Critical Decision Points - Trauma

Information Covered:

  1. Kinematics of trauma
    1. Definition
      1. Looking a trauma scene and attempting to determine what injuries might have resulted
      2. Kinetic energy – function of weight of an item and its speed.
      3. Blunt trauma
        1. Objects collide during crashes
        2. Unbelted drivers and front seat passengers suffer multi-system trauma due to multiple collisions of the body and organs
        3. Direction of the force has impact on type of injury
      4. Deceleration Injuries
      5. Penetrating Trauma
        1. Energy levels have effect
          1. low energy -- stabbings
          2. medium energy -- handguns and some rifles
          3. high energy -- military weapons
  2. Multi-System Trauma
    1. Definition
      1. Almost all trauma effects more than one system
      2. Typically a patient considered to have “multi-trauma” has more than one major system or organ involved
      3. Multi-trauma has a high level of morbidity and mortality
    2. The golden principles of out of hospital trauma care
      1. Safety of patient and rescue personnel
      2. Determination of additional resources
      3. Kinematics
        1. Mechanism of injury
        2. High index of suspicion
      4. Identify and manage life threats
      5. Airway management while maintaining cervical spinal immobilization
      6. Support ventilation and oxygenation
      7. Control external hemorrhage
      8. Basic shock therapy
      9. Maintain spinal immobilization on long board
      10. Transportation considerations
      11. Obtain medical history
      12. Secondary survey after maintenance of life threats
      13. “Do No Further Harm”
    3. Critical Thinking in multi-system trauma care
      1. Airway, ventilation and oxygenation are key elements to success
      2. Oxygenation can not occur when patients are bleeding profusely
      3. Sequence of treating patients
      4. Rapid transport is essential
      5. Backboards
      6. Documentation and Reporting
      7. Personal safety
        1. Most important when arriving on scene, and throughout care, an injured EMT can not provide care
        2. Be sure to assess your environment
          1. passing automobiles
          2. hazardous situation
          3. hostile environments
          4. unsecured crime scenes
          5. suicide patients who may become homicidal
      8. Experience
        1. Newly licensed paramedics who have not seen many multi-system trauma patients need to stick with the basics of life saving techniques
        2. Do not develop “tunnel” vision by focusing on patients who complain of lots of pain and are screaming for your help while other quiet patients who may be hypoxic or bleeding internally can not call out for help because of decreases in level of consciousness
        3. Be suspicious at trauma scenes, sometimes an obvious injury is not the critical cause one the potential for harm.
        4. Trauma care is a leading cause of death of young people. It is essential you keep important care principles in mind when providing care.
  3. Specific injuries related to multi system trauma
    1. Evidence-based decision making
      1. Traditional medical practice is based on
        1. Medical knowledge
        2. Intuition
        3. Judgment
      2. High-quality patient care should focus on procedures proven useful in improving patient outcomes
      3. The challenge for EMS is the relative lack of prehospital research.
      4. Evidence-based decision making technique

Content Creator: Ariel Wai
CAPCE Course Number: 20-EMTP-F3-2202
Total CE Hours: 1.5
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.