Lecture #8

ventilate with BVM at 24 breaths per minute

stabilize impaled object(s) with bulky dressing and transport with object in place

apply occlusive dressing and secure on three sides. if pt develops increased respiratory difficulty or tension pnuemothorax, remove dressing and roll onto affected side.

• the scene is unsafe
• critical injuries are affecting airway, breathing, circulation
• pt is blocking access to a pt with critical injuries affecting airway, breathing, or circulation

• the pt is repetitive (perseverative)
• severe or multiple episodes of vomiting

• indications: pt wearing helmet who requires airway preservation, stabilization of head to backboard, in line stabilization for transfer
• contraindications: do not remove football helmets unless airway is compromised. if you must, ensure shoulder pads are removed.

• MVAs
• ped vs vehicle
• falls
• blunt trauma
• penetrating trauma to head, neck, torso
• hanging
• unconscious trauma victims
• ETOH involved

• normal heart rate and low BP
• tenderness in area of injury
• pain with movement
• pain independent of movement/palpation
• obvious deformity of spine upon palpation
• associated soft tissue injuries
• numbness, weakness, or tingling in extremities
• loss of sensation or paralysis below suspected lvl of injury and/or upper or lower extremities
• incontinence

• Deformity
• contusion
• abrasion
• punctures
• penetrations
• paradoxical movement
• burns
• tenderness
• lacerations
• swelling

• Pia matter
• Arachnoid
• Dura matter

• Hypertension
• Bradycardia

• Hypertension
• Bradycardia
• Irregular respirations

All these things are the body's response to a build up of ICP

person is stiff with bent arms, clenched fists, and legs held out straight; indicates severe damage to the brain

the head is arched back, the arms are extended by the sides, and the legs are extended, allover rigidity, and clenched teeth

• concussion
• contusion
• laceration

subderal, epideral, or subarachnoid hematomas

a brain injury that occurs both at the site of the trauma and the opposite side of the brain

• MOI
• contusions, lacerations, hematomas to scalp
• deformity to skull
• blood/CSF leakage from ears or nose
• "raccoon eyes"
• battle signs
• unequal pupils
• seizure activity
• soft area or depression upon palpation
• altered or decreasing mental status
• irregular respiratory pattern
• nausea and/or vomiting

• when it is through the cheek
• anything that gets in the way on compressions

a test which scores the severity of a patient's injury (and prognosis) using the result of three tests: eye opening, verbal score, and motor response. best score of 15, worst score of 3

• conditions which interrupt or obstruct proper ventilation of the alveoli
• conditions which interrupt or obstruct proper lvls of circulation and result in hypoperfusion

Two or more ribs fracture in two or more places OR two or more fractured ribs with fractured sternum

• decreased ventilation
• paradoxical chest wall movement
• pain
• pulmonary contussion
• loose, moveable segment and crepitus upon palpation

• pulmonary contusion
• pulmonary edema

• massive hemothorax
• cardiac temponade
• myocardial contusion
• tension pneumothorax

a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse

• increased dyspnea despite oxygenation
• increasing hypotension

Blood in the pleural space

• frontal impact deceleration
• lateral impact acceleration
• fall deceleration

pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium)

• do not try to place organs back into abdomen
• cover with 4-sided occlusive dressing if possible
• protect against heat loss
• rapid transport

when pt is showing signs and symptoms of shock that are not explained by any injury

blood gathering between the dural and arachnoid matter.

blood gathering between the dura mater and the skull