trauma protocols critical care and paramedic levels
TRANSCRIPT
Trauma ProtocolsCritical Care and Paramedic Levels
Trauma: Unstable Patients
• Traumatic Arrest/Unstable Airway– Closest facility
• Transport unstable patients to hospital/landing zone within 10 minutes of extrication
Trauma: Transport Guidelines
Trauma: General Guidelines
• Prolonged transport– Consider aeromedical utilization – > 45 minutes by ground and air not available• Call medical direction – consider transporting to closest
emergency department
– Transporting trauma to non-trauma center• Notify emergency department as early as possible
Trauma: Aeromedical Utilization
• Must SIGNIFICANTLY reduce transport time
• Signs of life!!!• Don’t wait for the
helicopter • <20 mile transport?• Entrapment
Trauma: Pregnant Patients
• Adult trauma pt > 20 weeks gestation– Not meeting trauma criteria – ER of their choice– Meeting trauma criteria – Adult trauma center!
Trauma: Burn Patients
• Burn Criteria for transport to burn center– >10% BSA partial thickness burns– Involvement of face, hands, feet, genitalia, or major
joints– Third degree burns– Electrical burns, including lightning injuries– Chemical burns– Inhalation injury– Circumferential burns
Trauma: Burn Management
• Fentanyl added• Less BP effect• Med control only• Rigid chest with
rapid push
Trauma: Chest
• Fentanyl added
Trauma: Crush Injury
• New Protocol• For prolonged
entrapment only • Tourniquet use?• Pre-medicate
Trauma: Head Injury
• No changes
Trauma: Extremity Injury
• Tourniquet use• Hemostatic dressing• Once applied do not
remove• Fentanyl added
Trauma: Hypoperfusion
• Differing fluid goals for compressible injury
• Reflects current ITLS/ATLS guidelines