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Paramedic Care Principles & Practice Volume 4 Trauma Emergencies Second Edition Chapter 12 Shock Trauma Resuscitation Figure 12-1 Motor vehicle crashes account for about 30 percent of trauma fatalities in the United States. (© Craig Jackson/In the Dark Photography) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-2 A sample home safety inspection form. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-3 Young males account for a disproportionate representation of mortality and morbidity among trauma victims. (© Mark C. Ide) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-4 Assess the emergency scene quickly and carefully, looking for scene hazards, possible mechanisms of injury, the location of patients, and the possible need for additional resources. (© Jeff Forster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-5 Analyze the forces of a vehicle collision, and based on that analysis, anticipate possible patient injuries. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-6 Analyze the scene carefully to determine the need for body substance isolation procedures. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-7 Assess the emergency scene to determine the need for any additional resources. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-8 A trauma assessment form can help you organize priorities at any emergency scene. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-9 Form a general impression of the patient during the initial assessment and refine it during the rest of your time at the patient’s side. (© Craig Jackson/In the Dark Photography) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-10 Auscultate for the presence and quality of breath sounds. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-11 Inspect the chest carefully for signs of injury. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-12 At the end of the rapid trauma assessment or the focused assessment, make the final decision on whether to provide stabilization on the scene or to expedite transport of the patient. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-13 With a seriously injured trauma patient, employ the aggressive care steps of shock trauma resuscitation. (© Craig Jackson/In the Dark Photography) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-15 Use intravenous fluid warmers as necessary. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-16 Seriously injured patients who require rapid transport may be immobilized to a long spine board for effective splinting of limb fractures. (© Craig Jackson/In the Dark Photography) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-14 Hypothermia poses a serious threat to trauma patients. Assure that your care helps the patient maintain his body temperature. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-17 Anatomical and physiological considerations with infant and child patients. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-18 Paramedics must make special efforts to gain the confidence of pediatric patients. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-19 Consider intraosseous placement in the tibia when administering fluids and medications in children under age 6 if you cannot obtain normal intravenous access. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-20 Geriatric patients represent one of the fastest growing groups requiring emergency medical services. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-21 Age-related changes in geriatric patients. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-22 It is essential that information exchange among care providers be rapid, thorough, and accurate. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-23 In recent years, use of helicopters has become widely available to EMS systems throughout the country. (© Mark C. Ide) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-24 Helicopters can provide special services like search and rescue, vertical lifting, and specialized transport. (© Jeff Forster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-25 Special considerations with helicopters. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 12-26 The working space in a helicopter is limited, so try to complete all crucial procedures before you load the patient. (© Mark C. Ide) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Trauma Emergencies Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.