1. Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 33-1 Chapter 33 Trauma Overview

2. 33-2 Objectives

3. Reconsidering the Mechanism of Injury Perform a scene size-up and primary survey Reconsider the mechanism of injury (MOI) –MOI is the way in which an injury occurs, as well as the forces involved in producing the injury –Reevaluating the MOI is necessary to rule out the possibility of a more significant MOI than initially suspected or identified during the scene size-up. –Index of suspicion 33-3

4. Factors to Consider In a Motor Vehicle Crash Rate of speed Seatbelt use Impact site Amount of intrusion Airbag deployment Vehicle size Condition of steering wheel Condition of windshield 33-4

5. Significant Mechanism of Injury Golden hour Limit scene time to 10 minutes Perform a primary survey Follow with a rapid trauma assessment Move quickly and efficiently Consider the need for ALS personnel Consider immediate transport 33-5

6. Significant Mechanisms of Injury Penetrating injury to the head, neck, or torso Penetrating injury to the extremities above the elbow or knee Flail chest Combination trauma with burns Two or more proximal long-bone fractures Pelvic fractures Open or depressed skull fracture Paralysis Amputation above the wrist or ankle Major burns 33-6

7. MOI – Not Significant Perform a primary survey Begin the secondary survey with an assessment of the injured body part (focused physical exam) –Examine other areas of the body as needed 33-7

8. 33-8 Significant Mechanism of Injury Perform a rapid trauma assessment when: –A significant mechanism of injury exists –Additional injuries are suspected –A critical injury is found during the focused physical examination –A previously stable patient with no significant mechanism of injury becomes unstable during the focused physical examination –After providing any emergency intervention

9. 33-9 Significant Mechanism of Injury Spinal precautions as soon as practical based on MOI Primary survey –Airway –Breathing –Circulation –Disability –Expose

10. 33-10 Significant Mechanism of Injury Rapid trauma assessment –Reassess mental status –Assess Head Neck Chest Abdomen Pelvis Lower extremities Upper extremities Back –Compare one side of the body to the other

11. Revised Trauma Score (RTS) Scoring system used to predict the likelihood of serious injury or death following trauma Calculated from a combination of results from three categories A. Respiratory rate B. Systolic blood pressure C. Glasgow Coma Scale 33-11

12. Transport of the Priority Trauma Patient Consider the following: –Distance to the nearest Trauma Center –Availability of ground versus air ambulances –Time of day (traffic conditions) –Weather 33-12

13. 33-13 Trauma Patient Considerations If no significant mechanism of injury –Perform a focused trauma assessment Assess the injured area for DCAP-BTLS Assess vital signs Obtain a SAMPLE history –Provide emergency care based on the type and severity of the injury

14. 33-14 Key Point If the patient appeared stable at the end of the primary survey, but becomes unstable during the secondary survey, expedite patient transport to the closest appropriate medical facility.

15. Questions? 33-15