Paramedics Course – Managing Trauma

Managing Trauma

Micro Lecture by the Australian Paramedical College:

This micro lecture discusses managing the trauma patient. Trauma is something you’re going to see time and time again and it’s not all major catastrophic trauma either.

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Managing Trauma

Hey guys, my name’s Sam (from the Australian Paramedical College). Today we’re going to talk about managing the trauma patient in this micro lecture. Trauma is something you’re going to see time and time again and it’s not all major catastrophic trauma either.

You’ve got minor trauma and you’ve got major trauma and each of these will give you significant challenges including, depending on where the patient is, you’re going to find Sunday afternoons there’s a lot of sport going on. So you’re going to be going to people who have sustained sporting injuries. You’re going to have to be driving under the pitch, going into public stands, all those types of things.

Then you’ve got the major trauma, road traffic collisions, falls from height, so trauma in it’s own right is broken down into different types of trauma and they all come with their own levels of complexity.

Let’s talk through one situation. So you’re called to a motor vehicle accident, somebody’s been hit by a car at high speed. When you arrive on scene, the patient is conscientious and talking and they’re screaming in a lot of pain. Now there is a lot of stressed out bystanders and they’re calling you over, “Come here, come here, paramedics come here.” So that’s always a sign that the patient’s been injured quite badly because the members of the public are usual quite stressed when they witness these things because they’re not pleasant to see.

So you still have to apply your primary survey danger, is there anything dangerous to yourself, your crew mate or the public? Response, hello can you hear me, stay nice and still. Particularly if the patient’s, the bystanders are saying oh they were hit by this car at high speed. “Yeah, yeah, yeah, I’ve got a lot of pain in my leg, he hit me and drove off.” Now one of you should be managing the airway at this point and not be distracted by the fact that he’s telling you about his leg. So that’s what we call a distracting injury.

So I would in that case say, “Look, we need to keep you nice and still. Now my colleague is just going to hold your head because we don’t know if you’ve got any injuries to your neck.” Even if they’re saying to you, “It’s my leg, it’s my leg.”

This is where your communication skills really do come into their own. You need to talk, reassure them say, “Look, I know you’re saying your legs hurting, you’re suffering from leg pain, we’ll sort that out in a minute, but just in case you’ve got any other type of injury we need to keep you nice and still.”

So, that’s danger, response, airway and C-spine. Looking at their breathing and their color and then do their circulation. Now once you’re happy with all those things, your colleague of course will be holding their head trying to avoid the ears. So you don’t want to take their sense of hearing away. Then you can go down and have a look at the disability.

So that might involve cutting their clothes. Of course always get permission from the patient, because the last thing you want is a lawsuit. Even though you’ve saved them and you’ve helped them, they can turn around and sue you if you’ve damaged their property. Now before you expose and you cut through their clothing it may be that you need to give them some strong pain relief first. So you’ll need to go through those processes.

Of course, something to help your colleague because you’ll always be reflecting and thinking about what am I doing, have I missed anything? At some point you’ve got to put some kind of collar on the neck, if that’s where you service, what your services indicate because the research is showing that ambulance services and research is moving away from collars full stop.

Not just moving from the semi rigid collars to the soft collars but they’re actually moving full stop away from collars. So if you need to put a collar on, put it on at some point soon, but it’s fine while you’ve got someone maintaining the C-spine.

So get permission to cut their clothing, give them some pain relief, have a look at the injury. Apply the necessary immobilisation, it could be something as simple as a vacuum splint to the leg, of course if your patient’s sitting up you want to lay them down because according to the criteria these people who’ve got a distracting injury and suspect, and have trauma are indicated for full spinal immobilization.

Now something we haven’t mentioned is catastrophic hemorrhage which is something we’ll cover in another session but just very briefly, anybody who’s got catastrophic hemorrhage would, you would always treat that first over everything, even before airway.

Okay guys, that’s the micro lecture on managing the trauma patient, I hope you’ve enjoyed it. My name’s Sam Willis (from the Australian Paramedical College) and I look forward to talking to you again shortly.

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