Management trauma

Trauma ObjectivesUpon completion of this lecture, you will be better able to:Discuss how mechanism of injury affects your evaluation of an injured studentDescribe special assessment considerations for injured students of various agesBased on assessment findings, develop and prioritize a plan of care for selected injuries*

TRAUMA*

MECHANISM OF INJURYKineticThermalElectricalChemicalRadiantAsphyxiation*

KINETIC ENERGY FORCESBLUNTCRUSHACCELERATION/DECELERATIONPENETRATING*

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INJURY SEVERITY FROM FALLSFall >10 feet or 3 times the persons heightYielding vs. nonyielding surfaceBody area striking the ground first*

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CRUSH INJURIESEnergy concentrated in one body area

Usually involves nerves, muscle, bone, and tendons*

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ACCELERATION AND DECELERATION FORCES

Whiplash injuryAortic tearHepatic artery tear*

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PENETRATING INJURIESHigh velocity GunsLow velocity Knives, pencils*

BALLISTICSCaliberTumbleYawFragmentationCavitationRangeWeapon*

ASSESSMENT OF THE INJURED STUDENTInitial assessmentDetailed assessmentTriage and transport*

INITIAL ASSESSMENTAirway/Cervical Spine ControlBreathingCirculationDisability (neurological)Expose*

PURPOSE OF THE INITIAL ASSESSMENTIdentification of LIFE-THREATENING emergencies

Initiation of LIFE-SAVING measures (CPR)*

AIRWAY ASSESSMENTStridor Debris in oropharynxAirway obstruction*

AIRWAY INTERVENTIONSJaw thrustAVOID HYPEREXTENSION OR FLEXION OF THE NECKLog roll to side for emesis*

CERVICAL SPINE STABILIZATIONPlace hands on either side of the headMaintain neck midline*

BREATHING ASSESSMENTLook, listen, and feelObserve chest symmetryNote work of breathingJugular vein distentionTracheal deviation*

BREATHING INTERVENTIONSIf breathing is absent, begin mouth to mask ventilationsIf breathing is shallow or labored, maintain airway control*

CIRCULATORY ASSESSMENTLevel of consciousnessCarotid pulse (absent or present)Capillary refillSkin colorSkin temperatureSites of bleeding*

CIRCULATORY INTERVENTIONSIf pulse is absent, begin CPRApply direct pressure to open wounds*

NEUROLOGICAL ASSESSMENTLevel of consciousnessAVPU scaleAwakeVerbal responsePain responseUnresponsive*

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NEUROLOGICAL INTERVENTIONSProvide reassuranceTell student what is happening*

EXPOSERemove clothing to observe the chestObserve the chest for bruises, penetrations, and symmetryAuscultate breath soundsAuscultate heart sounds

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DETAILED ASSESSMENTFahrenheit (keep person warm)Get vital signsHead-to-toe assessmentInspect the back*

HEAD-TO-TOE ASSESSMENTPalpate the head and faceObserve for fluid from the nose and earsAssess for pupillary responseReassess the mouthPalpate the jaw*

BATTLES SIGN*

RACCOON EYES*

NECKPalpate for pain or tendernessObserve for tracheal deviationObserve for jugular vein distentionObserve for impaled objects and open wounds*

CHESTAuscultate breath sounds in all lobesAuscultate chest soundsObserve work of breathingPalpate for pain/tenderness*

ABDOMENObserve for bruising, impaled objects, open woundsPalpate lightly for pain, tenderness, and distentionObserve for guarding*

PELVISApply pressure on pelvis to determine its stabilityPerform genitalia exam at ones discretion*

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EXTREMITIESObserve for deformities, impaled objects, open wounds Palpate for pulses, crepitus, or swellingDetermine capillary refill, skin color, temperatureAssess for pain/tenderness*

INSPECT THE BACKLog roll student with assistanceSchool nurse must maintain cervical spine controlInspect and palpate the back for bruising, impaled objects, pain and tenderness*

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HISTORYSAMPLESymptomsAllergiesMedicationsPast historyLast mealEvents leading to the illness or injury

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OTHER CONSIDERATIONSStop the assessment if there are changes in the students airway, breathing, or circulationStabilize impaled objectsApply pressure to open woundsApply ice to fracturesRemove any restrictive clothing*

TRIAGE DECISIONSEMERGENT (life threatening injuries)URGENT (fractures, head injuries)NON-URGENT (minor bruises)

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

Absent or minimal pain, discomfort, and anxiety*

DOCUMENTATION

School health record

Prehospital providers*

SELECTED TRAUMA EMERGENCIESHead injuriesSpinal cord injuriesChest injuriesAbdominal injuriesMusculoskeletal injuriesAmputations*

CONSIDERATIONS IN PEDIATRIC HEAD TRAUMAScalp is large and vascularCranium is thin and pliableHead size is larger in proportion to body*

INTERVENTIONS IN HEAD TRAUMAContinuous monitoring of neurological status pupil size and reactivityLOCbody movementUse direct pressure on open woundsDO NOT PACK nose or ears if drainage is present!*

CONSIDERATIONS IN SPINAL TRAUMAEnergy forces associated with spinal trauma (hyperextension, hyperflexion, and axial loading)Usually occurs during sports or MVCPediatric spine is malleable and flexiblePediatric spine is adult by age 8SCIWORA diagnosed in younger children

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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!*

CONSIDERATIONS IN CHEST TRAUMARibs are cartilaginous, allowing energy to be transferred to the heart and lungsIn younger children, the liver is not protected by the rib cage, making liver injuries common*

INTERVENTIONS IN CHEST TRAUMAKeep airway openInitiate mouth to mask ventilationsStabilize impaled objectsUse 3 sided occlusive dressing for open chest woundsApply pressure to stop bleeding wounds*

CONSIDERATIONS IN ABDOMINAL TRAUMAMost abdominal injuries involve blunt traumaAbdominal muscles are thin and weakAbdominal organs are not well protectedLiver and spleen are particularly susceptible*

INTERVENTIONS IN ABDOMINAL TRAUMAMaintain the ABCs with simultaneous spinal stabilization if spinal injury suspectedCover open abdominal wounds with a sterile dressing moistened with sterile salineIf abdominal contents have extruded, DO NOT attempt to push them back in

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CONSIDERATIONS IN MUSCULOSKELETAL TRAUMAEpiphyseal plate area is weaker and more prone to injuryEpiphyseal injuries are of concern since they may inhibit growth and cause deformityIn children with multiple injuries, musculoskeletal injuries can contribute to hypovolemic shock*

INTERVENTIONS IN MUSCULOSKELETAL TRAUMAApply sterile dressings to any open woundsStabilize fracture to prevent further injuryApply splint as appropriate*

CONSIDERATIONS IN AMPUTATIONSEmergentRequires EMSVasoconstriction may occur, minimizing blood lossIt is critical to locate the amputated part and prepare it for transport with EMS

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INTERVENTIONS IN AMPUTATIONSRinse 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 timeApply direct pressure to the siteAvoid use of a tourniquetApply new dressings over old dressings*

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SPECIAL NEEDS CHILDRENAssess usual positioning, LOC and ability to communicateProvide reassuranceFollow the same sequence of care (ABCs)*

FOLLOW-UP AFTER TRAUMANote changes in students school routinesUpdate school health recordFacilitate care plan development*

TRAUMA PREVENTIONEncourage safe behaviorsTake legislative actionNote dangerous areas in school

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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.*

ANY QUESTIONS??*

PERTOLONGAN PERTAMAPATAH TULANG LEPAS SENDICEDERA JARINGAN LUNAK*

FUNGSITULANGMENOPANG TUBUH AGAR DAPAT BERDIRI TEGAK

TEMPAT BERSANDAR ATAU BERGANTUNGNYA JARINGAN TUBUH*

FUNGSISENDITEMPAT PERTEMUAN DUA BUAH TULANG

MEMBANTU MEMPERMUDAH PERGERAKAN*

KEMUNGKINANTERJADIPATAH TULANG (FRAKTUR)

LEPAS SENDI (DISLOKASI)

CEDERA JARINGAN LUNAK*

FRAKTURTERPUTUSNYA KONTINUITAS ATAU KELANGSUNGAN PERMUKAAN TULANG*

YANG SERINGPATAHTULANG - TULANG PANJANG

SEMUA TULANG BISA PATAH*

TULANG2PANJANGTULANG SELANGKATULANG LENGAN ATASTULANG LENGAN BAWAHTULANG PAHATULANG BETISTULANG LEHER / BELAKANG*

JENISPATAH TULANGPATAH TULANG TERBUKAPATAH TULANG TERTUTUPPATAH TULANG SEDERHANAPATAH TULANG KOMPLIKATAPATAH TULANG GREENSTIK*

PATAH TULANG TERBUKATULANG ATAU FRAGMEN TULANG MENEMBUS JARINGAN KULIT LUAR*

BAHAYA PATAH TULANG TERBUKATERJADI INFEKSI JARINGAN (OTOT,KULIT)

TERJADI INFEKSI TULANG (OSTEOMYLITIES)*

PATAH TULANG TERTUTUPJARINGAN KULIT DISEKITAR TULANG YANG PATAH TETAP UTUHTULANG TIDAK TAMPAK DARILUAR / TIDAK MENEMBUS*

FRAKTURSEDERHANAPATAHAN ATAU RETAKAN TULANG MASIH PADA TEMPATNYA*

TULANG YANG PATAH MENJADI BEBERAPA BAGIANFRAKTUR KOMPLIKATA*

PATAHNYA TULANG YANG MASIH MUDA DAN BELUM MATANG ANAK - ANAKFRAKTURGREENSTIK*

TEKANAN TAK LANGSUNG YANG TERJADI KETIKA MENAHAN JATUH DENGAN TANGANFRAKTUR AKIBAT TEKANAN TIDAK LANGSUNG15*

HAL YANG DITAKUTKAN DARI PATAH TULANGNEUROGENIC SHOCK (SHOCK KARENA TERLALU SAKIT)

HYPOVOLEMIC SHOCK (SHOCK KARENA KEHABISAN DARAH)*

TANDA PATAH TULANGKELAINAN BENTUKSUKAR DIGERAKKANGANGGUAN FUNGSIBENGKAKNYERI TEKAN SUMBUKREPITASITULANG / SENDI KELUAR*

18PENATALAKSANAANJANGAN PANIKATASI:D= DANGER BAHAYAR= RESPONSE REAKSIA= AIR WAY JALAN NAPASB= BREATHING BERNAPASC= CIRCULATION PEREDARAN DARAH*

KURANGI PERGERAKANATASI LUKA/PERDARAHANIMOBILISASI/BALUT/SPALKKIRIM KE CLINIC/RUMAH SAKIT*

IMOBILISASI2 SENDI TIDAK BERGERAKSENDI DIATAS TULANG YANG PATAH SENDI DIBAWAH TULANG YANG PATAH*

PERALATANSPALK / SPLINT / BIDAIKASA, ANTI SEPTICVERBAN ELASTIC / KAIN SEGI TIGAALAT ANGKUTAPA SAJA DAPAT DIPAKAI*

TINDAKAN PADAFRAKTUR*

FRAKTUR KAKI BAGIAN ATAS*

FRAKTUR KAKI BAGIAN BAWAH*

FRAKTUR LENGAN BAWAH*

FRAKTUR LENGAN ATAS*

FRAKTUR DI SEKITAR SIKU*

FRAKTUR TULANG SELANGKA*

FRAKTURTENGKORAKTIMBUNAN DARAHKESADARAN MENURUNTIDAK SADARGANGGUAN AKTIVITAS OTAK*

A ALERTWASPADAV VOICERESPON TERHADAP SUARAP PAINRESPON TERHADAP NYERIU UNRESPONSIVETIDAK MEMBERI RESPONMENILAITINGKAT REAKSI*

MENILAITINGKAT REAKSIMATA TERBUKA SPONTAN? TERBUKA BILA DIEPERINTAH? TERBUKA BILA RASA NYERI TIDAK ADA REAKSI*

BICARA NORMAL BINGUNG KACAU SUKAR DIMENGERTI TIDAK BEREAKSI

GERAKAN MEMATUHI PERINTAH BERGERAK SEBAGAI RESPON ATAS NYERI TIDAK BEREAKSI*

PERTOLONGANATASI: DRA B CMEMERIKSA ULANG TINGKAT REAKSILAKUKAN SECONDARY SURVEY*

AKIBAT TEKANAN YANG MEMUTAR LEPAS SENDI /DISLOKASI*

DISLOKASI BAHU*

GERAKAN YANG KUATATAU TIBA - TIBACEDERANYA JARINGAN LUNAK*

REST ISTIRAHATKANICE KOMPRESCOMPRESS TEKANELEVATE TINGGIKANPENATALAKSANAAN*

RESTISTIRAHATKANICE KOMPRES*

COMPRESS TEKANELEVATE TINGGIKAN*

SISTEMSIRKULASISISTEMSARAFTULANG BELULANG*

TERIMA KASIH ATAS PERHATIANNYA*

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