SPM 200 Clinical Skills Lab 8 Basic Trauma

SPM 200 Clinical Skills Lab 8 Basic Trauma Life Support and Trauma Resuscitation Daryl P. Lofaso, M. Ed, RRT

Trauma n n Trauma remains the leading cause of death in the first four decades of life (ages 1 - 44) 150, 000 deaths annually in the US Disabilities dwarfs mortality by 3 to 1 Trauma related cost: $400 billion annually

Trimodal Death Distribution n First Peak n n Second Peak n n death occurs in seconds to minutes of injury (lacerations: brain, brain stem, high cord , heart, aorta, &b large blood vessels) death occurs within minutes to several hours of injury (subdural/epidural hematomas, pneumothorax, spleen, liver, pelvic fx & blood loss) Third Peak n death occurs several day to weeks after initial injury (sepsis and multiple organ system failure)

Mechanism of Injury n Motor Vehicle Collision (MVC) § n Falls § § n > 12 ft. Lethal Dose (LD 50) > 48 ft. Penetrating § n T-bone, Roll-over Gunshot wound (GSW) & Stab Altercation § Fist, stick, pipe

Classification of Head Injury n Blunt n n n High velocity (MVC) Low velocity (fall, assault) Penetrating n n Gunshot wound (GSW) Other penetrating injuries (stab)

Severity of Head Injury n Mild n n Moderate n n GCS Score: 14 - 15 GCS Score: 9 - 13 Severe n GCS Score: 3 - 8

T-Bone Collision

T-Bone Collision Injuries n Impact to Driver: n n n Closed Head injury (CHI) C-spine Pelvic fx & Extremity fx (Long Bone) Spleen Blunt chest trauma n n n Pulmonary contusion Rib fx Cardiac contusion

T-Bone Collision Injuries n Impact to Passenger: n n Closed Head injury (CHI) C-spine Pelvic fx & Extremity fx (Long Bone) Solid organ injury n n Liver, spleen Blunt chest trauma n n Pulmonary contusion Rib fx Cardiac contusion Pneumo/Hemothorax

Pedestrian vs. Car n n n Most likely injury types: Adults – tibia / fibula or knee fx Teenagers – femur Small kids (ages 5 -7) head on the bumper

Pathophysiology of Shock is an acute state in which tissue perfusion is inadequate to maintain the supply of oxygen and nutrient necessary for normal cell function. (Alexander et al 1994), which results in widespread hypoxia. Inability to maintain homeostasis.

Shock: Inadequate Tissue Perfusion n ↓ Circulating blood volume Failure of the heart to pump effectively Massive increase in peripheral vasodilation

Classification of Shock n n n Hypovolaemic: ↓ Blood volume Cardiogenic: Left vent. failure Anaphylatic: severe allergic reaction (vasodilation) Septic: over-whelming bacterial toxins (vasodilation); (Most common: Gram -) Neurogenic: loss of sympathetic nerve activity (vasodilation); Drug or Trauma injury

Stages of Shock n n Initial Stage: cells are deprived of oxygen; no energy (ATP); cells become damaged Compensatory Stage: anaerobic metabolism and hyperventilation Progressive Stage: compensatory mechanisms fail Refractory Stage: vital organs have failed and shock can no longer be reversed

Fluid Replacement n Crystalloids Fluid ¡ ¡ n Peds. – Normal Saline (NS) (20 cc/kg) Adults – NS / Lactated Ringers (LR) (2 L) If unresponsive to fluid bolus, repeat & consider blood. ¡ ¡ ¡ “O” neg. (1 st available – 1 min. ) Type specific (2 nd available – 10 -15 min. ) Fully type and matched (3 rd available – 15 -30 min. )

PE Exam Signs of Trauma n n Raccoon Eyes Battle Sign Flail chest Indicate Retroperitoneal Injury ¡ Periumbilical Ecchymosis n ¡ Flank Ecchymosis n n Cullen’s sign Gray – Turner’s sign Seat Belt Sign n ↑ Probability of Intra-Abdominal Injury

Injuries n n n Hip Fx. - leg shortened & externally rotated Posterior Hip Dislocation – injury leg internally rotated & flexed Anterior Shoulder Dislocation – arm positioning – adduction and flexion at elbow