for for

suspected blunt injurysuspected blunt injury

One shot IVPOne shot IVP if GU injury is suspected if GU injury is suspected

A A CystogramCystogram may be done by clamping may be done by clamping

the catheterthe catheter

CT scanCT scan if accessible and available can if accessible and available can

be done on stable patientsbe done on stable patients

SECONDARY SURVEY

Examination of the Pelvis and RectumExamination of the Pelvis and Rectum

Check for scrotal hematomaCheck for scrotal hematoma

Check for blood in the urethral meatusCheck for blood in the urethral meatus

Check for a high lying prostateCheck for a high lying prostate

Blood on rectal exams may indicate injury to Blood on rectal exams may indicate injury to

the rectum or neighboring organsthe rectum or neighboring organs

Blood in the vagina vault or introitusBlood in the vagina vault or introitus

may indicate pelvic fracturemay indicate pelvic fracture

SECONDARY SURVEY

Examination of the BackExamination of the Back

A. InspectionA. Inspection

Chest Wall deformitiesChest Wall deformities

Open Injuries Open Injuries

Foreign Objects Foreign Objects

DislocationDislocation


Palpate for deformities along spinePalpate for deformities along spine

TendernessTenderness

SECONDARY SURVEY

Examine Upper & Lower ExtremitiesExamine Upper & Lower Extremities A. InspectionA. Inspection

>> Deformities, Open injuries, Swelling>> Deformities, Open injuries, Swelling

>> Color >> Color

>> Motion, Wiggle test >> Motion, Wiggle test

>> Sensation>> Sensation


>> Tenderness>> Tenderness >> Crepitation>> Crepitation

>> Deformities>> Deformities

SECONDARY SURVEY

Measuring Vital SignsMeasuring Vital Signs

1.1. Respiration Respiration

2. Pulse Rate2. Pulse Rate

3. Blood Pressure3. Blood Pressure

Increased BP Decreased BPIncreased BP Decreased BP

1. Cold environment 1. Heart failure1. Cold environment 1. Heart failure

2. Stress; Pain 2. Trauma2. Stress; Pain 2. Trauma

3. Smoking 3. Shock3. Smoking 3. Shock

4. Caffeine 4. Caffeine

5. Decongestant5. Decongestant

SECONDARY SURVEY

PupilsPupils

Normal FindingsNormal Findings Abnormal FindingsAbnormal Findings

> constricts when >> No reaction to> constricts when >> No reaction to

exposed to sun- lightexposed to sun- light

light >> Rlight >> Remains constricemains constrictedted

>Dilate with less >> Fixed, dilated or>Dilate with less >> Fixed, dilated or

light unequallight unequal

>Should be of the same size>Should be of the same size

SECONDARY SURVEY

ESSENTIAL LAB. PROCEDURESESSENTIAL LAB. PROCEDURES

Baseline Hematocrit, Blood Typing, and CrossBaseline Hematocrit, Blood Typing, and Cross

Matching.Matching.

A cross table x-Ray of the cervical spine w/oA cross table x-Ray of the cervical spine w/o

the victim being hyperextended. “Swimmer’s”the victim being hyperextended. “Swimmer’s”

view if not possible; x-Ray tube positioned atview if not possible; x-Ray tube positioned at

axilla directed to C-7. It will view lower axilla directed to C-7. It will view lower

Cervical vertebra and T1.Cervical vertebra and T1.

SECONDARY SURVEY

WHERE and HOW do WE LOOK for Blood Loss?WHERE and HOW do WE LOOK for Blood Loss?

There are three sites for exsanguinating There are three sites for exsanguinating

hemorrhage:hemorrhage:

CHEST CHEST

ABDOMENABDOMEN

THIGH (2-3 liters of blood in Hematoma)THIGH (2-3 liters of blood in Hematoma)

SECONDARY SURVEY

Patients with injury to these sites; Thoracic is Patients with injury to these sites; Thoracic is

11stst followed by Abdomen then extremities. followed by Abdomen then extremities.

Control of life threatening activities takes Control of life threatening activities takes

precedence over limb salvage.precedence over limb salvage.

Chest x-Ray important especially looking forChest x-Ray important especially looking for

sites of blood losssites of blood loss..

Other concerns in care of Casualties

Is INFECTION A RISK IN TRAUMA?Is INFECTION A RISK IN TRAUMA?

It is the leading cause of death occurring It is the leading cause of death occurring

beyond 2 days following trauma.beyond 2 days following trauma.

Prevent Infection byPrevent Infection by::

Repair or Restore mechanical structures Repair or Restore mechanical structures

and barriers to bacterial contamination.and barriers to bacterial contamination.

Support of Host defense > restoring Support of Host defense > restoring

circulating blood volume, adequate tissue circulating blood volume, adequate tissue

oxygenation & nutritional support.oxygenation & nutritional support.

Appropriate use of Appropriate use of ANTIBIOTICSANTIBIOTICS..


WHAT are the ANTIBIOTICS used IN TRAUMA?WHAT are the ANTIBIOTICS used IN TRAUMA?

Penicillin derivatives (Penicillin derivatives (CloxacillinCloxacillin; Ampicillin) ; Ampicillin)

for superficial wounds.for superficial wounds.

11stst generation Cephalosporins & Clindamycin generation Cephalosporins & Clindamycin

for more severe injuries.for more severe injuries.

For Multiple injuries:For Multiple injuries:

Broad spectrum Antibiotics for both gram – Broad spectrum Antibiotics for both gram –

& gram positive aerobes such as:& gram positive aerobes such as:

22ndnd generation Cephalosporins generation Cephalosporins

AminoglycosidesAminoglycosides

4fluoroquinolones w/ Metronidazole4fluoroquinolones w/ Metronidazole


WHAT are the ANTIBIOTICS used IN TRAUMA?WHAT are the ANTIBIOTICS used IN TRAUMA?

.. For intra Abdominal Trauma For intra Abdominal Trauma

Ampicillin and Beta lactamase InhibitorsAmpicillin and Beta lactamase Inhibitors

Broad Spectrum penicillins & Beta lactamase Broad Spectrum penicillins & Beta lactamase

Inhibitors.Inhibitors.

CarbapenimsCarbapenims

CefoxitinCefoxitin


HOW DO WE GIVE TETANUS PROPHYLAXIS?HOW DO WE GIVE TETANUS PROPHYLAXIS?

Tetanus prone woundTetanus prone wound::

Wound > 6hours oldWound > 6hours old

> 1 cm. deep caused by missile or Crushing > 1 cm. deep caused by missile or Crushing

injury.injury.

Burn or Frostbite with:Burn or Frostbite with:

Signs of infectionSigns of infection

Divitalized Tissue Divitalized Tissue

Contaminants Contaminants


Adequately Immunized PatientsAdequately Immunized Patients

A. Last dose w/in 5 years>>> All Wounds >> NONEA. Last dose w/in 5 years>>> All Wounds >> NONE

B. Last dose w/in 10 years:B. Last dose w/in 10 years:

Non Tetanus prone wound>>> NONENon Tetanus prone wound>>> NONE

Tetanus prone Wound>>>> ToxoidTetanus prone Wound>>>> Toxoid

C. Last dose > 10 years >> All Wounds >>> ToxoidC. Last dose > 10 years >> All Wounds >>> Toxoid

Inadequately Immunized PatientsInadequately Immunized Patients

Non Tetanus Prone Wound>>>> ToxoidNon Tetanus Prone Wound>>>> Toxoid

Tetanus prone Wound>>>Toxoid and AntitoxinTetanus prone Wound>>>Toxoid and Antitoxin

after one to 12 months>> Toxoidafter one to 12 months>> Toxoid

All injuries to the head are potentially All injuries to the head are potentially dangerousdangerous

Proper assessment of consciousnessProper assessment of consciousness>> If impaired>> If impaired

Damage to the brainDamage to the brain

Damage to the vessel inside the skullDamage to the vessel inside the skull

Skull fractureSkull fracture

HEAD INJURIES

I.CONCUSSIONI.CONCUSSION

Widespread but temporary disturbance of the Widespread but temporary disturbance of the

brain due to a violent blow to the head.brain due to a violent blow to the head.

A. REGOGNITIONA. REGOGNITION

1. Dizziness or nausea on recovery1. Dizziness or nausea on recovery

2. Loss of memory of events at the time 2. Loss of memory of events at the time

of or immediately preceeding the injuryof or immediately preceeding the injury

3. Mild generalized headache3. Mild generalized headache

HEAD INJURIES

II. SKULL FRACTUREII. SKULL FRACTURE

1. Suspected in patients of trauma with a 1. Suspected in patients of trauma with a

head woundhead wound

2. There maybe brain damage & bacteria 2. There maybe brain damage & bacteria

may pass thru easilymay pass thru easily

3. Patient is unconscious after head3. Patient is unconscious after head injury injury

HEAD INJURIES

VomitingVomitingBlurred visionBlurred visionHeadacheHeadacheNeck and back pain Neck and back pain Dizziness Dizziness ConfusionConfusionAny obvious depression or break in the Any obvious depression or break in the skullskullAny obvious sign or bleeding including Any obvious sign or bleeding including periorbital swelling and/or hematomaperiorbital swelling and/or hematomaFluid dripping from the ears or noseFluid dripping from the ears or nose

INDICATORS OF POSTERIOR BRAIN INJURY

III. CEREBRAL COMPRESSIONIII. CEREBRAL COMPRESSION

Very serious condition requiring surgeryVery serious condition requiring surgery

Occurs when a pressure is exerted on the Occurs when a pressure is exerted on the brain brain

within the skull due to:within the skull due to:

accumulation of bloodaccumulation of blood

swelling of the injured brainswelling of the injured brain

Associated with head injury and skull fractureAssociated with head injury and skull fracture

Maybe associated with stroke, infection and Maybe associated with stroke, infection and brain brain

tumor tumor

HEAD INJURIES

A.A. RECOGNITIONRECOGNITION

1. Recent head injury followed by full 1. Recent head injury followed by full

recovery.recovery.

2. Deterioration of level of response, 2. Deterioration of level of response, patient patient

becomes disoriented.becomes disoriented.

3. Intense headache3. Intense headache

4. Slow, yet full and strong pulses4. Slow, yet full and strong pulses

5. Unequal or dilated pupils5. Unequal or dilated pupils

HEAD INJURIES

6. Weakness or paralysis on one side of the 6. Weakness or paralysis on one side of the

face or bodyface or body7. High temperature or flushed face7. High temperature or flushed face

8. Drowsiness8. Drowsiness

9. Obvious change in personality or behavior 9. Obvious change in personality or behavior such as irritability.such as irritability.

HEAD INJURIES

1. Do a basic assessment of the patient1. Do a basic assessment of the patientIs the patient awakeIs the patient awakea. If patient is unconscious, make sure that a. If patient is unconscious, make sure that

the patient has a patent airway and is the patient has a patent airway and is breathing adequatelybreathing adequately

b. Is the breathing normalb. Is the breathing normalc. Is there a pulsec. Is there a pulse

2.Check for spinal cord injury2.Check for spinal cord injurya. If there is suspicion of possible brain a. If there is suspicion of possible brain

injury, assume cervical spine fracture injury, assume cervical spine fracture unless proven otherwise.unless proven otherwise.

PATIENTS WITH HISTORY OF HEAD TRAUMA

b. Immobilize patient’s head by applying b. Immobilize patient’s head by applying cervical collar or placing sandbags and cervical collar or placing sandbags and strapping him to the backboardstrapping him to the backboard 3. Control any bleeding in the scalp3. Control any bleeding in the scalp. Look for . Look for

other injuries and treat them:other injuries and treat them: a. If there is discharge from an ear, position a. If there is discharge from an ear, position

the patient so that the affected ear is the patient so that the affected ear is lower. Cover the ear with sterile dressing lower. Cover the ear with sterile dressing or clean pad, lightly secured with a or clean pad, lightly secured with a bandage. bandage. DO NOT PLUG THE EARDO NOT PLUG THE EAR..


In case of open skull fractureIn case of open skull fracture Clean the wound with water.Clean the wound with water. Cover exposed area with clean material.Cover exposed area with clean material. Do not attempt toDo not attempt to reposition reposition bone fragment. bone fragment. DO NOT remove impaled objects. Make a DO NOT remove impaled objects. Make a

fluffy dressing around the impaled fluffy dressing around the impaled object to stabilize it.object to stabilize it. 4. If patient is conscious4. If patient is conscious, make him comfortable , make him comfortable by raising head and shouldersby raising head and shoulders. .


5. 5. If patient is unconsciousIf patient is unconscious maintain maintain immobilization and support ABC. Turn to immobilization and support ABC. Turn to side if patient vomits to avoid aspiration side if patient vomits to avoid aspiration butbut maintain head &maintain head & neck immobilization neck immobilization..

6. 6. Call for an ambulanceCall for an ambulance or medical team. or medical team. Monitor and record breathing, pulse and Monitor and record breathing, pulse and level of response every 10 minutes until level of response every 10 minutes until help arrives.help arrives.


BLEEDING FLOW CHART

1.LOCATE BLEEDING SITE

2. APPLY DIRECT PRESSURE ON THE WOUND

BLEEDING STOPPED ?

3. ELEVATE EXTREMITY ABOVE CASUALTY’s HEART

5. TREAT FOR SHOCKCARE FOR WOUNDSEEK MEDICAL ATTENTION

BLEEDING STOPPED?4. LOCATE PRESSURE POINTS &

APPLY PRESSURE; KEEP PRESSURE OVER WOUNDS

TREAT SHOCKBLEEDING STOPPED?

BLEEDING FROM ARM OR LEG 6. APPLY TOURNIQUE AS LAST

RESORT

7. SEEK MEDICAL

ATTENTION

NO YES

YES

NO

YES

NO NO

YES

HEAD INJURIES

1. CHECK ABC’s & TREAT ACORDINGLY

2. CHECK FOR POSSIBLE SPINAL INJURY

IMMOBILIZE HEAD AND NECK

HEAD BLEEDING3. DIRECT PRESSURE OVER THE WOUND. If FRACTURE SUSPECTED APPLY PRESSURE TO OUTER EDGES OF THE INTACT BONE

4. DO NOT REMOVE IMPALED OBJECTSUNCONSCIOUS5. RAISE VICTIMS HEAD&

SHOULDERS IF NO SPINAL INJURY & NOT IN SHOCK

6 KEEP PATIENT LYING ON THE GROUND

7. SEEK IMMEDIATE MEDICAL ATTENTIONIF W/ SIGNS OF POSSIBLE BRAIN INJURY

YES

NO

NO

YES

ABDOMINAL INJURIES Flow ChartABDOMINAL INJURIES Flow Chart1.CHECK ABCs and TREAT ACCORDINGLY

PENETRATING WOUNDS

IMPALED OBJECTS

PROTRUDING ORGANS ?

2. DO NOT REMOVE OBJECT Stabilize subject

3. DO NOT RE-INSERT ORGAN DO NOT TOUCH ORGAN COVER W/ MOIST CLEAN DRESSING

BLOW TO ABDOMEN ?

4. ROLL VICTIM TO ONESIDE IN CASE OF VOMITING

5. SEEK MEDICAL ATTENTION

YESNO

NO

YESNO

YES

Treatment of Abdominal InjuriesTreatment of Abdominal Injuries LLay the casualty down on his back with his ay the casualty down on his back with his knees in upright positionknees in upright position Check the airway, breathing and circulation,Check the airway, breathing and circulation, resuscitate if necessaryresuscitate if necessary Impaled objects should not be removedImpaled objects should not be removed and should be stabilized by bunchingand should be stabilized by bunching dressing around it then fixed with dressing around it then fixed with adhesive tapeadhesive tape Protruding intestine should be covered Protruding intestine should be covered to prevent drying. If casualty coughsto prevent drying. If casualty coughs prevent further protrusion by pressingprevent further protrusion by pressing on the moist dressingon the moist dressing

Treatment of Abdominal InjuriesTreatment of Abdominal Injuries Do not touch with bare hands any exposedDo not touch with bare hands any exposed organ nor push them back into the abdomenorgan nor push them back into the abdomen If casualty suffered from a blunt abdominal If casualty suffered from a blunt abdominal injury, turn him to one side, preferably oninjury, turn him to one side, preferably on his injured side or in sitting position whichhis injured side or in sitting position which ever makes breathing easierever makes breathing easier

Do not give the victim anything to eat or drinkDo not give the victim anything to eat or drink however you can moisten lipshowever you can moisten lips Call for an ambulance or medical team. TreatCall for an ambulance or medical team. Treat patient with shock. Stay with the casualtypatient with shock. Stay with the casualty and check his or her condition every fewand check his or her condition every few minutes until help comesminutes until help comes

Penetrating Chest Wound “Sucking Chest Penetrating Chest Wound “Sucking Chest

WoundWound”” A penetrating chest wound can cause A penetrating chest wound can cause internal internal

damagedamage w/in the chest and upper abdomen. w/in the chest and upper abdomen.

Air can enter the thoracic cavity which has Air can enter the thoracic cavity which has

a negative pressure. Lung on the side of a negative pressure. Lung on the side of

wound injury will collapse. If pressure builds wound injury will collapse. If pressure builds

up to some extent it may prevent the heart up to some extent it may prevent the heart

from refilling properly w/ blood, impairing from refilling properly w/ blood, impairing

circulation and causing shock. (circulation and causing shock. (Tension Tension

pneumothoraxpneumothorax))

Penetrating Chest Wound “Sucking Chest WoundPenetrating Chest Wound “Sucking Chest Wound””

RECOGNITIONRECOGNITION

1. Difficult and painful breathing1. Difficult and painful breathing

2. Breathing maybe rapid, shallow & uneven2. Breathing maybe rapid, shallow & uneven

3. Casualty has a feeling of impending doom3. Casualty has a feeling of impending doom

There may also be:There may also be:

1. Signs of shock1. Signs of shock

2. Coughing up frothy, red blood2. Coughing up frothy, red blood

3. 3. Grey-blue color of mouthGrey-blue color of mouth, lips, nailbeds & skin, lips, nailbeds & skin

4. Crackling 4. Crackling feeling of the skinfeeling of the skin around the site around the site

of wound caused by air around the tissuesof wound caused by air around the tissues

CHEST INJURIESCHEST INJURIESFlow ChartFlow Chart

CHECK ABC’s and TREAT ACCORDINGLY

PENETRATING WOUNDS

IMPALED OBJECTS

SUCKINGCHEST WOUNDS

DO NOT REMOVE OBJECT Stabilize subject SEAL WOUND

TO PREVEN TAIR TO ENTER

RIB FRACTURE

4. STABILIZE RIBS and CHEST

5.SEEK MEDICAL ATTENTION

YESNO

NO

YES

YES

NO

Treatment of Chest InjuriesTreatment of Chest Injuries Check the ABCs and be ready to resuscitateCheck the ABCs and be ready to resuscitate

if necessary. Provide firm support for a if necessary. Provide firm support for a

conscious casualty, in the position he finds conscious casualty, in the position he finds

most comfortable.most comfortable.

Impaled objects should be stabilizedImpaled objects should be stabilized

Place a plastic film on a sucking chest woundPlace a plastic film on a sucking chest wound

and secure the three sides w/ adhesive tapeand secure the three sides w/ adhesive tape

which ensures a one way valvewhich ensures a one way valve

Stabilize a fractured rib by applying sling and Stabilize a fractured rib by applying sling and

swatheswathe

Treatment of Chest InjuriesTreatment of Chest Injuries Call for an ambulance or medical team. TreatCall for an ambulance or medical team. Treat

the patient for shock. Stay with him and the patient for shock. Stay with him and

check his condition every few minutes untilcheck his condition every few minutes until

help comes.help comes.

If the patient becomes unconscious, open theIf the patient becomes unconscious, open the

airway and check breathing. Be ready to airway and check breathing. Be ready to

resuscitate if needed; Place him lying withresuscitate if needed; Place him lying with

injured side uppermost.injured side uppermost.

Do not probe, clean, or remove foreign body,Do not probe, clean, or remove foreign body,

stuck clothing to chest wound.stuck clothing to chest wound.

AVULSIONSAVULSIONS

Wash and clean woundWash and clean wound

Control bleeding by direct pressureControl bleeding by direct pressure

Compression dressingCompression dressing

Call an Call an ambulanceambulance or medical team. or medical team.

or bring the patient to a hospitalor bring the patient to a hospital

AMPUTATIONSAMPUTATIONS Amputation is forceful Amputation is forceful partialpartial or complete or complete

removal of a limb. It is sometimes removal of a limb. It is sometimes

possible to “replant” the amputated possible to “replant” the amputated

part so, its important to locate and part so, its important to locate and

preserve it. The sooner the casualty preserve it. The sooner the casualty

and the severed part reaches the and the severed part reaches the

hospital, the better.hospital, the better.

AMPUTATIONSAMPUTATIONS CARE OF THE CASUALTYCARE OF THE CASUALTY

Control blood loss by direct pressure & Control blood loss by direct pressure &

raising the injured part. Do not use a raising the injured part. Do not use a

tourniquettourniquet

Apply a sterile dressing or non fluffy Apply a sterile dressing or non fluffy

clean pad secured with a bandageclean pad secured with a bandage

Treat the casualty for shockTreat the casualty for shock

Call for an ambulance or medical teamCall for an ambulance or medical team

celso m. fidel

AMPUTATIONSAMPUTATIONS

CARE OF THE AMPUTATED PARTCARE OF THE AMPUTATED PART

Wrap the severed part in a plastic bagWrap the severed part in a plastic bag

Wrap again in gauze or soft fabric, Wrap again in gauze or soft fabric,

place in another container filled with place in another container filled with

crushed icecrushed ice

Clearly mark the package w/ casualty’s Clearly mark the package w/ casualty’s

name time of injury and give it name time of injury and give it

personally to the medical personnel.personally to the medical personnel.

celso m. fidel

ImpalementImpalement This is a condition wherein a foreign This is a condition wherein a foreign

object is protruding from a casualty’s object is protruding from a casualty’s

bodybody

1. Do not remove the impaled object 1. Do not remove the impaled object

unless it is impaled in the cheek or unless it is impaled in the cheek or

affecting the airway or CPRaffecting the airway or CPR

2. Check the airway & breathing. Be 2. Check the airway & breathing. Be

ready to resuscitate if necessaryready to resuscitate if necessary

ImpalementImpalement

3. Check the airway & breathing. Be 3. Check the airway & breathing. Be

ready to resuscitate if necessaryready to resuscitate if necessary

4. Control the bleeding4. Control the bleeding

5. Prevent further injury by stabilizing 5. Prevent further injury by stabilizing

the object with bulky dressing, then the object with bulky dressing, then

applying bandageapplying bandage

6. Call an ambulance or a medical team 6. Call an ambulance or a medical team

Gunshot WoundsGunshot Wounds

Military gunshot wounds are often heavily Military gunshot wounds are often heavily

contaminated with delays in treatment. contaminated with delays in treatment.

The severity of the wound does not The severity of the wound does not

depend on the velocity of the bullet but depend on the velocity of the bullet but

depends on the amount of kinetic depends on the amount of kinetic

energ transferred to the tissues. . energ transferred to the tissues. .

Gunshot WoundsGunshot Wounds

. . How to Manage:How to Manage:

1. C1. Checkheck for ABC’sfor ABC’s. . ResuscitateResuscitate if if necessarynecessary

2. Control bleeding by direct pressure 2. Control bleeding by direct pressure

on the woundon the wound

3. Stabilize injured part if extremity is 3. Stabilize injured part if extremity is

affected. affected. Insert an intravenousInsert an intravenous access access

4. C4. Cover wound w/ cleanover wound w/ clean, , sterile sterile dressing.dressing.

5.Transport immediately for wound 5.Transport immediately for wound

debridement, Tetanus prophylaxis & debridement, Tetanus prophylaxis &

antibiotic coverage. antibiotic coverage.

Crushing InjuriesCrushing InjuriesCommon among casualties who Common among casualties who

have been crushed beneath debris have been crushed beneath debris bbecauseecause of explosives, natural disasof explosives, natural disasters, ters, or vehicular disasters. They are at or vehicular disasters. They are at risk risk of of developing developing ”Crush Syndrome”Crush Syndrome” ” or or traumatic rhabdomyolysistraumatic rhabdomyolysis resulting resulting from skeletal muscle injury with from skeletal muscle injury with release of muscle cell content intorelease of muscle cell content into

the general circulation.the general circulation.

Crushing InjuriesCrushing Injuries Local injuries includes fractures, swelling, Local injuries includes fractures, swelling,

blisters, internal bleeding. The crushing force blisters, internal bleeding. The crushing force may also impair the circulation, causing may also impair the circulation, causing numbness at or below the site of injury; no numbness at or below the site of injury; no detectable pulse in the crushed limb.detectable pulse in the crushed limb.

Dangers of Prolonged Crushing Dangers of Prolonged Crushing

Shock- If pressure is removed, tissue fluids Shock- If pressure is removed, tissue fluids

may leak into the damage muscle tissue.may leak into the damage muscle tissue.

Crush Syndrome- Toxic substances from Crush Syndrome- Toxic substances from

damage tissues are suddenly released. This damage tissues are suddenly released. This

is extremely serious and fatal. is extremely serious and fatal.

Crushing InjuriesCrushing Injuries TREATMENT for CRUSHING VICTIMSTREATMENT for CRUSHING VICTIMS

CCasualtiesasualties Crushed for less thanCrushed for less than 10 minutes 10 minutes

ReReleaselease the casualty as quicklythe casualty as quickly as as possibpossiblele

CControlontrol external bleedingexternal bleeding & cover & cover woundwound

SecureSecure & support suspected fracture& support suspected fracture

Examine & observe for shock; Treat Examine & observe for shock; Treat

accordinglyaccordingly

Call for an ambulance. Insert an IV Call for an ambulance. Insert an IV

line line

Crushing InjuriesCrushing Injuries TREATMENT for CRUSHING VICTIMSTREATMENT for CRUSHING VICTIMS

Casualties Crushed for more than 10 Casualties Crushed for more than 10 minutesminutes

Call for an ambulance or medical teamCall for an ambulance or medical team

Insert an IV line while waiting for an Insert an IV line while waiting for an

ambulanceambulance

Comfort and reassure casualty until Comfort and reassure casualty until

help comeshelp comes

Blast InjuryBlast Injury Injuries Sustained in Blast ExplosionsInjuries Sustained in Blast Explosions

1. Rupture of the Tympanic Membrane= 1. Rupture of the Tympanic Membrane=

Ear pain;ringing in the ears; hearing Ear pain;ringing in the ears; hearing

loss loss

2. Respiratory Effects= Inhalation injury; 2. Respiratory Effects= Inhalation injury;

airway hemorrhageairway hemorrhage

3. Skull Fractures3. Skull Fractures

4. Burns4. Burns

5.Fractures5.Fractures

Blast InjuryBlast Injury Injuries Sustained in Blast ExplosionsInjuries Sustained in Blast Explosions

6. Traumatic Brain Injury6. Traumatic Brain Injury

7. Arterial Air Emboli= Confusion; 7. Arterial Air Emboli= Confusion;

disorientation; focal neurologic signsdisorientation; focal neurologic signs

Blast InjuryBlast Injury

TREATMENT of VICTIMS in Blast ExplosionsTREATMENT of VICTIMS in Blast Explosions

1. Lay the casualty on the ground. Reassure 1. Lay the casualty on the ground. Reassure

patient.patient.

2. Maintain an open airway. Check breathing. 2. Maintain an open airway. Check breathing.

Be ready to resuscitate if necessary.Be ready to resuscitate if necessary.

3. Control bleeding; Cover wounds with clean 3. Control bleeding; Cover wounds with clean

and if possible sterile dressing. May apply and if possible sterile dressing. May apply

a cervical collar if neck injury is suspected.a cervical collar if neck injury is suspected.

4. Call an ambulance or medical team; May 4. Call an ambulance or medical team; May

start an start an intravenousintravenous line if trained to do so. line if trained to do so.

5. Continuously 5. Continuously monitor patientmonitor patient until help arrives until help arrives

Eye WoundsEye Wounds The Eye can be bruised or cut by direct blows The Eye can be bruised or cut by direct blows

or by sharp, chipped fragments of metal & or by sharp, chipped fragments of metal &

glass. All eye injuries are potentially glass. All eye injuries are potentially

serious. Corneal injury can lead to scarring serious. Corneal injury can lead to scarring

with resultant loss of vision. There may be with resultant loss of vision. There may be

rupture of the eyeball.rupture of the eyeball.

RECOGNITIONRECOGNITION

Visible WoundVisible Wound

Bloodshot appearance to the injured eyeBloodshot appearance to the injured eye

Partial or total loss of visionPartial or total loss of vision

Leakage of blood or fluid from the woundLeakage of blood or fluid from the wound

Eye WoundsEye Wounds TREATMENTTREATMENT

1. Lay the casualty down on his back, holding 1. Lay the casualty down on his back, holding

his head to keep it as still as possible.his head to keep it as still as possible.

2.Tell the casualty, keep both eyes still; 2.Tell the casualty, keep both eyes still;

movement of the good eye will cause movement of the good eye will cause

movement of the injured eye; Do not movement of the injured eye; Do not

touch, attempt to remove an embedded touch, attempt to remove an embedded

foreign body.foreign body.

3. Ask the casualty to hold an eye pad over 3. Ask the casualty to hold an eye pad over

injured eye. Bandage the pad in place.injured eye. Bandage the pad in place.

4. Take or send the casualty to a hospital.4. Take or send the casualty to a hospital.

celso m. fidel

Internal BleedingInternal Bleeding

TREATMENTTREATMENT

1. Help the casualty to lie down; raise and 1. Help the casualty to lie down; raise and

support his legs. Loosen clothing at the support his legs. Loosen clothing at the

neck, chest and waist. If unconscious neck, chest and waist. If unconscious

place him with injury uppermost.place him with injury uppermost.

2. Call for an ambulance or a medical team.2. Call for an ambulance or a medical team.

3. Insulate him from the cold. Monitor and 3. Insulate him from the cold. Monitor and

record breathing, pulse and level of record breathing, pulse and level of

response every 10 minutes.response every 10 minutes.

4. Note the type, amount and source of blood 4. Note the type, amount and source of blood

loss coming from bony orifices. loss coming from bony orifices.

Bleeding At Special SitesBleeding At Special Sites Scalp and Head WoundsScalp and Head Wounds

1. It has a rich blood supply, when damaged, 1. It has a rich blood supply, when damaged,

the skin splits >>gaping wound>> profuse the skin splits >>gaping wound>> profuse

bleeding.bleeding.

2. May be part of a more serious underlying 2. May be part of a more serious underlying

injury>> skull fractureinjury>> skull fracture TREATMENTTREATMENT

1. With gloves replace displaced skin flaps1. With gloves replace displaced skin flaps

2. Direct 2. Direct pressure over pressure over sterile dressing on woundsterile dressing on wound

3. Secure dressing w/ roller bandage3. Secure dressing w/ roller bandage

4. If unconscious, open airway; Check BC’s4. If unconscious, open airway; Check BC’s

5. Send casualty to Hospital5. Send casualty to Hospital

Bleeding At Special SitesBleeding At Special Sites Wounds To The PalmWounds To The Palm

Richly supplied with blood, wound bleed Richly supplied with blood, wound bleed

profusely; Deep wound may severe profusely; Deep wound may severe

tendons and nerves. tendons and nerves. TREATMENTTREATMENT

1. Press a clean pad or sterile dressing firmly 1. Press a clean pad or sterile dressing firmly

into the palm and let him clench his fist into the palm and let him clench his fist

over it. If he over it. If he finds it difficult tofinds it difficult to press hard, press hard,

let him use the uninjured hand to grasp it.let him use the uninjured hand to grasp it.

2. Bandage the casualty’s fingers so they are 2. Bandage the casualty’s fingers so they are

clenchedclenched overover the pad the pad. Tie knot over fingers.. Tie knot over fingers.

3. S3. Supportupport arm w/ elevation sling; Sendarm w/ elevation sling; Send to hospital to hospital

Bleeding At Special SitesBleeding At Special Sites Wounds To The Joint CreasesWounds To The Joint Creases

Major vessels cross the inside of the elbow andMajor vessels cross the inside of the elbow and

knee; if severed will bleed profusely.knee; if severed will bleed profusely.

TREATMENTTREATMENT

Press a clean pad over the injury. Bend the Press a clean pad over the injury. Bend the

joint as firmly as possible.joint as firmly as possible.

With the joint firmly bent to press on the pad,With the joint firmly bent to press on the pad,

raise the limb. If possible, lay casualty raise the limb. If possible, lay casualty

down to reduce shock.down to reduce shock.

Take or send the casualty to hospital; Release Take or send the casualty to hospital; Release

the pressure briefly every 10 minutes to the pressure briefly every 10 minutes to

restore normal blood flowrestore normal blood flow

Bleeding At Special SitesBleeding At Special Sites Bleeding From The EarBleeding From The Ear

Bleeding that originates from inside the ear Bleeding that originates from inside the ear

generally follows a ruptured eardrum which generally follows a ruptured eardrum which

may be caused by explosion. Sharp pain is may be caused by explosion. Sharp pain is

experienced followed by earache & deafness.experienced followed by earache & deafness.

From a head injury blood may appear thin & From a head injury blood may appear thin &

wwateryatery w/c is serious >> CSF leakingw/c is serious >> CSF leaking from brain. from brain. TREATMENTTREATMENT

1. Help victim into half sitting position, head 1. Help victim into half sitting position, head

inclined to the injured sideinclined to the injured side

2. Cover 2. Cover the ear with a sterile dressingthe ear with a sterile dressing or clean pad or clean pad

3. Send or take the casualty to the hospital3. Send or take the casualty to the hospital

Bleeding At Special SitesBleeding At Special Sites Bleeding From The MouthBleeding From The Mouth

It usually originates from cuts from the It usually originates from cuts from the

tongue, lips, or lining of the mouth usually tongue, lips, or lining of the mouth usually

from victims teeth. Bleeding can be profuse from victims teeth. Bleeding can be profuse

and alarming.and alarming. TREATMENTTREATMENT

1. Sit 1. Sit the casualtythe casualty down, with theirdown, with their head forward & head forward &

inclined towards the injured side to allow inclined towards the injured side to allow

blood to drain.blood to drain.

2. Ask victim to press the wound between 2. Ask victim to press the wound between

thumb thumb & finger w/ a gauze pad over& finger w/ a gauze pad over the wound the wound..

Bleeding At Special SitesBleeding At Special Sites

3. 3. If bleeding persists, replace the pad with a If bleeding persists, replace the pad with a

fresh one. Tell victim to let escaping blood fresh one. Tell victim to let escaping blood

dribble; dribble; If swallowed If swallowed it may induce vomiting.it may induce vomiting.

4. Do not wash the mouth as this may disturb 4. Do not wash the mouth as this may disturb

a clot.a clot.

5. Advise casualty to avoid hot drinks for 12 5. Advise casualty to avoid hot drinks for 12

hours.hours.

6. If the wound is large or bleeding persists 6. If the wound is large or bleeding persists

beyond 30 minutes, or recurs; seek beyond 30 minutes, or recurs; seek

medical or dental consultation. medical or dental consultation.

Bleeding At Special SitesBleeding At Special Sites NosebleedsNosebleeds

Most commonly occurs when blood vessels Most commonly occurs when blood vessels

inside the nostrils rupture. It is usually inside the nostrils rupture. It is usually

ununpleasantpleasant, but can be dangerous if casualty , but can be dangerous if casualty

loloses a lot of blood. Thinses a lot of blood. Thin & watery& watery noseblenosebleeds eds

aafter head injury is seriousfter head injury is serious probleproblem= m= CSF CSF leakagleakage.e. TREATMENTTREATMENT

1. Sit the casualty down with his head held 1. Sit the casualty down with his head held

forward. Do Not let his head tip back; bloodforward. Do Not let his head tip back; blood

may may run down his throatrun down his throat and induce vomiting and induce vomiting..

Bleeding At Special SitesBleeding At Special Sites

2. Ask the casualty to breathe thru his mouth, 2. Ask the casualty to breathe thru his mouth,

(calm effect) and to pinch nose just below(calm effect) and to pinch nose just below

the bridge. Help him if necessary.the bridge. Help him if necessary.

3. Tell him not to speak, swallow, cough, spit, 3. Tell him not to speak, swallow, cough, spit,

sniff, as it disturbs a blood clot. Give him a sniff, as it disturbs a blood clot. Give him a

clean cloth or tissue to mop up dribble.clean cloth or tissue to mop up dribble.

4. After 10 minutes, tell the casualty to release 4. After 10 minutes, tell the casualty to release

the pressure. If his nose is still bleeding, the pressure. If his nose is still bleeding,

reapply the pressure for further periods of reapply the pressure for further periods of

10 minutes. 10 minutes.

Bleeding At Special SitesBleeding At Special Sites 4. 4. If it persists beyond 30 minutes, take or send If it persists beyond 30 minutes, take or send the casualty to hospital.the casualty to hospital.

5. Once the bleeding is under control, and with 5. Once the bleeding is under control, and with the casualty still leaning forward, clean the casualty still leaning forward, clean gently around his nose and mouth withgently around his nose and mouth with lukewarm water.lukewarm water.

6. Advise the casualty to rest quietly for a few 6. Advise the casualty to rest quietly for a few hours and to avoid exertion and, in hours and to avoid exertion and, in particular, not to blow his nose, as this will particular, not to blow his nose, as this will disturb any clot.disturb any clot.

principles of trauma care (2)

Health & Medicine