NREMTP Review-Ezekiel M. 🚒🚑 Trauma
Shock
Hypoperfusion
Biproduct of hypoperfusion=Lactic Acid
EVERY ONE OF THESE COLLAPSED LUNGS WILL PRESENT W/ ABSENT OR DIMINISHED LS ON THE AFFECTED SIDE
Collapsed Lungs
Pneumothorax (Simple or Closed)-Blunt Trauma
Open Pneumothorax=Sucking Chest Wound-Penetrating Trauma
Tension Pneumothorax
Hemothorax
Pleura
Outer 2 coverings of the lungs
Pneumothorax (Closed) or Open Pneumothorax (Sucking chest wound)
Patho-a collapsed lung caused by trauma, when air escapes from the lung and accumulates in the pleural space
Chest pain
Absent or diminished LS on affected side
SOB
Dyspnea
Anxiety/agitation
Tachycardia
Tachypnea
Cyanosis
Low Spo2
The clock now starts ticking!!!!!
Tension Pneumothorax
!!!WE ONLY NEEDLE DECOMPRESS A TENSION PNEUMOTHORAX!!!
Patho-a collapsed lung caused by trauma, when air escapes from the lung and accumulates in the pleural space. Every breath the pt. takes in, it CANNOT be exhaled. On each inhalation TENSION builds, putting pressure on the heart, decreasing cardiac output
All the signs of a regular pneumothorax, plus the following
Hypotension
JVD
Subcutaneous emphysema
Hyper resonant sounds
Tracheal Shift to the opposite side
Obstructive shock
Needle Decompression
12 or 14 g-2 inches in length
2-3rd ICS-Mid clavicular line
4-5th ICS-Mid axillary line
Hemothorax
Patho-A collapsed lung, caused by blunt or penetrating trauma, when blood accumulates in the pleural space
Chest Pain
Absent or diminished LS on affected side
SOB
Dyspnea
Low Spo2
Hypo resonant****
Flattened neck veins*****
Hypotension
Tachycardia
hypovolemic Shock
Ribs
12 pairs of ribs
Ribs 1-7-True Ribs
Ribs 8-10-False Ribs
Ribs 11-12-Floating Ribs
Flail Chest
Patho-2 or more ribs are broken, in 2 or more places
Causes a free-floating rib segment
Always affects the TRUE RIBS
Blunt Trauma
Severe chest & Rib pain
Paradoxical Chest Movement (Inhalation-Chest moves in/Exhalation-Chest goes out)
Crepitus
Unstable chest wall
Severe Dyspnea
SOB
Hypoxia
Low Spo2
Tachycardia
Ecchymosis to the chest
Paramedic Treatment
High flow o2
Often, they will need PPV via BVM
IV
Opioid pain management
Stabilize the free-floating pieces (Heavy bulky dressing, sandbag, 1 liter IV Bag)
Pulse Pressure
The difference between the SBP & DBP
Normal PP-30-50 120/80=40
Widened PP->50 210/100=110 (HTN crisis, ICP, Head injuries)
Narrowed PP-<30 80/60=20 (Cardiac tamponade, Shock)
Tampon-to press upon
Cardiac Tamponade
Patho-May occur in both a trauma and certain medical conditions
Blood or fluid is accumulating in the pericardial sac, pressing upon the heart, decreasing cardiac output
Beck's Triad
Muffled heart sounds
Hypotension
JVD
Tachycardia
Narrowed Pulse pressure***
Pulsus paradoxus*****
Pulsus Alternans****
Pulsus Alternans
The pulse is alternating between strong beats, weak beats, strong beats
Pulsus Paradoxus
A drop in the SBP during inhalation
Example-When palpating a pulse, it disappears every time the pt. inhales
If we can feel a carotid pulse, the SBP >80 mmHg
If we can feel a radial pulse, the SBP >90 mmHg
90-90-9 Rule
This rule is related to TBI w/ ICP
If the SBP drops below 90
OR
The Spo2 falls below 90
OR
The GCS falls below 9
The pt. has a 50% increased risk of morality=DEATH!!!!
You are on scene w/ a 25 y/o male involved in a motorcycle crash. VS-BP-82/40, HR-110, RR-30, Spo2-90%, GCS=12. Deformity to both legs and severe CP and SOB. What would this pts. RTS be?
RTS (Revised Trauma Score)
ICP (Intracranial Pressure)
Normal ICP-5-15 mmHg
3 things in the Brain
Brain Tissue (parenchyma)-80%
CSF-10%
Blood-10%
Causes of Increased ICP
TBI-Brain Bleeds (Epidural Hematoma & Subdural Hematoma)
Hemorrhagic Stroke-Ruptured aneurysm (ICH-Intracerebral hemorrhage & SAH-Subarachnoid hemorrhage)
Meningitis
Encephalitis
Peds-Hydrocephalus (Too much CSF)
Hepatic Encephalopathy
_________________________________________________________________
Most important part of the brain
Brain Stem
Medulla (Regulates HR, RR, Vomiting center)
Hypothalamus (Temperature regulation)
Pons
Increased ICP
Early Signs
Headache
Mild changes in LOC
Anxiety
Mod-Late findings
Cushing's Triad (Reflex)
Increased SBP
Bradycardia
Depressed & Irregular respirations
Widened Pulse Pressure
Unequal Pupils
Unconsciousness
High fever
Seizures
Posturing (Decorticate & Decerebrate)
Brain Herniation!!!!!=Instant Death
hernia=to push out
Brain herniation-the actual brain tissue explodes out of the skull or pushes out through the foramen
Paramedic Treatment
Secure an airway=Intubate!!!!!
MUST give LIDOCAINE prior to intubation!! (to decrease ICP)
maintain ETCO2-between 30-40
WE DO NOT HYPERVENTILATE HEAD INJURIES!!!
ventilate at 10/min
Elevate the HOB >30 degrees.
IVs
Do NOT give fluid boluses
Be prepared for seizures (have benzos available)
Passive cooling
May consider mannitol (osmotic diuretic-pulls fluid from the brain and allows the kidneys to excrete it