Illinois EMSC 1

Trauma ObjectivesUpon completion of this lecture, you will

be better able to: Discuss how mechanism of injury affects

your evaluation of an injured student Describe special assessment considerations

for injured students of various ages Based on assessment findings, develop and

prioritize a plan of care for selected injuries

Illinois EMSC 2

TRAUMA

Illinois EMSC 3

MECHANISM OF INJURY

Kinetic Thermal Electrical Chemical Radiant Asphyxiation

Illinois EMSC 4

KINETIC ENERGY FORCES BLUNT CRUSH ACCELERATION/DECELERATION PENETRATING

Illinois EMSC 5

Illinois EMSC 6

Illinois EMSC 7

INJURY SEVERITY FROM FALLS

Fall >10 feet or 3 times the person’s height

Yielding vs. nonyielding surface Body area striking the ground

first

Illinois EMSC 8

Illinois EMSC 9

CRUSH INJURIES Energy

concentrated in one body area

Usually involves nerves, muscle, bone, and tendons

Illinois EMSC 10

Illinois EMSC 11

ACCELERATION AND DECELERATION FORCES

Whiplash injury Aortic tear Hepatic artery

tear

Illinois EMSC 12

Illinois EMSC 13

PENETRATING INJURIES High velocity

Guns Low velocity

Knives, pencils

Illinois EMSC 14

BALLISTICS Caliber Tumble Yaw Fragmentation Cavitation Range Weapon

Illinois EMSC 15

ASSESSMENT OF THE INJURED STUDENT

Initial assessment Detailed assessment Triage and transport

Illinois EMSC 16

INITIAL ASSESSMENT Airway/Cervical Spine

Control Breathing Circulation Disability (neurological) Expose

Illinois EMSC 17

PURPOSE OF THE INITIAL ASSESSMENT

Identification of LIFE-THREATENING emergencies

Initiation of LIFE-SAVING measures (CPR)

Illinois EMSC 18

AIRWAY ASSESSMENTStridor Debris in oropharynxAirway obstruction

Illinois EMSC 19

AIRWAY INTERVENTIONS

Jaw thrust AVOID HYPEREXTENSION OR FLEXION OF THE NECK

Log roll to side for emesis

Illinois EMSC 20

CERVICAL SPINE STABILIZATION

Place hands on either side of the head

Maintain neck midline

Illinois EMSC 21

BREATHING ASSESSMENT

Look, listen, and feel Observe chest symmetry Note work of breathing Jugular vein distention Tracheal deviation

Illinois EMSC 22

BREATHING INTERVENTIONS

If breathing is absent, begin mouth to mask ventilations

If breathing is shallow or labored, maintain airway control

Illinois EMSC 23

CIRCULATORY ASSESSMENT

Level of consciousness Carotid pulse (absent or present) Capillary refill Skin color Skin temperature Sites of bleeding

Illinois EMSC 24

CIRCULATORY INTERVENTIONS

If pulse is absent, begin CPR

Apply direct pressure to open wounds

Illinois EMSC 25

NEUROLOGICAL ASSESSMENT

Level of consciousness AVPU scale

Awake Verbal response Pain response Unresponsive

Illinois EMSC 26

Illinois EMSC 27

NEUROLOGICAL INTERVENTIONS

Provide reassurance Tell student what is

happening

Illinois EMSC 28

EXPOSE Remove clothing to

observe the chest Observe the chest for bruises,

penetrations, and symmetry Auscultate breath sounds Auscultate heart sounds

Illinois EMSC 29

DETAILED ASSESSMENT Fahrenheit (keep person warm) Get vital signs Head-to-toe assessment Inspect the back

Illinois EMSC 30

HEAD-TO-TOE ASSESSMENT

Palpate the head and face Observe for fluid from the nose

and ears Assess for pupillary response Reassess the mouth Palpate the jaw

Illinois EMSC 31

BATTLE’S SIGN

Illinois EMSC 32

RACCOON EYES

Illinois EMSC 33

NECK Palpate for pain or

tenderness Observe for tracheal

deviation Observe for jugular

vein distention Observe for impaled

objects and open wounds

Illinois EMSC 34

CHEST

Auscultate breath sounds in all lobes

Auscultate chest sounds Observe work of breathing Palpate for pain/tenderness

Illinois EMSC 35

ABDOMEN Observe for bruising,

impaled objects, open wounds

Palpate lightly for pain, tenderness, and distention

Observe for guarding

Illinois EMSC 36

PELVIS Apply pressure on pelvis to

determine its stability Perform genitalia exam at

one’s discretion

Illinois EMSC 37

Illinois EMSC 38

EXTREMITIES Observe for deformities,

impaled objects, open wounds Palpate for pulses, crepitus, or

swelling Determine capillary refill, skin

color, temperature Assess for pain/tenderness

Illinois EMSC 39

INSPECT THE BACK Log roll student with

assistance School nurse must maintain

cervical spine control Inspect and palpate the

back for bruising, impaled objects, pain and tenderness

Illinois EMSC 40

Illinois EMSC 41

HISTORY SAMPLE

Symptoms Allergies Medications Past history Last meal Events leading to the illness or

injury

Illinois EMSC 42

OTHER CONSIDERATIONS

Stop the assessment if there are changes in the student’s airway, breathing, or circulation

Stabilize impaled objects Apply pressure to open wounds Apply ice to fractures Remove any restrictive clothing

Illinois EMSC 43

TRIAGE DECISIONS EMERGENT (life threatening

injuries) URGENT (fractures, head

injuries) NON-URGENT (minor bruises)

Illinois EMSC 44

EXPECTED OUTCOMES

Maintenance of airway, cervical spine alignment, adequate respiratory effort, adequate circulation to brain and vital organs

Absent or minimal pain, discomfort, and anxiety

Illinois EMSC 45

DOCUMENTATION

School health record

Prehospital providers

Illinois EMSC 46

SELECTED TRAUMA EMERGENCIES

Head injuries Spinal cord injuries Chest injuries Abdominal injuries Musculoskeletal injuries Amputations

Illinois EMSC 47

CONSIDERATIONS IN PEDIATRIC HEAD TRAUMA

Scalp is large and vascular Cranium is thin and pliable Head size is larger in

proportion to body

Illinois EMSC 48

INTERVENTIONS IN HEAD TRAUMA

Continuous monitoring of neurological status pupil size and reactivity LOC body movement

Use direct pressure on open wounds

DO NOT PACK nose or ears if drainage is present!

Illinois EMSC 49

CONSIDERATIONS IN SPINAL TRAUMA Energy forces associated with spinal

trauma (hyperextension, hyperflexion, and axial loading)

Usually occurs during sports or MVC Pediatric spine is malleable and

flexible Pediatric spine is “adult” by age 8 SCIWORA diagnosed in younger

children

Illinois EMSC 50

Illinois EMSC 51

INTERVENTIONS IN SPINAL TRAUMA

Keep student immobilized or lying down

Use the jaw thrust to keep the airway open

A spinal cord injury should ALWAYS be suspected in a student with a head injury!

Illinois EMSC 52

CONSIDERATIONS IN CHEST TRAUMA

Ribs are cartilaginous, allowing energy to be transferred to the heart and lungs

In younger children, the liver is not protected by the rib cage, making liver injuries common

Illinois EMSC 53

INTERVENTIONS IN CHEST TRAUMA

Keep airway open Initiate mouth to mask

ventilations Stabilize impaled objects Use 3 sided occlusive dressing

for open chest wounds Apply pressure to stop bleeding

wounds

Illinois EMSC 54

CONSIDERATIONS IN ABDOMINAL TRAUMA Most abdominal injuries involve

blunt trauma Abdominal muscles are thin and

weak Abdominal organs are not well

protected Liver and spleen are particularly

susceptible

Illinois EMSC 55

INTERVENTIONS IN ABDOMINAL TRAUMA Maintain the ABC’s with

simultaneous spinal stabilization if spinal injury suspected

Cover open abdominal wounds with a sterile dressing moistened with sterile saline

If abdominal contents have extruded, DO NOT attempt to push them back in

Illinois EMSC 56

CONSIDERATIONS IN MUSCULOSKELETAL TRAUMA Epiphyseal plate area is weaker

and more prone to injury Epiphyseal injuries are of concern

since they may inhibit growth and cause deformity

In children with multiple injuries, musculoskeletal injuries can contribute to hypovolemic shock

Illinois EMSC 57

INTERVENTIONS IN MUSCULOSKELETAL TRAUMA

Apply sterile dressings to any open wounds

Stabilize fracture to prevent further injury

Apply splint as appropriate

Illinois EMSC 58

CONSIDERATIONS IN AMPUTATIONS Emergent Requires EMS Vasoconstriction may occur,

minimizing blood loss It is critical to locate the

amputated part and prepare it for transport with EMS

Illinois EMSC 59

INTERVENTIONS IN AMPUTATIONS Rinse amputated part with saline (if

available), wrap in saline moistened gauze, place in plastic bag and place bag on cold pack, label bag with name, date and time

Apply direct pressure to the site Avoid use of a tourniquet Apply new dressings over old

dressings

Illinois EMSC 60

Illinois EMSC 61

SPECIAL NEEDS CHILDREN

Assess usual positioning, LOC and ability to communicate

Provide reassurance Follow the same

sequence of care (ABC’s)

Illinois EMSC 62

FOLLOW-UP AFTER TRAUMA

Note changes in student’s school routines

Update school health record

Facilitate care plan development

Illinois EMSC 63

Illinois EMSC 64

TRAUMA PREVENTION

Encourage safe behaviors

Take legislative actionNote dangerous areas in school

Illinois EMSC 65

SUMMARYInjuries are the leading cause of

death in school-aged children. Appropriate assessment and management of injured students is one of your more important roles.

Track school injuries and use the resulting data as part of your injury prevention efforts.

Illinois EMSC 66

Illinois EMSC 67

ANY QUESTIONS??