Injury caused by an object breaking the skin and entering the body. immediate intervention to repair internal
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1 1 Chapter 16: Trauma & Trauma Systems 2 Trauma Leading killer of persons under in US. -150,000 Deaths annually -44,000 MVC -28,000 GSW Most medical problem in terms of lost wages, initial care, rehabilitation, and lifelong maintenance. 3 Types of Trauma Injury caused by an object breaking the skin and entering the body. Injury caused by the collision of an object with the body in which the object does not enter the body. 4 Serious/Life Threatening Problems Occur in less than % of all trauma patients. Must recognize difference between & nonserious problems and triage your care. 5 Serious trauma is a disease; its proper care is immediate intervention to repair internal hemorrhage sites. 6 Trauma Care System Highway Safety Act of 1966 Lead to development of Victims of MVC s suffered from the initial trauma, but also from inadequate care. American College of Surgeons 1990: Trauma Care Systems Planning and Development Act -Establish guidelines, funding and state-level leadership for the development of systems 7 Designation/Verification of Trauma Centers National standard ACS optimal resource document as a ACS Committee on Trauma verification/ consultation on site Allows for local variations and accreditation 8 Trauma Care System Integration of EMS and care Reduces Cost Time to 1
2 Mortality Proper Care Immediate surgical intervention to repair sites 9 Trauma Center Designation Level I Trauma Center All types of specialty trauma 24/7 Includes unit. Research and teaching Level II Trauma Center Majority of surgical and medical subspecialties available 24/7 10 Trauma Center Designation Level III Trauma Center Specialized ED with the majority of surgical and medical subspecialties available 24/7 (on call) Level IV Rural hospitals No immediate surgical intervention necessary Stabilize and out 11 Trauma Center Designation Specialty Centers Burn Centers Trauma Therapy Microsurgery 12 EMS Role (1 of 3) Trauma Triage Criteria Nearest Facility Mechanism of Injury Analysis (MOI) Processes and forces that trauma. Consider forces 13 EMS Role (2 of 3) Index of Suspicion (IOS) Anticipation of to a body region, organ or structure based on MOI Shock and Injury Frequent reassessment and 2
3 14 EMS Role (3 of 3) The Golden Hour: Research has shown that the BEST survivability from incident to surgery is hr. (The smaller time, the better!) 10 Minutes -Scene time limited to 10 minutes Treat immediate life threats and everything else should be done 15 Air Transport Compare vs Speed Utilize to time to ER Utilize to obtain specialized care Chest tubes Rapid sequence Specialized drugs Specialized 16 Trauma Scoring Systems Used to apply to trauma patients that can immediately provide a score that indicates the severity of injury. Two most common scoring systems are: Coma Scale Trauma Scale 17 Glascow Coma Scale (GCS) 18 Revised Trauma Score 19 Pediatric GCS 20 Pediatric RTS 21 Trauma Triage Criteria Indicating Immediate Transport (1 of 3) MOI-Adults: > fall Pedestrian/Bicyclist versus auto Thrown or run over by vehicle Struck by vehicle traveling > mph Motorcycle impact >20 mph from a vehicle 22 Trauma Triage Criteria Indicating Immediate Transport (2 of 3) More MOI-Adults: Severe vehicle impact > mph >12 intrusion 3
4 >20 vehicle deformity with signs of serious impact of another occupant Extrication time > minutes 23 Trauma Triage Criteria Indicating Immediate Transport (3 of 3) MOI-Pediatrics: > fall collision Vehicle collision at medium speed Any vehicle collision involving an unrestrained infant or child 24 Physical Findings in Need of Immediate Transport (1 of 2) Revised Trauma Score < Pediatric Trauma Score <9 Glasgow Coma Scale < Systolic blood pressure <90 Respiratory rate < > 25 Physical Findings in Need of Immediate Transport (2 of 2) >2 proximal long bone fractures chest Pelvic fracture Limb paralysis Burn > % BSA Burn to face or airway trunk, neck and head trauma 26 EMS Role (1 of 3) Decision to Transport Based upon trauma triage criteria - Problems -IV Access and other time consuming procedures enroute -Err on the side of If patient DOES NOT fit a trauma triage criteria but has signs & symptoms,! 27 EMS Role (2 of 3) Injury Prevention: safety programs Firearm safety Boat safety Child Safety Seat classes and checking Data & Trauma Registry: Data system for trauma patient information 4
5 Used to evaluate and the trauma system 28 EMS Role (3 of 3) Quality Improvement: QI, QA, or QM Examining the performance and attempt to improve and provide better patient care. Evaluate calls to determine if of care was met Accurate and complete 5
6 Glascow Coma Scale (GCS) Revised Trauma Score EYES VERBAL MOTOR 4 Spontaneous 5 Oriented 6 Obeys 3 Speech 4 Confused 5 Localizes 2 To Pain 3 Inappropriate 4 Withdraw 1 None 2 Garbled 3 Flexion 1 None 2 Extends 1 None GLASCOW SCALE SYSTOLIC BP RESPIRATIONS > > Pediatric GCS Pediatric RTS EYES VERBAL MOTOR 4 Spontaneous 5 Coo, babbles 6 Spontaneous 3 Open to Speech 4 Irritable, Cries 5 Withdraws to touch 2 Open to Pain 3 Cries to Pain 4 Withdraws from pain 1 None 2 Moans to Pain 3 Abnormal Flexion 1 None 2 Abnormal Extension 1 None COMPONENT Weight >20 Kg Kg <10 Kg Airway Normal Maintainable Unmaintainable CNS Awake Obtunded Coma Systolic > <50 Open wound None Minor Major Skeletal None Closed fracture Open/multiple Fxs **Pulse palpable At wrist At groin No pulse palpable **If proper size BP cuff is unavailable, BP can be assigned by determining pulse palpable point
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