Publication - EPD - VAO - Trauma Other Than BTLS Handoutvgate.net.au/handouts/Publication_EPD_VAO_Trauma_Other... · 2015. 3. 23. · o BTLS o Neither your or the patient’s life

VAO TRAUMA OTHER THAN BTLS MODULE

AMBULANCE TASMANIA Education and Professional Development Unit V2.8 January 2015

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HANDOUT



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Clinical Field Protocols

To complete this module, you will need to become familiar with the following clinical protocols: • Clinical Approach to a Patient • VAO CFP010 Trauma – Chest Injuries • VAO CFP011 Trauma – Burns • VAO CFP012 Trauma – Fracture / Amputation

Management • VAO CFP03 Pain Relief

You will also need to become familiar with the following drug protocols: • VAO D029 Oxygen • VAP D021 Methoxyflurane (Penthrane)



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AMPUTATED PARTS

• Partial or complete • These injuries can be very graphic • Associated bleeding of various degrees • Associated pain of various levels with conscious patients • Crushed, excised and or torn tissues

o DRABC (apply appropriate haemorrhage control) o BTLS o Neither your or the patient’s life should be put at risk in an

effort to save the part o If time allows, subject to the criticality of the patient, package

the part with a wet dressing over the wound. o Do not allow ice to remain in contact with the tissues as this

will cause tissue death o Consider the need to pass on the information early so that the

hospital is aware

In some cases amputated parts can be successfully reattached. The success of the reattachment depends on:

• What body part was amputated. • The condition of the amputated part. • The time since the amputation and receiving medical care. • The general health of the injured person.

Advise Comms early with detailed information so appropriate backup can be dispatched and advice can be sought on appropriate destination.



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CHEST INJURY

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CLOSED PNEUMOTHORAX

Air enters the pleural

space from the lung,

but cannot escape.

This is likely to be the

result of trauma, but it

may occur spontaneously,

(spontaneous pneumothorax).

Air in pleural space.

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Air can enter but not leave

the pleural space. As a

result the pressure within

the pleural space continues

to increase placing

pressure on mediastinal

structures.

TENSION PNEUMOTHORAX

Air in pleural space increasing, unable to escape.



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FLAIL CHEST

A flail chest occurs when a series of ribs are fractured in at least two places on each rib (producing a free segment). The free segment moves in on inspiration (opposite to the rest of the chest wall) and causes respiratory distress and extreme pain.

Flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation. Often, it is the contusion, not the flail segment, that is the main cause of respiratory failure in patients with both injuries.

Initial Patient Care

• If the patient is conscious, place in a comfortable position (normally half-sitting, leaning to the injured side). Adjust the patient’s position to relieve the pain as much as possible possible.

• If the patient is unconscious, turn to the injured side, in a recovery position.

• Loosen tight clothing. • Place a large bulky dressing over the loose area with a firm

bandage. • If patient is not breathing effectively and altered conscious state,

consider gentle IPPV.



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PENETRATING WOUNDS

Remember to check those vital signs and treat the signs and symptoms


• DRABC • Place patient in whatever position makes breathing easiest. • Cover the wound, initially with your own gloved hand then replace

with sterile dressing. • Seal with tape on three sides (not bottom), to allow fluid to escape. • Confirm paramedic backup has been dispatched. • Consult with Duty Manager (Comms) or Clinical Coordinator

regarding commencement of transport to meet paramedic backup en route.



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BURNS

• Injury to the epidermis (outer skin)

• Injury to underlying tissues – often a combination of both, depending on the type of burn i.e. cause

• Causes of burns o Thermal e.g fires o Chemical . e.g. acids alkalines o Electrical e.g. residential power source o Radiation e.g. sun burn

• Cool burned area with running water for at least 20 mins, but watch

for hypothermia subject to the environmental conditions.

• If possible, remove constrictive items (e.g. rings, watches, clothing) without causing further tissue damage then cover with glad wrap (don’t wrap).

• Assess the adequacy of airway and breathing.

• Consider inhalation burns if patient was in confined space with hot

or toxic gas or fumes.

• Rule of nines to assess area of injury.

• Consult with Duty Manager (Comms) or Clinical Coordinator regarding commencement of transport to meet paramedic backup en route.

Always assume inhalation injury if there are burns to the face, nasal hairs, eyebrows or eyelashes or of there is evidence of carbon deposits in the nose or mouth. Coughing of black particles in sputum, hoarse voice and/or breathing difficulties may also indicate airway damage.



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For more details see ARC Guideline 9.1.3



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COMPRESSION INJURY

Compression injuries occur when part of the body is entrapped and the circulation is compromised. “Crush syndrome” refers to the multiple problems that may subsequently develop. Crush syndrome results from disruption of the body’s chemistry and can result in kidney, heart and other problems. The likelihood of developing acute crush syndrome is directly related to the compression time.

If safe and physically possible, all compressive forces should be removed as soon as possible, regardless of how long they have been trapped.

Be aware that once the patient or part is removed from the compression forces that there may be:

• increased haemorrhage - control • changes in cardiac electrical activity – check;

o pulses o capillary refill o conscious state o B/P o prepare AED as there is a risk of cardiac arrest post

compression o ECG can be attached if you have one o Paramedic backup essential

Although they may appear to be alert and not distressed after being freed, there is risk of deterioration. All patients with a compression injury must be closely monitored and transported to hospital.

For more details see ARC Guideline 9.1.7



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FRACTURES

Consider history of event i.e. mechanism of injury 1. PILSDUCT :

§ Pain § Irregularity § Loss of function § Swelling § Deformity § Unnatural position § Crepitus (grating) § Tenderness

2. NILDOOCARRF

§ Nature § Intensity § Location § Duration § Onset § Offset § Concomitant factors § Aggravating factors § Relieving factors § Radiating § Frequency



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• A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces.

• A comminuted fracture is where the bone has broken into several

pieces.

• Fractures are either open or closed. o A closed fracture is one in which the overlying skin is intact o An open (or compound) fracture involve a wound that

exposes the fracture. Open injuries carry a higher risk of infection.


• Assess – PILSDUCT • Support • Haemorrhage control • Reassurance • Pain Management • Transport to hospital



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SOFT TISSUE INJURY

Injuries to skin and muscle tissues, usually as a result of blunt trauma, appears as lacerations, swelling, bruising and abrasions. As there may be serious underlying injury and associated bleeding it is important to assess your patients well. Look for signs of shock such as pale and clammy skin, rapid pulses, slow C/R, low B/Ps, nausea, vomiting and altered conscious state. Treat accordingly. Wet dressings to wounds RICE - for bruising as appropriate. - Rest - Ice - Compression - Elevation Refer to clinical field protocols for more information

Publication - EPD - VAO - Trauma Other Than BTLS Handoutvgate.net.au/handouts/Publication_EPD_VAO_Trauma_Other... · 2015. 3. 23. · o BTLS o Neither your or the patient’s life

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