Trauma

• D - Danger
• R - Response 
• C - Catastrophic Haemorrhage 
• A - (C) - Airway ( c-spine consideration)
• B -  Breathing 
• C - Circulation 
• D -  Disability
• E - Expose and Examine.

• Due to Blood Loss
• Loose 30-40% Blood Loss you are in trouble. 
• 50% Blood Loss - circling the drain.

• Increased Respiration Rate
• Increased Heart Rate
• Vasoconstriction (keep blood in the vital organs)

• Less than 5 min for penetrating Trauma 
• Less than 20min for Blunt Trauma

All trauma pts to receive 100% o2 as soon as airway is clear/Patent.

• All Pts with a serious head injury or Loss of Consciousness ( LOC) has a spinal injury until proven otherwise
• Treat for the worst

• C - Call Sign
• A - Age
• T - Time of Injury 
• M - Mechanism of Injury ( MOI) 
• I  - Injuries
• S - Severity 
• T - Treatment Given/Required

• "Energy that comes into contact with the body that causes injury"
• PTS aged 20-50 best able to compensate

Force applied to outside of body that doesn't pierce the skin

Goes into the body

• The MOI is the physical Force that is Exerted on the body which results in an injury
• High Mechanism - high energy transfer, high injury
• Maintain high index of suspicion

• P1 Red Immediate response 
• P2 Yellow Urgent Response 
• P3 Green Delayed Response 
• White - Dead no treatment

Re-assesment of Patients

• S - Safety
• C - Cause ( MOI) 
• E - Environment 
• N - No of PTS
• E - Extra Resources Required

• M - Major Incident Declared 
• E - Exact Location
• T - Type of Incident 
• H - Hazards
• A - Access/egress for Vehicles 
• N - No of PTS
• E - Emergency Services Required

• A - Age
• T - Time of Incident
• M - Mechanism of Injury 
• I - Injuries 
• S - Severity 
• T - treatment given/required

Or 

• C - Call sign/cad number
• A
• T
• M
• I
• S
• T

• S - Situation 
• B - Background
• A - Assessment 
• R - Recommendations, Requests, Read back.

• "Is the inadequate perfusion of a tissue"
• Eg. A short fall of blood
• Losing volume, you lose pressure

• Parasympathetic - Rest, digest, dilates vessels
• Sympathetic - HR, BR, things that keep us alive - constricts the vessels.

• Severe haemorrhage ( Internal/ External) 
• Extensive Burns ( loss of Fluids from the Blood) 
• Severe Diarrhoea/vomiting - loss of electrolytes and water.

• Chest - Haemothorax ( blood in the pleural cavity) 
• Abdomen - Ruptured Organs
• Pelvis - Vasculature inside the pelvis
• Longbones - fractured femur/humerus

• Bruising/ contusions
• Haematoma
• Abdo - Guarding or Rigidity
• Open wounds on surface
• swelling deformity
• seatbelt injury marks

• Stage 1 - Body is able to cope with the loss and no obvious clinical signs ( 15% blood loss),RR, Pulse Rate all elevated. 
• Stage 2 - Compensated Stage, blood loss more significant body compensatory mechanisms maintain blood pressure despite reduced blood volume ( RR, Pulse Rate increased) 15-20% blood loss
• Stage 3 - Decompensated shock body cant cope with changes in blood volume. Bp Drops, BradyCardia, becoming hypoxic due to tachypnea ( air hunger) 30-40% Blood Loss
• Stage 4 - Irreversible stage, organ failure has set in even if pt's circulation is restored, very likely they will die.  40% + Blood Loss

• Tachycardia 
• Tachypnea ( Increased RR) or Depth
• Abnormal Behaviour Agitated due to hypoxia
• Dizzy/Faint
• Pale,cold extremities, delayed cap refil, dilated pupils, thirst
• stage 4 - near fatal, reduced LOC, Bradycardia

• Apply Splint for Pelvis/long bones if suspected fracture
• immobilise only if necessary ie NOT for a single stab wound
• Minimise unnecessary movement to aid clotting
• nil by mouth incase anaesthetic required
• prevent hypothermia ( as it will reduce ability to clot blood) 
• minimal time on scene - load and go
• pre alert MTC on Pd 09 use Catmist 
• constant re-assesment, use capnography for RR 
• perform secondary survey on route if time allows

• Spinal cord runs in spinal canal down to L2 in Adults
• Spinal canal in Cervical region is large, risk of secondary injury due to swelling is reduced with immobilisation. 
• Thoracic region spinal cord is wider and spinal column is relatively narrower, an injury here is more likely to completely disrupt and damage spinal cord.
• Bradycarida, drop in BP, Slow RR, Flushed Face, if at C7 neurogenic shock at high cervical level

Complete loss of motor function and often sensory loss

and 

State of Poor tissue perfusion caused by sympathetic tone loss often after a spinal cord injury

• Sporting injuries 
• Falls
• RTC

• neck or Back Pain
• Reduction/loss of sensation or movement in limbs
• Burning sensation in trunk or limbs
• sensation or electric shock in trunk or limbs

• Diaphragmatic or Abdo breathing
• warm Peripheries/Vasodilation in presence of hypoextension
• Flaccid Muscles with Absent reflexes
• priapism - erection in the penis

• Hypotension ( Systolic B often 80-90mmhg) 
• Bradycardia

• Request Para or Hems early 
• administer 100% o2 via non rebreather 
• keep movement to a minimum to prevent further injury to spinal cord
• prevent hypothermia 
• carefully immobilise patients with MOI suggests SCI ie fall from height
• if extrication required use KED/longboard if time allows and ABC's stable and controlled log roll
• don't transport on long board use orthopaedic stretcher 
• minimal time on scene
• nil by mouth in case anaesthetic required
• pre alert MTC via PD09 using catmist 
• constant reassesment and capnography for RR
• only perform secondary survey if time allows on route.