Download Paramedic Care: Principles & Practice Volume 4

Paramedic Care:
Principles & Practice
Volume 4
Trauma Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 12
Shock Trauma Resuscitation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Introduction to Shock Trauma Resuscitation
Injury Prevention
Trauma Assessment
Shock Trauma Resuscitation
Interaction with Other Care Providers
Standard Precautions at the Trauma Scene
Air Medical Transport
Research and Trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to Shock Trauma
Resuscitation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to Shock Trauma
Resuscitation
EMS professionals must secure a future for
prehospital emergency care and assure that
our patients receive the best chances for
survival
– Promoting injury prevention
– Assure that our practices are current and truly
benefit those who receive our care
– Function as an integrated component of the health
care system
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Injury Prevention
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Injury Prevention
Prevention is the greatest key to reduce injury
– Injury prevention is the future of EMS
Programs
Workplace standards for safety
Improved motor vehicle safety
Focus on at-risk populations
Males 13–35
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Injury Prevention
Home Inspection Example
Click here to view the injury prevention home inspection form.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Dispatch Information
– Critical pre-arrival information:
Nature of call
Number of victims
Mechanism of injury
Safety of scene
– Anticipate and prepare for injuries:
Equipment to be brought to the patient
Procedures to be performed
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Scene Size-up
– Mechanism of
Injury Analysis
– Hazard
Identification
– Accounting for
and Locating all
Patients
– Resource Needs
Determination
© Jeff Forster
© Mark C. Ide
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Initial Assessment
Spinal Precautions
– Provide spinal restriction after appropriate
assessment of neck and back
General Impression
Mental Status
– AVPU
– A&O x 4
Time, place, event, and person
– Noxious or painful stimuli
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Initial Assessment
Airway
– Open
– Patent
– Noisy Respirations
Breathing
–
–
–
–
High-Flow O2
Auscultation
Assess injuries
Ventilatory effort
Circulation
– Detect signs of shock
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Initial Assessment
Concluding the
initial assessment
– Modify MOI analysis
– Safety
– Assessment
considerations
Rapid trauma
Focused
– Transport
considerations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Examination
Techniques
The rapid trauma assessment and the
focused exam use basic techniques of
assessment:
– Patient questioning
– Inspection
– Palpation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Examination
Techniques
Questioning
– Question the patient about any symptoms
– Patient complaints are subjective
Watch response to pain
Note if easily distracted from pain
– Note complaint in patients own words
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Examination
Techniques
Inspection
– Look first to the skin color
Initial coloration is a baseline when you examine injured
regions of the body
– Look for deformities
Compare limb to limb or one side of the body to the other
– Examination for disruption of the skin (wounds)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Examination
Techniques
Palpation
– Gently touch the entire surface of the area being
evaluated
– Note any muscle spasm (guarding) or pain on
palpation
Observe for painful movement or rebound tenderness
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Examination
Techniques
Auscultation
– Evaluate for the
presence and
quality of breath
sounds
– Compare side-toside and regional
differences
Percussion
– Resonance
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Rapid Trauma Assessment
– Scan the body looking for hemorrhage or
evidence of significant injury
– Examine the patient’s head, neck, chest,
abdomen, pelvis, extremities, and back
– Quick patient history and a set of vital signs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Focused Exam and History
–
–
–
–
–
Performed if limited injuries
Direct exam to location of patient complaints
Use examination criteria for detailed examination
Patient history
Vitals
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Detailed Physical Exam
– An organized and intensive evaluation of each
body area:
Head, neck, chest, abdomen, back, pelvis, and
extremities
– DCAP-BTLS may be useful in identifying potential
injuries to each area
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Detailed Physical Exam
Head
– Inspect and Palpate
– Evaluate
Eyes
Pupillary response
H-Pattern evaluation
Ears
Fluid
Nose and Mouth
Fluid and obstructions
Face
Battle’s sign and raccoon’s eyes
Le Fort fractures
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Detailed Physical Exam
Neck
– Signs of injury
– Position of trachea
Displacement indicative of tension pneumothorax
– Status of jugular veins
Normal
Distended in supine position
Flatten as head raised above 45o
Abnormal
Distended
Flat
Hypovolemia
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Detailed Physical Exam
Chest
–
–
–
–
–
–
Retractions
Sucking wounds
Paradoxical chest movement
Erythema
Auscultate all lung fields
Palpate
Crepitus
Gentle pressure on rib cage
Subcutaneous emphysema
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Detailed Physical Exam
Abdomen
– Asymmetry
– Pulsing masses
– Contusion, erythema, and ecchymosis
Pelvis
– Firm pressure on iliac crests medially
– Downward on pubis
– Examine buttocks and inguinal area
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Detailed Physical Exam
Extremities
–
–
–
–
–
Muscle tone
Distal pulse
Temperature
Color
Capillary refill
Back
– Evaluate during log roll
– Maintain proper spinal restriction procedures
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Patient History
AMPLE History
–
–
–
–
–
Allergies
Medications
Past medical history
Last oral intake
Events leading up to the incident
Vital Signs
–
–
–
–
Pulse rate and quality
Respiratory rate and quality
Blood pressure
Skin temperature and condition
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Glasgow Coma Scale
Determine
your patient’s
Glasgow
Coma Scale
score
Best eye,
verbal, and
motor
response
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Transport Decision
– Rapid Transport
Trauma triage criteria
Revised Trauma Score
Includes Glasgow score, pulse, and blood pressure
– Treat and Transport
No significant MOI and non-urgent injuries
– Treat and Release
Minor and isolated injuries
– Patient Care Refusals
Provide the patient with information
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Steps to Follow for
Patient Refusals
Strongly suggest that patient receives
assessment, care, and transport
Warn patient of the dangers of refusing
assessment, care, and transport
Suggest that the patient see a family
physician for follow-up
Encourage the patient to contact EMS if the
problem persists or worsens
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma Assessment
Ongoing Assessment
–
–
–
–
To monitor and guide care
Critical: every 5 minutes
Non-critical: every 15 minutes
Components
Vitals
Recheck interventions
Mental status
Skin condition
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Signs of Deterioration
Pulse
Mental Status
– Increasing pulse
– Decreasing pulse
strength
– Narrowing pulse
pressure
– Increasing capillary refill
time
– Decreasing mental
status
– Increasing anxiety or
restlessness
Skin
– Changes in skin color or
temperature
Respirations
– Increasing respiratory
rate
– Decreasing respiratory
volume
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Hypovolemia/Hypotension/Hypoperfusion
– Describes status of cardiovascular system
Hypovolemia
Reduced volume in cardiovascular system
Hypotension
Reduction in blood pressure caused by cardiac, vascular,
neurogenic, or volume problems
Hypoperfusion
Low or inadequate distribution of blood to body organs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Shock trauma resuscitation is care to rapidly
support the seriously injured trauma patient
– Providing airway protection with endotracheal
intubation or rapid sequence intubation
– Assuring adequate oxygenation and ventilations
– Providing appropriate fluid resuscitation
– Performing pleural decompression
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Airway Protection
– Intubation
– RSI
Assure adequate oxygenation and ventilation
– <12 or >30 breaths/minute
BVM
Provide rapid fluid resuscitation
– 2 large-bore IVs
– Isotonic fluids
Maximum 3 L
Chest Decompression
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Hypothermia
– Due to
sympathetic
effects
– Body begins to
conserve energy
– Prevention:
Provide warm
fluids during fluid
resuscitation
Maintain patient’s
body temperature
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Body Splinting
– Splinting must be
effective and
performed quickly
– Best accomplished
by aligning limbs
and securing body
on long spine board
© Craig Jackson/In the Dark Photography
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Rapid Transport
– Best way to reduce mortality
Rapid packaging
Reduce time on scene
Limit scene time to 10 minutes
Perform procedures en route to hospital
IV and PASG while immobilizing spine
Other critical procedures en route unless delayed on scene time
due to prolonged extrication
Consider using air medical transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Fight-or-Flight Response
– Autonomic nervous system response
Sympathetic nervous system stimulation
Increase heart rate
Increase stroke volume
Increase respiratory rate and volume
– Calm and reassure the patient to minimize effects
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shock Trauma Resuscitation
Non-Critical Patients
–
–
–
–
–
Account for 80% of trauma patients
Receive focused exam
Receive focused care
Monitor interventions
Monitor for deterioration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Patients
Pediatrics
– Same basic
anatomy and
physiology as adults
– Trauma greatest
cause of death
during first year of
life
Blunt trauma
greatest cause
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pediatric Anatomical
Differences
Smaller size and
weight
– Larger ratio of body
surface area to
volume
Organs closer
together
Limbs proportionally
shorter
Heads proportionally
larger
Tongues more likely
to obstruct airway
Obligatory nose
breathers
Trachea shorter and
more delicate
Bones softer and
more pliable
– Energy of trauma
distributes better to
organs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Patients: Pediatrics
Compensatory Mechanisms
– Vibrant cardiovascular system
Greater compensation during shock
Rapid deterioration once compensation fails
Rapid progression to irreversible shock
Loss of vital signs
– Respiratory system has less reserves
Less able to tolerate stressors
Muscles tire quickly due to faster respirations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pediatric Care
Maintain airway in neutral position
– Pad under shoulders
Insert oral airways using tongue blade
Keep nasal passage clear in children under
6 months of age
Use uncuffed endotracheal tube
– Approximate size of little finger
IV access same as adult
– Consider IO in children <6 yrs
– Fluid bolus: 20 mL/kg:
Administer sooner than in adults
Can repeat to up to 60 mL/kg
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Patients
Geriatrics
– Fastest growing
population
Healthier lifestyles
and the advances of
modern medicine are
extending life
– Trauma accounts for
25% of mortality
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Geriatric Patients
Aging affects virtually
every body system
Preexisting diseases
are more prevalent in
the geriatric population
Assessment of the
geriatric patient is often
difficult
– Problem is often masked
by other signs and
symptoms of disease
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Patients
Geriatric Care
– Initiate shock care early
Provide care conservatively
Monitor for fluid overload
–
–
–
–
–
Consider smaller IV catheters
Frequent chest auscultation
Maintain warmth
Monitor ECG
Aggressive oxygenation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interaction with Other
Care Providers
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interaction with Other
Care Providers
Providing information to
other health care
providers:
– Mechanism of injury
– Results of assessment
Injuries
Normal or abnormal
history
Vital signs and trends
Patient age, sex, and
weight
SAMPLE history
– Interventions
Information must be
clear and concise
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Standard Precautions
at the Trauma Scene
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Standard Precautions
at the Trauma Scene
Handle contaminated materials while
wearing PPE
Dispose of contaminated linens, clothing,
dressing, and equipment in properly labeled
containers
Dispose of sharps in puncture-resistant
sharps container
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Standard Precautions
at the Trauma Scene
Do not recap sharps
Do not stick sharps into mattresses
Scan the scene prior to departure to ensure
that contaminated material has been
collected
Contact Infection Control Officer if personnel
become contaminated
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Air Medical Transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Air Medical Transport
Indications for air transport
– Ground versus air transport
If ground transport time exceeds 20 minutes, helicopter
transport may be warranted
Air transport equates to 1 min/2 miles
Consider rendezvous with helicopter
– Consider placing helicopter on standby
Limitations for air transport
– Weather
– Dispatched to another call
– Down time for maintenance
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Air Medical Transport
Landing Zone Criteria
– Free of debris and dust
Consider wetting to reduce “dust out”
–
–
–
–
As level as possible
Free of power lines
Charged fire hose
Size of landing zone
Small helicopter: 60’ x 60’
Medium helicopter: 75’ x 75’
Large helicopter or in doubt: 120’ x 120’
– Contact local helicopter agency for their specific
landing zone criteria
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Air Medical Transport
Working around the Helicopter
–
–
–
–
–
–
Approach only after pilot signals
Approach from front at direction of flight crew
Allow flight crew to load and unload patient
Keep head down
Secure hats and glasses
Secure sheets and items that can be drawn up
into rotors
– Follow flight crew instructions
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Considerations
with Helicopters
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Air Medical Transport
Flight Physiology
– Higher altitude-less pressure on patient
Internally trapped air exerts more pressure
Conditions that can worsen:
Asthma
COPD
Tension pneumothorax
Interventions that can worsen:
PASG can increase in pressure exerted
Cuffed ET tubes expand
Pressure infusing bags exert more pressure
Air splints exert more pressure
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Air Medical Transport
Flight
Considerations
– Confined working
area
Perform crucial
procedures prior to
loading
– Limited ability to
perform procedures
Fully immobilize
patient prior to
transport
© Mark C. Ide
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Air Medical Transport
Air Medical Patient Preparation
– Assure maximal oxygenation
– Assure maximal ventilation
– Administer high-flow oxygen
Consider intubation or RSI
– Assess for pneumothorax
Decompress prior to loading
– Establish 2 large-bore IV lines
– Provide flight crew with complete and abbreviated
patient report
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Research and Trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Research and Trauma
Research must occur to assure that EMS
uses procedures beneficial to patient
outcomes
– Outcomes include discharge from hospital
NOT delivering a “live” patient to the hospital
All EMS personnel must participate to ensure
optimal patient care
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Introduction to Shock Trauma Resuscitation
Injury Prevention
Trauma Assessment
Shock Trauma Resuscitation
Interaction with Other Care Providers
Standard Precautions at the Trauma Scene
Air Medical Transport
Research and Trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ