Page 27 - PJ MED OPS Handbook 8th Ed

Penetrating Eye Trauma
Dx:
1. Vision test: document highest level of function – read print, count fingers, hand motion, light
perception, no light perception

Rx:
1. Rigid eye shield
2. Antibiotics (PO if able)

Abdominal Evisceration
Rx:
1. Stop the bleeding and clean the bowel
2. Gently put back in if able, otherwise moist dressing over bowels, occlusive over that
3. Suture staple tape abdomen closed if bowels replaced
4. Ertapenem

Flail Chest
Rx:
1. Analgesics
2. Monitor patient for desaturation or respiratory distress
3. Positive pressure ventilation: assisted ventilations or RSI and bag/vent

Extremity Trauma
Rx:
1. Splint/immobilize
2. Use traction device for isolated mid – femur fractures
3. Document PMS
4. Reduce fractures and dislocations when possible
5. R/O compartment syndrome: pain out of proportion to appearance and pain with passive motion
6. Consider fasciotomy for leg compartment syndrome and >6 hours to definitive care

WARNING Do not use traction device if the pelvis is unstable.

Shock: Non-hemorrhagic
Rx:
1. 1–2 L of LR, except 250mL boluses for cardiogenic shock
2. Anaphylactic: Epi, Benadryl, Decadron, Pepcid (Dx – allergic stimulus, red skin, facial swelling,
respiratory distress, hypotension)
3. Septic: Ertapenem, Epi if no response to LR ( Dx – source of infection, fever)
4. Neurogenic: Epi if no response to LR (Dx – spine trauma, back pain, deformity of spine, weak-
ness/paralysis/decreased sensation of extremities, etc.)
5. Cardiogenic: FONA (fentanyl, oxygen, Nitro, aspirin) for chest pain, hold nitro and fentanyl for
systolic BP <90

Chapter 4. PJ Medical and Trauma Protocols (MTPs) n 25