Trauma General
HX - MOI - Location of trauma, pentrating vs blunt injury? Assess LOC (alert, verbal, pain, unconscious.) AIRWAY obstruction? Pulses, BP, capillary refill, severe bleeding? Disability/neuro assessment. Glasgow coma score. Expose and perform exam, Check pupils; tracheal deviation? Sub-Q air? Juglar venous distension?
Assess chest: look for trauma, pneumo, check lung sounds. Evaluate adbomen, pelvis, extremities, back. Abdominal guarding, distension, rigidty, hypotension, pallor, bruising? Are there medical causes? (e.g. diabetes, CVA, MI, ect.)
--Assess scene safety. Protect C-spine, Give O2, Check respiratory rate, adequacy -- vent if needed.
Trauma Head
HX - MOI-- estimate forces involved. Any changes in LOC? Amnesia? Was seat belt, helmet worn? Resp. rate, pattern, quality; Chest or trunk injuries? Vitals, Pupils, Neuro deficits? Posturing? Reflexes? Blood or CSF from ears, nose? Scalp, skull depression, associated facial trauma?
++--Secure airway while providing C-spine immobilization. Control bleeding with direct pressue. Do not stop bleeding from nose, ears if CSF leak is suspected. Give )2, start large bore IV (TKO unlesspatient is in shock.) Monitor vitals & neuro status. EKG, Pulse, oximetry; consider intubation and ventilation if GCS<= 8.
CAUTION-- Airways suspect C-spine injury in the head injury patient. Assess and document LOC changes. Be alert for airway problems and seizures. Restlessness & or agitation can be due to hypoxia or hypoglycemia. Check chemstrip.
Traumatic Cardiac Arrest
--Penetrating trauma? Transport rapidly to trauma center.--
HX - If blunt trauma (MVA, crash injury) survival =< 1%; consider pronouncing patient dead in the field, espically if there are other patients who need medical care (contact OLMC).
++--Secure airway, do CPR (shock VF). O2 IVs, en route. Splint fractures en route.
