Patients With Traumatic Injuries

8/15/2019 Patients With Traumatic Injuries

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Patients With TraumaticPatients With Traumatic

InjuriesInjuries

Condell Medical CenterCondell Medical Center

EMS SystemEMS System

August 2008 CEAugust 2008 CE

Site code #0!"200E208Site code #0!"200E208

Prepared by: Sharon Hopkins, RN, BSN, EMT-P


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$jecti%es$jecti%es

& '(on success)ul com(letion o) this'(on success)ul com(letion o) thismodule* the EMS (ro%ider should $emodule* the EMS (ro%ider should $e

a$le to+a$le to+

, Identi)y the di-erences $et.een a CategoryIdenti)y the di-erences $et.een a CategoryI* II and III trauma (atientI* II and III trauma (atient

, State trans(ort decisions )or traumaState trans(ort decisions )or trauma

(atients $ased on /egion guidelines(atients $ased on /egion guidelines

, 'nderstand .hat the mechanism o) injury is'nderstand .hat the mechanism o) injury isand the in)ormation it (ro%idesand the in)ormation it (ro%ides

, 'nderstand the di-erence $et.een the'nderstand the di-erence $et.een the

inde1 o) sus(icion and the generalinde1 o) sus(icion and the general

im(ressionim(ression


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$jecti%es contd$jecti%es contd, 3escri$e assessment and treatment3escri$e assessment and treatment

a((ro(riate )or the (atient .ith traumatica((ro(riate )or the (atient .ith traumaticinsult $ased on /egion SPsinsult $ased on /egion SPs

&4urns* tension (neumothora1* suc5ing chest4urns* tension (neumothora1* suc5ing chest.ound* 6ail chest* (ericardial tam(onade*.ound* 6ail chest* (ericardial tam(onade*e%iscerated organse%iscerated organs

, Success)ully calculate the 7CS and /TS gi%enSuccess)ully calculate the 7CS and /TS gi%enthe (atients (arametersthe (atients (arameters, Identi)y and a((ro(riately state inter%entionsIdenti)y and a((ro(riately state inter%entions

)or a %ariety o) E7 rhythms)or a %ariety o) E7 rhythms, Identi)y ST ele%ation on a 2 lead E7Identi)y ST ele%ation on a 2 lead E7

, Success)ully identi)y the landmar5 and (er)ormSuccess)ully identi)y the landmar5 and (er)ormchest needle decom(ressionchest needle decom(ression

, Acti%ely (artici(ate in trauma scenarioActi%ely (artici(ate in trauma scenariodiscussiondiscussion

, Success)ully com(lete the 9ui: .ith a score o)Success)ully com(lete the 9ui: .ith a score o)

80; or $etter80; or $etter


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and o%er* the leading causes o) death arediseasedisease

, cardio%ascular disease and cancerscardio%ascular disease and cancers

& These statistics (oint to a ?nancial $urden These statistics (oint to a ?nancial $urden

(laced on the (atient as .ell as society )or(laced on the (atient as .ell as society )orunintentional injuriesunintentional injuries

& Source+ @ational ital Statistics System* @ational Center )orSource+ @ational ital Statistics System* @ational Center )orBealth Statistics* C3CBealth Statistics* C3C


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Additional


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/egion SP !Trauma/egion SP !Trauma

Trans(ort Trans(ort&Systolic 4PSystolic 4P HH 0 on 20 on 2

consecuti%e readings For (edsconsecuti%e readings For (eds

HH 80G80G

, Trans(ort to the Trans(ort to the highest level highest level Trauma Center Trauma Center .ithin 2>.ithin 2>

minutesminutes

, 2> minute cloc5 starts )rom the2> minute cloc5 starts )rom the

time o) injurytime o) injury


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/egion SP Trauma/egion SP Trauma

Trans(ort Trans(ort& Traumatic arrest* isolated $urns J20; Traumatic arrest* isolated $urns J20;, Trans(ort to the Trans(ort to the closest closest TraumaTrauma

Center Center

&@o air.ay@o air.ay

, Trans(ort to the Trans(ort to the closestclosestEmergency Department Emergency Department


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Trans(ort Trans(ort&Category ICategory I Trauma Patient Trauma Patient

, 'nsta$le %ital signs'nsta$le %ital signs

, 4ased on anatomy o) the injury4ased on anatomy o) the injury, Trans(ort to the Trans(ort to the highest level highest level Trauma Center Trauma Center .ithin 2> minutes.ithin 2> minutes

, 2> minute cloc5 starts )rom the2> minute cloc5 starts )rom thetime o) injurytime o) injury


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Trans(ort Trans(ort&Category IICategory II Trauma Patient Trauma Patient

, 4ased on mechanism o) injury4ased on mechanism o) injury

&Bigh (otential )or injury $ut (atient isBigh (otential )or injury $ut (atient is

sta$le )or no.sta$le )or no., 4ased on e1istence o) co!mor$id )actors4ased on e1istence o) co!mor$id )actors

that increase the ris5 o) com(lications tothat increase the ris5 o) com(lications to

reco%eryreco%ery

, Trans(ort to the Trans(ort to the closest closest Trauma Center Trauma Center


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Trans(ort Trans(ort& Category IIICategory III Trauma Patient Trauma Patient, All other traumatic injuries andAll other traumatic injuries and

routine care is $eing (ro%idedroutine care is $eing (ro%ided

, Isolated traumatic injury FgenerallyIsolated traumatic injury Fgenerally7CS J0G7CS J0G&Isolated )racturesIsolated )ractures

&Minor $urnsMinor $urns&


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Mechanism o) InjuryMechanism o) Injury

& The (rocess and )orces that cause The (rocess and )orces that causetraumatrauma

& Mentally recreate the incident )rom theMentally recreate the incident )rom thee%idence notede%idence noted& Identi)y strength o) )orces in%ol%edIdenti)y strength o) )orces in%ol%ed& Identi)y direction )orces came )romIdenti)y direction )orces came )rom& Identi)y areas o) the (atients $odyIdenti)y areas o) the (atients $ody

most li5ely a-ected $y the )orcesmost li5ely a-ected $y the )orces

& Start to identi)y the mechanism o) injuryStart to identi)y the mechanism o) injury

during the scene si:e!u(during the scene si:e!u(


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Injury Patterns , PedestriansInjury Patterns , Pedestrians

& AdultsAdults, 7enerally turn a.ay K (resent lateral7enerally turn a.ay K (resent lateral

sur)acessur)aces, Anatomically* im(act is lo. on the $odyAnatomically* im(act is lo. on the $ody, Injuries to ti$ia* ?$ula* )emur* 5nee* lateralInjuries to ti$ia* ?$ula* )emur* 5nee* lateral

chest* u((er e1tremity* then head K nec5chest* u((er e1tremity* then head K nec5

& PediatricsPediatrics, 7enerally turn and )ace the %ehicle7enerally turn and )ace the %ehicle

, Injuries anatomically higher on the $ody thanInjuries anatomically higher on the $ody thanadultsadults

, Injuries to )emur* (el%is and then thoseInjuries to )emur* (el%is and then thosesustained .hen run o%er or (ushed aside $ysustained .hen run o%er or (ushed aside $y

the %ehiclethe %ehicle


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Injury Patterns , MotorInjury Patterns , Motor

ehicleehicle& /otational FL8; o) MCG/otational FL8; o) MCG, Injuries similar to )rontal K lateralInjuries similar to )rontal K lateral, 3eceleration is usually more gradual K3eceleration is usually more gradual K

injuries less serious although the %ehiclesinjuries less serious although the %ehiclesloo5 .orseloo5 .orse

& rontal FL2; o) MCGrontal FL2; o) MCG, '( and o%er (ath.ay'( and o%er (ath.ay

&emur )racturesemur )ractures

&4lunt a$dominal injury %ia com(ression4lunt a$dominal injury %ia com(ression&


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ehicleehicle, 3o.n and under (ath.ay3o.n and under (ath.ay&


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ehicleehicle& ; o) MC 22; o) all MC; o) MC 22; o) all MC

)atalitiesG)atalitiesG

, Much less structural steel )or (rotection $et.eenMuch less structural steel )or (rotection $et.een

%ictim and im(act site%ictim and im(act site

, ehicle damage may not loo5 se%ere $ut internalehicle damage may not loo5 se%ere $ut internal

injury (otential is highinjury (otential is high

, '((er K lo.er e1tremity )ractures on im(act side'((er K lo.er e1tremity )ractures on im(act side

,


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ehicleehicle& /ear end F; o) MCG/ear end F; o) MCG

, Bead rotates $ac5.ard and then sna(sBead rotates $ac5.ard and then sna(s)or.ard)or.ard

,


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Inde1 o) Sus(icionInde1 o) Sus(icion

& Oour antici(ation o) injury to a Oour antici(ation o) injury to a$ody* region* organ* or structure$ody* region* organ* or structure

$ased on identi?cation o) the$ased on identi?cation o) themechanism o) injurymechanism o) injury

& Oour inde1 o) sus(icion is honed Oour inde1 o) sus(icion is honed)rom e1(erience and time on the)rom e1(erience and time on the

jo$ jo$


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7eneral im(ression7eneral im(ression

&ormed )rom mechanism o)ormed )rom mechanism o)injury and inde1 o) sus(icioninjury and inde1 o) sus(icion

&Will guide the EMS (ro%iderWill guide the EMS (ro%iderregarding a direction on ho.regarding a direction on ho.

to (roceed in caring )or thisto (roceed in caring )or this(atient and $e a guideline on(atient and $e a guideline onchoosing .hich SP to )ollo.choosing .hich SP to )ollo.


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3ocumentation To Include o)3ocumentation To Include o)

The Com(laint The Com(laint

& ! onset ! onset

&P , (ro%ocation(alliationP , (ro%ocation(alliation& ! 9uality ! 9uality

&/ ! radiation/ ! radiation

&S , se%erity F0 , 0GS , se%erity F0 , 0G

& T , timing , .hen did it start T , timing , .hen did it start


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3ocumentation3ocumentation

&Pro%ide ans.ers to+Pro%ide ans.ers to+, Who Fthe (atient youre caring )orGWho Fthe (atient youre caring )orG

, What Fha((enedGWhat Fha((enedG

, When Fdid it ha((enGWhen Fdid it ha((enG

,Where F.hich $ody (artGWhere F.hich $ody (artG, Bo. Fdid it occurGBo. Fdid it occurG


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Trauma Care , Am(utated Trauma Care , Am(utated

PartsParts& /outine trauma care/outine trauma care& To remo%e gross contamination* gently rinse To remo%e gross contamination* gently rinse

.ith normal saline.ith normal saline

, 3 @T use distilled .ater to irrigate o(en3 @T use distilled .ater to irrigate o(en

.ounds.ounds

, @ormal saline is isotonic and less harm)ul to@ormal saline is isotonic and less harm)ul to

tissuetissue

& Co%er stum( .ith dam( Fnormal salineG sterileCo%er stum( .ith dam( Fnormal salineG steriledressing and ace .ra(dressing and ace .ra(

, Ace (ro%ides uni)orm (ressure to stum(Ace (ro%ides uni)orm (ressure to stum(

& Co%er .ounds .ith sterile dressingCo%er .ounds .ith sterile dressing


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Care o) Am(utated PartsCare o) Am(utated Parts

&Place (art in a (lastic :i(Place (art in a (lastic :i(loc5 $agloc5 $ag

&Place $ag in larger $ag orPlace $ag in larger $ag orcontainer o%er ice and .atercontainer o%er ice and .ater

&3o not ice the (art alone3o not ice the (art alone


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Pain Management Including )orPain Management Including )or

Adult 4urnsAdult 4urns

&Mor(hine )or (ain controlMor(hine )or (ain control, 2 mg slo. IP o%er 2 minutes2 mg slo. IP o%er 2 minutes

, May re(eat e%ery 2 minutes asMay re(eat e%ery 2 minutes asneeded to a ma1imum o) 0 mgneeded to a ma1imum o) 0 mg

, Watch )or res(iratory de(ressionWatch )or res(iratory de(ression

, Monitor )or a dro( in $loodMonitor )or a dro( in $lood

(ressure due to %asodilation(ressure due to %asodilation

)rom the medication)rom the medication


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Adult 4urns ! ElectricalAdult 4urns ! Electrical

& Immo$ili:e the (atientImmo$ili:e the (atient, Bigh (otential )or traumatic injuryBigh (otential )or traumatic injury

&Muscle s(asms during contactMuscle s(asms during contact

.ith source.ith source& Thro.n .hen (o.er source cut Thro.n .hen (o.er source cut

, Assess )or dysrhythmia , (lace onAssess )or dysrhythmia , (lace on

cardiac monitorcardiac monitor

, Assess distal neuro%ascular status o)Assess distal neuro%ascular status o)a-ected (arta-ected (art

, Co%er .ounds .ith dry sterileCo%er .ounds .ith dry sterile

dressingsdressings


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Adult 4urns ! InhalationAdult 4urns ! Inhalation

& Bigh ris5 )or air.ay com(romiseBigh ris5 )or air.ay com(romise& @ote (resence o) .hee:ing*@ote (resence o) .hee:ing*

hoarseness* stridor* car$onaceoushoarseness* stridor* car$onaceous

s(utum* singed nasal hairs(utum* singed nasal hair& Bigh 6o. o1ygen %ia non!re$reatherBigh 6o. o1ygen %ia non!re$reather

mas5mas5

& Monitor )or need o) ad%anced air.ayMonitor )or need o) ad%anced air.ayde%icede%ice, ETTETT

,Com$itu$e i) trained and a((ro%edCom$itu$e i) trained and a((ro%ed


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Adult 4urns ! ThermalAdult 4urns ! Thermal

& Su(er?cial , Su(er?cial , stst degreedegree, Cool $urned area .ith salineCool $urned area .ith saline

, H20; 4SA in%ol%ed* a((ly sterileH20; 4SA in%ol%ed* a((ly sterilesaline soa5ed dressingssaline soa5ed dressings

, J20; 4SA* a((ly dry sterile dressingJ20; 4SA* a((ly dry sterile dressing

& 3o not o%ercool major $urns or a((ly3o not o%ercool major $urns or a((lyice directly to $urned areasice directly to $urned areas


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Adult 4urns ! ThermalAdult 4urns ! Thermal

&Partial or )ull thic5ness F2Partial or )ull thic5ness F2ndnd or Lor Lrdrd degreeGdegreeG, Wear sterile glo%es and mas5 .hile $urn areasWear sterile glo%es and mas5 .hile $urn areas

are e1(osedare e1(osed

, Co%er $urn .ound .ith dry sterile dressingsCo%er $urn .ound .ith dry sterile dressings

&Pre%enting air 6o. o%er e1(osed $urn areasPre%enting air 6o. o%er e1(osed $urn areasreduces (ain le%elsreduces (ain le%els

, Place (atient on clean sheet on stretcherPlace (atient on clean sheet on stretcher

, Co%er (atient .ith dry clean sheets and $lan5et ,Co%er (atient .ith dry clean sheets and $lan5et ,(rotect )rom hy(othermia(rotect )rom hy(othermia


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In)ant di-erences+$ac5 L;*each $uttoc5s

2D>;* each entireleg =;


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Case Study #Case Study #

& Adult (atient .ho reached o%er a charcoal grillAdult (atient .ho reached o%er a charcoal grill just as the match .as thro.n onto the soa5ed just as the match .as thro.n onto the soa5edcoalscoals

& Injury is restricted to the right armInjury is restricted to the right arm

& What ty(e o) $urn is thisRWhat ty(e o) $urn is thisR

& 'sing the /ule o) @ines* .hat is the TS4A'sing the /ule o) @ines* .hat is the TS4A

$urnedR$urnedR& What ty(e o) care is a((ro(riateRWhat ty(e o) care is a((ro(riateR

& Bo. can the (ain $e managedRBo. can the (ain $e managedR

& What does the documentation loo5 li5eRWhat does the documentation loo5 li5eR


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Case Study # , Patient .ithCase Study # , Patient .ith

4urns4urns

http://homeemergency.files.wordpress.com/2007/04/burn1.jpghttp://homeemergency.files.wordpress.com/2007/04/burn1.jpghttp://homeemergency.files.wordpress.com/2007/04/burn1.jpg


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Case Study #Case Study #& Com$ination o) su(er?cial and (artial thic5ness $urnsCom$ination o) su(er?cial and (artial thic5ness $urns

a((ro1 =D>; TS4A Fcircum)erential around )orearmGa((ro1 =D>; TS4A Fcircum)erential around )orearmG, E%idence o) redness .ith a $listered area althoughE%idence o) redness .ith a $listered area although

$lister is $ro5en$lister is $ro5en

& A((ro(riate care includes cooling $urn* a((lying sterileA((ro(riate care includes cooling $urn* a((lying sterilesaline soa5ed dressing FH20; T4SAGsaline soa5ed dressing FH20; T4SAG

& Additional hel()ul careAdditional hel()ul care, Ele%ation o) arm* remo%al o) ring $e)ore ?ngers s.ellEle%ation o) arm* remo%al o) ring $e)ore ?ngers s.ell

& or (ain controlor (ain control, Mor(hine 2 mg slo. IP can re(eat 2 mg in 2Mor(hine 2 mg slo. IP can re(eat 2 mg in 2

minutes u( to 0 mgminutes u( to 0 mg


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Chest Injuries , TraumaticChest Injuries , Traumatic

Arrest , Category I TraumaArrest , Category I Trauma

& 4egin CP/4egin CP/& Trans(ort to closest Trauma Center Trans(ort to closest Trauma Center

, A hos(ital on $y!(ass must ta5e aA hos(ital on $y!(ass must ta5e a(atient in li)e threatening condition i)(atient in li)e threatening condition i)they are the closest a((ro(riate hos(italthey are the closest a((ro(riate hos(ital

& Per)orm $ilateral chest decom(ressionPer)orm $ilateral chest decom(ression

, 'se common sense , does your scene'se common sense , does your scenesi:e ,u(* e%aluation o) mechanism o)si:e ,u(* e%aluation o) mechanism o)injury and general im(ression indicate ainjury and general im(ression indicate a(otential chest .all injuryR(otential chest .all injuryR


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Chest Injuries , TensionChest Injuries , Tension

Pneumothora1 , Category IPneumothora1 , Category I

Trauma Trauma& Bistory o) injury to the chest .allBistory o) injury to the chest .all

& 3iminished $reath sounds3iminished $reath sounds

& By(erresonance i) (ercussion doneBy(erresonance i) (ercussion done& Se%ere dys(neaSe%ere dys(nea

& By(erin6ation o) chestBy(erin6ation o) chest

& ugular %ein distention ugular %ein distention

& Tachycardia Tachycardia

& By(otensionBy(otension


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uic5 Way to ind 2uic5 Way to ind 2ndnd ICSICS

& eel )or the to( o) the sternumeel )or the to( o) the sternum

& /oll your ?nger ti( to the anterior sur)ace at/oll your ?nger ti( to the anterior sur)ace atthe to( o) the sternumthe to( o) the sternum

& eel the little $um( near the to( o) theeel the little $um( near the to( o) the

sternumsternum, This $um( is the Angle o)


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Alternate Method to ind 2Alternate Method to ind 2ndnd Intercostal S(aceIntercostal S(ace& Pal(ate the cla%icle and ?nd the midlinePal(ate the cla%icle and ?nd the midline

, The midline is )arther out Fmore lateralG )rom The midline is )arther out Fmore lateralG )rom

the sternum than most (ersons reali:ethe sternum than most (ersons reali:e

& Mo%e your ?nger ti(s under the cla%icleMo%e your ?nger ti(s under the cla%icleinto the into the stst intercostal s(aceintercostal s(ace

, stst ri$ is under the cla%icle and is not (al(atedri$ is under the cla%icle and is not (al(ated

, S(aces identi?ed )or the num$ered ri$ a$o%eS(aces identi?ed )or the num$ered ri$ a$o%e

the s(acethe s(ace

& eel )or the ?rm 2eel )or the ?rm 2ndnd ri$ and (al(ate theri$ and (al(ate theso)t s(ace $elo. the ri$so)t s(ace $elo. the ri$

, This is the 2 This is the 2ndnd

ICSICS


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@eedle 3ecom(ression@eedle 3ecom(ression

& ind your o.n 2ind your o.n 2ndnd ICSICS& @o. ?nd your neigh$ors 2@o. ?nd your neigh$ors 2ndnd ICSICS

, 'se $oth methods to ?nd the landmar5'se $oth methods to ?nd the landmar5and decide .hich is easiest )or youand decide .hich is easiest )or you

& 3ocumentation3ocumentation, To include signs and sym(toms To include signs and sym(toms

, Si:e o) needle used Flength and gaugeGSi:e o) needle used Flength and gaugeG

, Site needle inserted intoSite needle inserted into

, /es(onse )rom the (atient/es(onse )rom the (atient


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E9ui(mentE9ui(ment

&


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S5in Pre(arationS5in Pre(aration

Midline o) cla%icle

Angle o)


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Case Study #2Case Study #2

& EMS is called to the scene )or a >2 year!oldEMS is called to the scene )or a >2 year!oldmale .ith co sudden onset dys(nea .ithmale .ith co sudden onset dys(nea .ith

(ain $et.een his shoulder $lades .hile(ain $et.een his shoulder $lades .hile

.atching T at homeD The (atient is agitated*.atching T at homeD The (atient is agitated*short o) $reath* .ith increased res(iratoryshort o) $reath* .ith increased res(iratory

rate and Sarate and Sa22 o) 8;Do) 8;D

& urther assessment re%eals decreased $reathurther assessment re%eals decreased $reathsounds on the right and clear on the le)tsounds on the right and clear on the le)t

& ital signs+ 8N2 B/ 8 // L2 and shallo.ital signs+ 8N2 B/ 8 // L2 and shallo.

& Oour im(ression K inter%ention (lanR Oour im(ression K inter%ention (lanR


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& S(ontaneous tension (neumothora1S(ontaneous tension (neumothora1, They dont all de%elo( )rom trauma They dont all de%elo( )rom trauma

& 4egin su((lemental o1ygen su((ort %ia4egin su((lemental o1ygen su((ort %ia

non!re$reather* cardiac monitor*non!re$reather* cardiac monitor*(re(aration )or I(re(aration )or I

4'T4'T

& uic5ly (re(are )or needle decom(ressionuic5ly (re(are )or needle decom(ression.hile the a$o%e are $eing (re(ared.hile the a$o%e are $eing (re(ared, Patients .ith a tension (neumothora1 cantPatients .ith a tension (neumothora1 cant

.ait and .ill deteriorate .ithout needle.ait and .ill deteriorate .ithout needle

decom(ressiondecom(ression


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Suc5ing Chest Wound ,Suc5ing Chest Wound ,

Category I TraumaCategory I Trauma& Most common .ith (enetrating .oundsMost common .ith (enetrating .ounds

& ree (assage o) air $et.een theree (assage o) air $et.een theatmos(here and (leural s(ace i) theatmos(here and (leural s(ace i) the

o(en .ound is at leasto(en .ound is at least 22LLrdrd the si:e o)the si:e o)the diameter o) the tracheathe diameter o) the trachea

, Si:e o) trachea a$out the si:e o) (ts >Si:e o) trachea a$out the si:e o) (ts >thth ?nger?nger

& Air is dra.n into the chest ca%ityAir is dra.n into the chest ca%ity

& Air re(laces lung tissueAir re(laces lung tissue

&


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Suc5ing Chest WoundSuc5ing Chest Wound

& Se%ere dys(neaSe%ere dys(nea

& (en chest .ound(en chest .ound

, Chec5 anterior* (osterior* a1illa areasChec5 anterior* (osterior* a1illa areas

& rothy $lood at .ound o(eningrothy $lood at .ound o(ening

& Suc5ing sound as air mo%es in andSuc5ing sound as air mo%es in andoutout

& Tachycardia .ith hy(o%olemia Tachycardia .ith hy(o%olemia


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Treatment Suc5ing Chest Treatment Suc5ing Chest

WoundWound& Immediate treatment is to seal theImmediate treatment is to seal the

o(eningo(ening, May start $y (lacing a glo%ed hand o%er theMay start $y (lacing a glo%ed hand o%er the

.ound.ound

, When a$le* (lace an occlusi%e dressing*When a$le* (lace an occlusi%e dressing*ta(ed on L sides* o%er the .oundta(ed on L sides* o%er the .ound

& Wound no. con%erted to a closedWound no. con%erted to a closed

(neumothora1(neumothora1& Monitor )or signs o) tensionMonitor )or signs o) tension(neumothora1(neumothora1, May need to li)t a corner o) the dressing toMay need to li)t a corner o) the dressing to

release tra((ed air %ia $ur(ing dressingrelease tra((ed air %ia $ur(ing dressing


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lail Chest , Category Ilail Chest , Category I

Trauma Trauma& L or more adjacent ri$s $ro5en in 2 orL or more adjacent ri$s $ro5en in 2 or

more (lacesmore (laces, Segment $ecomes )ree .ith (ardo1ical chestSegment $ecomes )ree .ith (ardo1ical chest

.all motion during res(irations.all motion during res(irations

, Parado1ical mo%ement more e%ident a)ter theParado1ical mo%ement more e%ident a)ter themuscles s(linting the 6ail segment )atiguemuscles s(linting the 6ail segment )atigue

& 'sually ta5es a tremendous amount o)'sually ta5es a tremendous amount o)$lunt trauma to cause a 6ail chest$lunt trauma to cause a 6ail chest

& )ten (resent .ill $e associated se%ere)ten (resent .ill $e associated se%ereunderlying injury Fie+ (ulmonary contusionGunderlying injury Fie+ (ulmonary contusionG

& /es(iratory %olume reduced and/es(iratory %olume reduced andres(iratory e-ort increasedres(iratory e-ort increased

T t t l il Ch tT t t l il Ch t


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Treatment lail Chest Treatment lail Chest& Place (atient on the injured sidePlace (atient on the injured side Fmay not $eFmay not $e

(ossi$le to do this in the ?eld $ased on mechanism o)(ossi$le to do this in the ?eld $ased on mechanism o)injuryGinjuryG

& Bigh 6o. o1ygen , nonre$reather mas5Bigh 6o. o1ygen , nonre$reather mas5, Monitor )or need to assist %entilations %ia 4MMonitor )or need to assist %entilations %ia 4M

to deli%er (ositi%e (ressure %entilationsto deli%er (ositi%e (ressure %entilations&E%idence o) underlying (ulmonary injuryE%idence o) underlying (ulmonary injury

&E-ort and )atigueE-ort and )atigue

&Pulse o1imetryPulse o1imetry

& E7 monitoringE7 monitoring, Tremendous amount o) )orce is deli%ered to the Tremendous amount o) )orce is deli%ered to the

chest .all and cardiac injury is highly li5ely as achest .all and cardiac injury is highly li5ely as a

resultresult


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Pericardial Tam(onade ,Pericardial Tam(onade ,

Category I TraumaCategory I Trauma

& 4lood or other 6uid ?lls the (ericardial sac4lood or other 6uid ?lls the (ericardial sacrestricting cardiac ?lling K contractilityrestricting cardiac ?lling K contractility

& Most o)ten related to (enetrating traumaMost o)ten related to (enetrating trauma& enous return to the heart is restrictedenous return to the heart is restricted

& 3ecreased cardiac out(ut3ecreased cardiac out(ut

& Pressure on the coronary arteries restrictsPressure on the coronary arteries restricts$lood 6o. to the myocardium$lood 6o. to the myocardium

i di l d Si K


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Pericardial Tam(onade Signs KPericardial Tam(onade Signs K

Sym(tomsSym(toms

& 'sually history o) (enetrating trauma'sually history o) (enetrating trauma& Agitated (atientAgitated (atient& 3iminished strength o) (ulses F.ea5 and threadyG3iminished strength o) (ulses F.ea5 and threadyG

.ith tachycardia.ith tachycardia

& @arro.ing (ulse ([email protected] (ulse (ressure, 3iastolic K systolic num$ers mo%ing closer together3iastolic K systolic num$ers mo%ing closer together

& 3istended nec5 %eins F3G3istended nec5 %eins F3G& 3ia(horetic and (ale3ia(horetic and (ale

& Mued* distant heart tonesMued* distant heart tones& By(otensionBy(otension


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Treatment Pericardial Treatment Pericardial

Tam(onade Tam(onade

& Treatment in the ?eld is limited to Treatment in the ?eld is limited to$eing su((orti%e$eing su((orti%e

& Patient re9uires high inde1 o)Patient re9uires high inde1 o)sus(icion andor ra(id identi?cationsus(icion andor ra(id identi?cation

.ith ra(id trans(ort.ith ra(id trans(ort

, In E3 .ill (er)orm needle thoracentesisIn E3 .ill (er)orm needle thoracentesisand then trans)er the (atient to the /and then trans)er the (atient to the /

)or o(en heart surgery)or o(en heart surgery


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E%aluation Pearls ,


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E%aluation Pearls ,


58/107

MoreMore

CaseCase

StudiesStudies

Case Study #LCase Study #L


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Case Study #LCase Study #L& Oour L= year!old Oour L= year!old

(atient recei%ed a(atient recei%ed a7SW to the right7SW to the right

u((er a$domenDu((er a$domenD

& They are conscious They are consciousand alert 4P 0N2and alert 4P 0N2B/ 20 // 28B/ 20 // 28

$leeding is minimal$leeding is minimal

& Category traumaRCategory traumaR

& What are yourWhat are yourinter%entionsRinter%entionsR

ase u y , a egoryase u y , a egory


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ase u y a egoryase u y a egory Trauma Trauma& Ma5e sure the scene is securedMa5e sure the scene is secured

& Consider need )or s(inal immo$ili:ationConsider need )or s(inal immo$ili:ation& 3uring assessment o) .ound* consider3uring assessment o) .ound* consider

thoracic injury in addition to a$dominalthoracic injury in addition to a$dominalinjury de(ending on the angle o) the 7SWDinjury de(ending on the angle o) the 7SWD

& E1amine )or an e1it .oundE1amine )or an e1it .ound, Chec5 the $ac5 and the a1illaChec5 the $ac5 and the a1illa

& Pre(are )or the .orst , assume the (atientPre(are )or the .orst , assume the (atient.ill deteriorate $e)ore E3 arri%al.ill deteriorate $e)ore E3 arri%al

& /e(eat S+ 4P 80 B/ =0 // L2*/e(eat S+ 4P 80 B/ =0 // L2*remains conscious and in (ainremains conscious and in (ain

& Trans(ort to the highest le%el Trauma Trans(ort to the highest le%el Trauma

Center .ithin 2> minutesCenter .ithin 2> minutes

C S d L


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Case Study #L ! TreatmentCase Study #L ! Treatment

& /outine trauma care/outine trauma care& uestion , is this an isolated a$dominaluestion , is this an isolated a$dominal

.ound or is it a com$ination a$dominal chest.ound or is it a com$ination a$dominal chest

.oundR.oundR

, @eed to treat (atient )or (otential injuries o)@eed to treat (atient )or (otential injuries o)$oth $ody ca%ities$oth $ody ca%ities

, EMS cannot determine in the ?eld the angleEMS cannot determine in the ?eld the angle

o) the trajectoryo) the trajectory& Co%er the .ound and .atch )or e%iscerationCo%er the .ound and .atch )or e%isceration

& luid resuscitation , 5ee( 4P at lo. le%elsluid resuscitation , 5ee( 4P at lo. le%elsthe higher the 4P the )aster the (atientthe higher the 4P the )aster the (atient

$leeds out$leeds out

Case Study #L !Case Study #L !


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Case Study #L Case Study #L


& I) (atient states anything* (ut it in 9uotesI) (atient states anything* (ut it in 9uotes& I) in)ormation a%aila$le* add angle (atient shotI) in)ormation a%aila$le* add angle (atient shot

)rom Fie+ a$o%e* $elo.G and distance )rom)rom Fie+ a$o%e* $elo.G and distance )rom

.ea(on.ea(on

& I) 5no.n* list ty(e o) .ea(on usedI) 5no.n* list ty(e o) .ea(on used& Include results o) ins(ection* auscultation*Include results o) ins(ection* auscultation*

(al(ation(al(ation

,


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Case Study #=Case Study #=

& Oour 0 year!old (atient Oour 0 year!old (atienthas a (enetratinghas a (enetrating

injury to the right leginjury to the right leg

a$o%e the 5nee .hilea$o%e the 5nee .hile

(laying in his $ac5yard(laying in his $ac5yard

& Initial S+ 4P 0"0Initial S+ 4P 0"0B/ L0 // L2 noB/ L0 // L2 no

acti%e $leedingacti%e $leeding& Category traumaR ieldCategory traumaR ield

inter%entionsRinter%entionsR


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Case Study #= , Category IIICase Study #= , Category III

& @e1t S+ 4P 2N= B/ 0 // 20D@e1t S+ 4P 2N= B/ 0 // 20D& Sta$ili:e )oreign $ody in (laceSta$ili:e )oreign $ody in (lace& $tain distal neuro%ascular status$tain distal neuro%ascular status

, 3istal (ulses3istal (ulses

, Mo%ement , Ucan you .iggle your toesRVMo%ement , Ucan you .iggle your toesRV

, Sensation , Uclose your eyes and tell meSensation , Uclose your eyes and tell me

.hich toe I am touchingV.hich toe I am touchingV& 3ocument distal neuro%ascular3ocument distal neuro%ascular

status and descri$e ho. the )oreignstatus and descri$e ho. the )oreign

o$ject is sta$ili:ed in (laceo$ject is sta$ili:ed in (lace

C S d >C St d #>


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Case Study #>Case Study #>& Oour N2 year!old (atient had a$dominal Oour N2 year!old (atient had a$dominal

surgery .ee5 agoD Today at home hesurgery .ee5 agoD Today at home hesnee:ed hard and )elt a tearingsnee:ed hard and )elt a tearing

sensation in hissensation in hisa$domen anda$domen and

called EMSD called EMSD

& S+ 4P 00N0S+ 4P 00N0B/ 0 // 2=B/ 0 // 2=

& @o acti%e@o acti%e$leeding$leeding

& WhatWhatinter%entionsinter%entions

are a((ro(riateRare a((ro(riateR

C St d #>C St d #>


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Case Study #> !Case Study #> !

Inter%entionsInter%entions& Immediately co%er the .oundImmediately co%er the .ound

, @eed to minimi:e contamination@eed to minimi:e contamination

, @eed to (re%ent more organs )rom (rotruding@eed to (re%ent more organs )rom (rotruding

,@eed to (re%ent loss o) 6uids@eed to (re%ent loss o) 6uids

& Place a saline moistened dressing o%er thePlace a saline moistened dressing o%er thee1(osed tissuee1(osed tissue

& Place dry gau:e o%er the saline dressingsPlace dry gau:e o%er the saline dressings

& Can (lace light manual control o%er theCan (lace light manual control o%er theorgans to (re%ent )urther e%iscerationorgans to (re%ent )urther e%isceration

es(ecially during mo%ement* coughing*es(ecially during mo%ement* coughing*

snee:ing* dee( $reathssnee:ing* dee( $reaths


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Case Study #NCase Study #N

& 2 year!old dro%e into a metal )enceD '(on2 year!old dro%e into a metal )enceD '(onEMS arri%al* there is o$%ious e1ternal chestEMS arri%al* there is o$%ious e1ternal chest

injury .ith $leedingD Coming closer to theinjury .ith $leedingD Coming closer to the

(atient* EMS can hear a suc5ing sound )rom(atient* EMS can hear a suc5ing sound )romthe chest .oundDthe chest .oundD

& Patient is alert* in (ain* se%ere dys(neaPatient is alert* in (ain* se%ere dys(nea

& S+ 4P 0N2 B/ L0 // L= 7CS >S+ 4P 0N2 B/ L0 // L= 7CS >& 4reath sounds < J /4reath sounds < J /

&


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MC Into Metal encingMC Into Metal encing

C St d #N C t IC St d #N C t I


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Case Study #N , Category ICase Study #N , Category I

& An ade9uate dressing .ill $e dicult toAn ade9uate dressing .ill $e dicult toachie%e .ith such an e1tensi%e .oundachie%e .ith such an e1tensi%e .ound, A glo%ed hand just .ont $e enough to getA glo%ed hand just .ont $e enough to get

startedstarted

& This (atient may $e a candidate )or This (atient may $e a candidate )orconscious sedation and intu$ation toconscious sedation and intu$ation to(ro%ide (ositi%e (ressure %entilation(ro%ide (ositi%e (ressure %entilation

& /eassessment S+ 4P 80>N B/ =0/eassessment S+ 4P 80>N B/ =0// LN 7CS remains >// LN 7CS remains >

& Trans(ort is to highest le%el trauma Trans(ort is to highest le%el traumacenter .ithin 2> minutescenter .ithin 2> minutes


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Case Study #N !Case Study #N !


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Case Study #N Case Study #N


& What , cause o) the injury F(enetration*What , cause o) the injury F(enetration*MC* (edestrian* etcGMC* (edestrian* etcG

& When , the injury occurredWhen , the injury occurred

&Where , $y $ody locationWhere , $y $ody location, UU9uadrantV re)ers to the a$domen9uadrantV re)ers to the a$domen

, Chest injuries uses re)erence such asChest injuries uses re)erence such asanterior (osterior* ni((le line* u((erlo.eranterior (osterior* ni((le line* u((erlo.erchest .allchest .all

& Bo. , the injury occurredBo. , the injury occurred& E1(and and gi%e detail descri(tion o) theE1(and and gi%e detail descri(tion o) the

injury* treatment rendered* (t res(onseinjury* treatment rendered* (t res(onse


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Case Study #"Case Study #"

& Oour => year!old (atient is a Oour => year!old (atient is aconstruction .or5er .ho .asconstruction .or5er .ho .asaccidentally shot in the head .ith aaccidentally shot in the head .ith a

nail gunnail gun& '(on arri%al* the (atient is a.a5e*'(on arri%al* the (atient is a.a5e*alert* tal5ing F7CS >Galert* tal5ing F7CS >G

& S+ 4P L2"8 B/ N // 20S+ 4P L2"8 B/ N // 20com(lains o) a minor headachecom(lains o) a minor headacheminimal $leeding at a )e. (unctureminimal $leeding at a )e. (uncture.ounds noted on the occi(ital area o).ounds noted on the occi(ital area o)the scal( F(atient has thic5 hairGDthe scal( F(atient has thic5 hairGD

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!ray!ray

)rom)rom

E3E3

@o@o

de?citde?citss

notednoted

http://www.pacificariptide.com/.shared/image.html?/photos/uncategorized/2008/04/28/p676d63fd_1.png


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& Oou are called to the scene )or a 0 year!old Oou are called to the scene )or a 0 year!old)emale .ho has $een run o%er $y a $us)emale .ho has $een run o%er $y a $us

& As (atient e1ited $us* she $ent do.n to tieAs (atient e1ited $us* she $ent do.n to tieher shoe and .as caught under the .heelsher shoe and .as caught under the .heels

o) the $uso) the $us& '(on your arri%al* you note a large amount'(on your arri%al* you note a large amount

o) a%ulsed tissue .ith $leeding )rom the le)to) a%ulsed tissue .ith $leeding )rom the le)thi(* le)t $uttoc5* and le)t u((er thigh areahi(* le)t $uttoc5* and le)t u((er thigh area

& The (atient is screaming in (ain The (atient is screaming in (ain& S+ 4P 0"0 B/ 0 // 2N 7CS >S+ 4P 0"0 B/ 0 // 2N 7CS >& What is your im(ressionRWhat is your im(ressionR& What is your treatment (lanRWhat is your treatment (lanR

0 o run o er $ $us0 yo run o%er $y $us


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0 yo run o%er $y $us0 yo run o%er $y $us

Case Study #8 , Category I orCase Study #8 , Category I or


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y g yy g yIIRIIR& 7eneral im(ression7eneral im(ression

, Category II minimally , (edestrian run!o%erCategory II minimally , (edestrian run!o%er, Category I trauma , i) unsta$le (el%is or 2 orCategory I trauma , i) unsta$le (el%is or 2 or

more long $ones F(ro1imal $onesG )racturedmore long $ones F(ro1imal $onesG )racturedand %ital signs unsta$leand %ital signs unsta$le

& Potential (ro$lems to consider K addressPotential (ro$lems to consider K address, Massi%e hemorrhage K control o) hemorrhageMassi%e hemorrhage K control o) hemorrhage

, S(inal injuryS(inal injury

, Additional injuriesAdditional injuries

, Air.ay controlAir.ay control

, E9ui(ment to ?t a 0 year!oldE9ui(ment to ?t a 0 year!old

, urther .ound contaminationurther .ound contamination

year ' .ith s5in gra)ts year ' .ith s5in gra)ts


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year ' .ith s5in gra)ts year ' .ith s5in gra)ts

7lasgo. Coma Scale 7SC7lasgo. Coma Scale 7SC


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7lasgo. Coma Scale ! 7SC7lasgo. Coma Scale ! 7SC

& Tool used to e%aluate and monitor a Tool used to e%aluate and monitor a(atients condition(atients condition

& E%aluatesE%aluates

4est eye o(ening4est eye o(ening4est %er$al res(onse4est %er$al res(onse

4est motor res(onse4est motor res(onse

& Ser%es as an indicator(redictor o) sur%i%alSer%es as an indicator(redictor o) sur%i%al& To $e (er)ormed on all EMS (atients To $e (er)ormed on all EMS (atients

7CS7CS


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7CS7CS&Possi$le total score L Flo.estG , > FhighestGPossi$le total score L Flo.estG , > FhighestG

&Minor head injury , (atient scores L , >Minor head injury , (atient scores L , >

&Moderate head injury , (atient scores , 2Moderate head injury , (atient scores , 2

&Se%ere head injury , (atient scoresSe%ere head injury , (atient scores HH88, Signi?cant mortality ris5Signi?cant mortality ris5


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7CS Pearls7CS Pearls

& The change in the 7CS is more im(ortant The change in the 7CS is more im(ortantthan the a$solute scorethan the a$solute score

& Chec5 )or associated injuriesChec5 )or associated injuries, Manage a head injury as a multi(le injuredManage a head injury as a multi(le injured

(atient until other injuries ruled out(atient until other injuries ruled out

& Sta$ili:e the nec5 )or any head injurySta$ili:e the nec5 )or any head injury

& 3ont assume the le%el o) consciousness is3ont assume the le%el o) consciousness is

altered just $ecause o) ETB andor drugsaltered just $ecause o) ETB andor drugs, Is there an occult FhiddenG injury (resentRIs there an occult FhiddenG injury (resentR

& Pro%ide accurate* clear* detailedPro%ide accurate* clear* detaileddocumentationdocumentation

7CS , Eye (ening !=7CS , Eye (ening !=


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y ( gy ( g

PointsPoints& S(ontaneous F=G , eyes o(en may or may not )ocusS(ontaneous F=G , eyes o(en may or may not )ocus

& To %oice FLG , (rior to touching the (atient* eyes .ill o(en to To %oice FLG , (rior to touching the (atient* eyes .ill o(en tosounds around them or EMS callingyelling to them to o(ensounds around them or EMS callingyelling to them to o(eneyeseyes

, )ten dicult to accurately assess due to EMS gaining)ten dicult to accurately assess due to EMS gainingimmediate c!s(ine control so dicult at times toimmediate c!s(ine control so dicult at times to

determine i) (atient res(onded to %oice or touch F(ainGdetermine i) (atient res(onded to %oice or touch F(ainG& To (ain F2G , doesnt necessarily im(ly you must a((ly To (ain F2G , doesnt necessarily im(ly you must a((ly

(ain)ul stimulus* could $e just to touch(ain)ul stimulus* could $e just to touch

, lutter o) eyelids is scored as 2lutter o) eyelids is scored as 2

& @one FG , eyes remain closed .ith no eyelid 6utter or other@one FG , eyes remain closed .ith no eyelid 6utter or othereye mo%ement eyes do not o(eneye mo%ement eyes do not o(en


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7CS , Motor /es(onse !N7CS , Motor /es(onse !N


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(PointsPoints

& $eys command FNG$eys command FNG& GG, Patient .ho (ulls e9ui(ment o- (ushes yourPatient .ho (ulls e9ui(ment o- (ushes your

hands a.ay (ur(ose)ul mo%ementhands a.ay (ur(ose)ul mo%ement, This (atient 5no.s .here the o$no1ious stimuli is This (atient 5no.s .here the o$no1ious stimuli is

contacting his $odycontacting his $ody& Withdra.s to (ain F=GWithdra.s to (ain F=G

, Pt cannot isolate .here they )eel the no1iousPt cannot isolate .here they )eel the no1iousstimuli so just (ulls $ac5.ithdra.sstimuli so just (ulls $ac5.ithdra.s

& le1ion FLG , arms $ent to.ards midline .henle1ion FLG , arms $ent to.ards midline .henstimulatedstimulated

& E1tension F2G , arms e1tended .henE1tension F2G , arms e1tended .henstimulatedstimulated

& @one FG , remains 6accid@one FG , remains 6accid


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& 7i%e the (atient the $est score7i%e the (atient the $est score(ossi$le(ossi$le, I) the (atient mo%es the right side o) theirI) the (atient mo%es the right side o) their

$ody $ut no mo%ement on their le)t* score$ody $ut no mo%ement on their le)t* scorethem )or the mo%ement they currentlythem )or the mo%ement they currentlye1hi$it on the righte1hi$it on the right

, I) (atient deteriorates* easier to see theI) (atient deteriorates* easier to see the

dro( or change in the 7CS scoredro( or change in the 7CS score& When testing )or res(onses* .atchWhen testing )or res(onses* .atch

e%en )or minimal acti%ity li5e eyelide%en )or minimal acti%ity li5e eyelid6utter or a grimace6utter or a grimace


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& Acce(ta$le no1ious stimuliAcce(ta$le no1ious stimuli, Arm(it (inch or nail$ed (ressureArm(it (inch or nail$ed (ressure

, Sternal ru$* (inching .e$ s(aceSternal ru$* (inching .e$ s(ace$et.een ?ngers* (inching shoulder$et.een ?ngers* (inching shoulder

muscle Ftra(e:iusGmuscle Ftra(e:iusG

, Earlo$e (inch is out o) )a%orEarlo$e (inch is out o) )a%or

&Can cause mo%ement o) head KCan cause mo%ement o) head Knec5 in res(onse to the (ainnec5 in res(onse to the (ain


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/TS , Scoring 0 , 2 (oints/TS , Scoring 0 , 2 (oints


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/TS , Scoring 0 , 2 (oints/TS Scoring 0 2 (oints


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7CS K /TS Practice #7CS K /TS Practice #

& Patient eyes are o(en and they .atch youPatient eyes are o(en and they .atch youduring the e1aminationduring the e1amination

& The (atient is con)used they dont The (atient is con)used they dont

remem$er ho. they got hurt and cantremem$er ho. they got hurt and cantremem$er the day o) the .ee5remem$er the day o) the .ee5

& When you as5 the (atient to Usho. me 2When you as5 the (atient to Usho. me 2?ngersV* they res(ond $ut are slo. to do so?ngersV* they res(ond $ut are slo. to do so

& S+ 4P 20"0 B/ 88 // 8S+ 4P 20"0 B/ 88 // 8& Total 7CSR Total 7CSR

& Total /TSR Total /TSR

7CS K /TS Practice #27CS K /TS Practice #2


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7CS K /TS Practice #27CS K /TS Practice #2

& The (atient does not o(en their eyes The (atient does not o(en their eyes& The (atient groans .hen (inched or The (atient groans .hen (inched oran injured $ody (art is touchedan injured $ody (art is touched

& The (atient does not )ollo. The (atient does not )ollo.commands and .ill (ush your handscommands and .ill (ush your handsa.ay .hen you touch thema.ay .hen you touch them

& S+ 4P NN8 B/ 02 // 22S+ 4P NN8 B/ 02 // 22& Total 7CSR Total 7CSR& Total /TSR Total /TSR


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7CS K /TS Practice #L7CS K /TS Practice #L

& The (atients eyes are o(en The (atients eyes are o(en& When as5ed U.hat month is thisRV*When as5ed U.hat month is thisRV*

the (atient res(onds* Uhe* umm* heXthe (atient res(onds* Uhe* umm* heXmy jac5etD I dont DDVmy jac5etD I dont DDV

& I) touched or (inched* the (atientI) touched or (inched* the (atient(ulls a.ay )rom the contact(ulls a.ay )rom the contact

& S+ 4P L2"2 B/ N // NS+ 4P L2"2 B/ N // N& Total 7CSR Total 7CSR& Total /TSR Total /TSR

7CS K /TS Practice #=7CS K /TS Practice #=


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7CS K /TS Practice #=7CS K /TS Practice #=

& Oour (atients eyes are closed $ut they Oour (atients eyes are closed $ut theyo(en .ide i) the (atients injury iso(en .ide i) the (atients injury istouchedtouched

& The (atient yells UdontV or Usto(V .hen The (atient yells UdontV or Usto(V .henthere are (inched $ut does not ans.erthere are (inched $ut does not ans.er9uestions or s(ea5 in sentences9uestions or s(ea5 in sentences

& The (atient .ill (ush your hands a.ay The (atient .ill (ush your hands a.ay.hen you touch them.hen you touch them

& S+ 4P 08N= B/ 02 // 8S+ 4P 08N= B/ 02 // 8& Total 7CSR Total 7CSR& Total /TSR Total /TSR

7CS K /TS Practice #>7CS K /TS Practice #>


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7CS K /TS Practice #>7CS K /TS Practice #>

& The (atients eyes are closed $ut the The (atients eyes are closed $ut theeyelids 6utter .hen you loudly call outeyelids 6utter .hen you loudly call outtheir nametheir name

& The (atient does not ans.er 9uestions The (atient does not ans.er 9uestions$ut .ill groan .hen touched $ut not say$ut .ill groan .hen touched $ut not sayrecogni:a$le .ordsrecogni:a$le .ords

& The (atient does not )ollo. commands The (atient does not )ollo. commands$ut .ill (ush a.ay your hands .hen$ut .ill (ush a.ay your hands .hen

touchedtouched& S+ 4P 80>2 B/ 2 // 2S+ 4P 80>2 B/ 2 // 2& Total 7CSR Total 7CSR

& Total /TSRTotal /TSR

7SC K /TS Practice #N7SC K /TS Practice #N


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7SC K /TS Practice #N7SC K /TS Practice #N

& The (atients eyes are closed $ut .ill o(en The (atients eyes are closed $ut .ill o(en.hen the (atient is touched.hen the (atient is touched

& The (atient says Ulea%e me aloneV and The (atient says Ulea%e me aloneV andU.hat are you doingRV and goes $ac5 toU.hat are you doingRV and goes $ac5 to

slee(D When eyes are o(en they res(ond UIslee(D When eyes are o(en they res(ond UIdont 5no.V to 9uestionsdont 5no.V to 9uestions

& They do not )ollo. command and .ill (ush They do not )ollo. command and .ill (ushyour hands a.ay .hen touchedyour hands a.ay .hen touched

& S+ 4P 0N8 B/ 88 // 20S+ 4P 0N8 B/ 88 // 20& Total 7CSR Total 7CSR& Total /TSR Total /TSR

7CS/TS Practice Ans.ers7CS/TS Practice Ans.ers


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7CS/TS Practice Ans.ers7CS/TS Practice Ans.ers

& # , 7CS , = F=* =* NG# , 7CS , = F=* =* NG /TS , 2 F7CS = // = 4P =G/TS , 2 F7CS = // = 4P =G& #2 , 7CS , 8 F* 2* >G#2 , 7CS , 8 F* 2* >G

/TS , 0 F7CS 2 // = 4P =G/TS , 0 F7CS 2 // = 4P =G

& #L , 7CS , F=* L* =G#L , 7CS , F=* L* =G/TS , F7CS L // = 4P =G/TS , F7CS L // = 4P =G& #= , 7CS , F2* =* >G#= , 7CS , F2* =* >G /TS , F7CS L // = 4P =G/TS , F7CS L // = 4P =G

& #> , 7CS , 0 FL* 2* >G#> , 7CS , 0 FL* 2* >G

/TS , 0 F7CS L // = 4P LG/TS , 0 F7CS L // = 4P LG

& #N , 7CS , F2* =* >G#N , 7CS , F2* =* >G

/TS , F7CS L // = 4P =G/TS , F7CS L // = 4P =G

Id i) /h h S i #


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Identi)y /hythm Stri( #Identi)y /hythm Stri( #

Treatment Sym(tomatic Treatment Sym(tomaticd di


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4radycardia4radycardia& 4radycardia or Ty(e I Wenc5e$ach4radycardia or Ty(e I Wenc5e$ach

, Atro(ine 0D> mg ra(id IPAtro(ine 0D> mg ra(id IP

, May re(eat e%ery L!> minutes to total o) LmgMay re(eat e%ery L!> minutes to total o) Lmg

, I) ine-ecti%e* $egin (acingI) ine-ecti%e* $egin (acing

& Ty(e II or L Ty(e II or Lrdrd degree heart $loc5degree heart $loc5, 4egin TCP4egin TCP

, alium 2 mg slo. IP )or discom)ortalium 2 mg slo. IP )or discom)ort

, May re(eat 2 mg IP e%ery 2 minutes to ma1 0 mgMay re(eat 2 mg IP e%ery 2 minutes to ma1 0 mg

, TCP set at rate 80minute and start at lo.est mA TCP set at rate 80minute and start at lo.est mA

, Watch )or ca(tureWatch )or ca(ture

, I) TCP not e-ecti%e* gi%e Atro(ine 0D> mg ra(id IPI) TCP not e-ecti%e* gi%e Atro(ine 0D> mg ra(id IP

, May re(eat Atro(ine 0D> mg e%ery L!> minutes ma1May re(eat Atro(ine 0D> mg e%ery L!> minutes ma1LmgLmg

Identi)y /hythm Stri( #2 ,Identi)y /hythm Stri( #2 ,


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Identi)y /hythm Stri( #2 de y y S (

N second stri( N second stri(

Treatment Sinus /hythmTreatment Sinus /hythm


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Treatment Sinus /hythm Treatment Sinus /hythm

& @o treatment necessary )or the rhythm@o treatment necessary )or the rhythm& Treat the (atients com(laint Treat the (atients com(laint& I ACS* thenI ACS* then

, As(irin L2= mg che.ed F)aster a$sor(tionGAs(irin L2= mg che.ed F)aster a$sor(tionG, @itroglycerin 0D= mg sl@itroglycerin 0D= mg sl

&May re(eat in > minutes .atch 4PMay re(eat in > minutes .atch 4P, Mor(hine i) 2Mor(hine i) 2ndnd @T7 dose not e-ecti%e@T7 dose not e-ecti%e

&2 mg slo. IP2 mg slo. IP&May re(eat e%ery 2 minutes to ma1 0 mgMay re(eat e%ery 2 minutes to ma1 0 mg&Screen )or recent iagra ty(e drug usageScreen )or recent iagra ty(e drug usage

Identi)y /hythm Stri( #L ,Identi)y /hythm Stri( #L ,


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y y (y y (

N second stri( N second stri(

Treatment Treatment /a(id/

a(id AtrialAtrial

i$ ill ii$ ill ti


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i$rillationi$rillation

& Sta$le (atient .ith 4PSta$le (atient .ith 4P JJ00 mmBg00 mmBg, era(amil >mg Smg S minutes K 4P sta$le*I) no res(onse in > minutes K 4P sta$le*re(eat >mg Smg S


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d i) S l i


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# , Identi)y ST Ele%ation

#2 , Identi)y ST


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#2 Identi)y STele%ation

#L , Identi)y ST Ele%ation


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#L , Identi)y ST Ele%ation

ST El ti A ST Ele ation Ans er e


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ST Ele%ation Ans.er eyST Ele%ation Ans.er ey

& E7 # ,


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Patients With Traumatic Injuries