Page 17 - 2023 SMOG Digital

Trauma

MULTIPLE TRAUMA

Signs and Symptoms: Possible Injuries / Diagnoses:
• Pain, Swelling, Bleeding, Ecchymosis • Tension Pneumothorax • Head Injury, HEENT injuries
• Deformity • Flail Chest • Extremity Fracture / Dislocation
• Altered Mental Status • Pericardial Tamponade • Hypothermia
• Respiratory Distress / Failure • Open Chest Wound • Burns
• Vomiting • Hemothorax • Pelvis / Long-bone Fracture
• Hypotension / Shock • Intra-abdominal Injury / • Spine / Spinal Cord Injury
• Cardiac Arrest Bleeding
Continued from: Consider early airway
Tactical Evacuation Guideline HEMORRHAGE CONTROL management per Respirations <8 or >30
• Check / Add Tourniquet Airway and Chest • Reposition Airway / OPA
Rapid Assessment with GCS • Pack and Dress Wound Trauma Guidelines • AIRWAY GUIDELINE
Concentration on C, A, B • Pressure Dressing o Nasopharyngeal Airway
• Hemostatic Dressing Spinal o Intubation
Minimize On-Scene Time • Treatment Order by Immobilization PRN o Cricothyroidotomy
Severity of Hemorrhage
IV / IO GUIDELINE Chest Injury (Impacts Breathing)
HYPOTENSION / SHOCK GUIDELINE • CHEST TRAUMA GUIDELINE
• Blood (if available) (Blood Guideline) Vital signs / perfusion? o Needle Thoracostomy
o Finger Thoracostomy
o Tube Thoracostomy
TXA: 2g IV/IO Abnormal Normal o Positive Pressure Ventilation
IF Hemorrhage with HR >100 or SBP <100
ENSURE Fractures are Stable: Altered Mental Status
• Reduction / Compression of pelvic fractures or MOI c/w Head or Head Injury Guideline
• Reduction of long bone (Femur) fractures Spinal Injury
• Re-assess Control of External Hemorrhage
(Continued Decompensation) Abnormal Vital signs / perfusion Normal
Restart Guideline PAIN MANAGEMENT GUIDELINE
Check and Readdress: (Hemodynamic & Mental Status Stable)
• Hemorrhage control (MOST IMPORTANT) Loss of Circulation at
• Airway: Respiration rate, O 2 , SpO₂ any time:
• Breathing: Equal Rise / Fall, Bruising, Tracheal Start CPR Return to:
shift, Sub-Q Emphysema Move to:
• IV / IO lines open and running TRAUMA ARREST Tactical Evacuation
Guideline
• Pelvic / Femur FXs reduced and stable Guideline
• Head and/or Spinal Injury
Pearls:
• Optimize Hemostasis:
o Hemorrhagic trauma with NO significant head injury:: Should target maintaining SBP >100. Casualties able to maintain
SBP >100 do not need immediate fluid resuscitation.
o Hemorrhagic trauma WITH significant head injury: : should target maintaining SBP >110
o If SBP falls <100 (with TBI <110), transition to Enroute Damage Control Resuscitation guideline.
o Narrowed pulse pressure should prompt resuscitation - do not wait for decompensation to ensue.
o Stabilize pelvic fractures with pelvic splint or sheet / binder and tie feet together. Up to 4-6L of blood can be hidden in the pelvis

17