History:

 

• Time of injury
• Type of injury
• Mechanism (blunt vs. penetrating)
• Open vs. closed wound/fracture
• Wound contamination
• Medical history
• Medications
• Tetanus history
• Evidence for multi-trauma

 

Significant Findings:

 

• Pain
• Swelling/bleeding
• Respiratory distress/failure
• Altered sensation/motor function distal the injury
• Diminished pulse/capillary refill distal the injury
• Major traumatic mechanism of injury
• Seat belt markings

 

Differential:

 

• Hollow/solid organ trauma
• Grey Turner's sign (bruising at flanks)
• Cullen's sign (bruising around navel)
• Referred pain (caused from the brain's inability to localize area of irritation
• Parietal pain (caused by irritation to the parietal peritoneal wall)
• Visceral pain (caused from acute stretching of the structure's wall)

 

Treatment:

 

• Oxygen

• Limit scene time to 10 min

• Initiate IV

 

Penetrating ?

 

• Yes

 

• • Consider Spinal Immobilization only if neurological deficit

 

• • Just enough Normal Saline IV to maintain a radial pulse (MAP of 60)

 

• • Vented chest seals if indicated

 

• • Consider pleural decompression

 

Blunt ?

 

• Yes

 

• • Consider Spinal Immobilization

 

• • Just enough Normal Saline IV to maintain a radial pulse (MAP of 60)

 

• • Consider pleural decompression

 

• • Notify receiving facility or contact Medical Control

 

PEARLS:

 

• Solid abdominal organs: lungs, liver, spleen, kidneys, pancreas. Presents with constant pain. May be referred.
• Hollow organs: heart, stomach, intestines, bladder, gall bladder, uterus, diaphragm, appendix.  Presents with visceral, parietal or referred pain. Pain presents as intermittent ache or cramp or sharp, pinpoint pain.
• Notify Greenville Memorial as soon as possible with:
  •  BP (or hemodynamic stability)
  • Airway status (patent, unstable or secured)
  • MOI
  • GCS
  • ETA.
• See Trauma Alert activation standard policies 1.13 for alert criteria