What does FLAPS stand for?
- Feel (chest walls for sweeling, deformity)
- Look (for subtle changes)
- Auscultate (Lateral chest and anterior armpit)
- Search (for wounds and blood/fractures)
What does TWELVE stand for?
- Tracheal elevation
- Emphysema (under the skin)
- Laryngeal crepitus
- Venous engorgement
- Exclude: Pneumothorax, Haemothorax, Flail Chest.
What does SBAR stand for?
- Situation (me, P/C, any concerns)
- Background (HxPC, MHx, DHx, SFHx)
- Assessment (Obs, O/E)
- Recommendations (include requests and read-back)
What does CATMIST stand for?
- Call sign
- Time of injury
- Injury found
- Signs (vital signs)
- Treatment given
What can get injured?
Heart, blood vessels, lungs, airways, soft tissue, bones, spinal cord, liver, kidneys, spleen.
What are the important checks for breathing?
- Expose the chest!
- Basic obs - RR, SPO2.
- Look for wounds
- Look for symmetrical breathing
- Look at the neck
- Listen to the lungs
- Feel for any deformities or swelling
What are the signs and symptoms?
- Deformity, bruising, swelling.
- Resp rate - lack of, fast, slow.
- Shallow respirations.
- Use of accessory muscles
- Emphysema under skin.
- Signs of clinical shock.
What treatment options?
- Wound dressings - consider Russell Chest Seal and Nightingale Dressing.
- Assist ventilations
- Position patient
- Paramedic intervention?
What are the signs and symptoms / pathophysiology of fractured ribs?
- Inadequate breathing.
- Blood loss.
- Damage to soft tissue including lungs, leading to secondary injury.
What is the pathophysiology / signs and symptoms of a fractured sternum?
- Indicates SIGNIFICANT chance of other major injuries.
- The force required to break it means other organs or bones may be injured.
- Time critical.
Signs and symptoms / Pathophysiology of Flail Chest?
- Paradoxical chest movment
- Two or more ribs broken in two or more places.
- Likelihood of lung injury or bruising.
Pathophysiology and signs/symptoms of a pneumothorax?
- Air in the pleural cavity.
- Can be life threatening.
- Puts pressure on the lung causing it to collapse.
- Eventually causes other structures to displace (eg trachea).
- Puts pressure on blood vessels returning blood to the heart, and becomes an obstructive shock.
- Open pneumothorax - can see a sucking wound as thoracic pressure changes and air is drawn into the pleural space.
- Tension pneumothorax - air enters the pleural cavity but cannot escape, occupying space (as above)
Signs / symptoms / pathophysiology of a haemothorax?
- Blood in the pleural cavity.
- Usually from penetrating trauma injuring major blood vessels. Can be from blunt trauma which shears.
- Blood fills the pleural cavity and takes up space usually occupied by lungs and they collapse.
Signs / symptoms / pathophysiology of Cardiac Tamponade?
- Excessive fluid in the pericardial sac, compresses the heart, limiting it's ability to pump.
- Usually a penetrating wound to the heart.
- Clinical shock is a result.
- Distended veins.
What are the causes?
- High-energy transfer from RTCs, falls from height, crushing.
- Also can be pathogenic - in the elderly with osteoporosis, or receiving radiotherapy.
Signs / symptoms / pathophysiology?
- Increased risk of haemorrhage.
- Urogenital injuries.
- Often accompanied by other injuries.
- Deformity / swelling
- Shortening of lower limb
- Pain over hips, groin, sacrum.
- Hypovolaemic shock.
- Frogs Legs.
How should these be managed?
- Control catastrophic haemorrhage.
- High flow O2.
- Pelvic splint (with log roll).
- Paramedic assistance.
- Swift transfer to MTC.
- Avoid repeated movement.
- Do not spring the pelvis.