Packaging The Trauma Patient

[EMSRookie]

I am a new EMT student looking for some advice on packaging the major trauma patient. When you have an unstable patient with multiple fractures, and the mechanism of injury suggests severe internal trauma- Would you take time splinting a radius/ulna ? Obvious dislocated shoulder ? Tib/Fib ? Or Femur ?

 

[Medic Tim]

I am a new EMT student looking for some advice on packaging the major trauma patient. When you have an unstable patient with multiple fractures, and the mechanism of injury suggests severe internal trauma- Would you take time splinting a radius/ulna ? Obvious dislocated shoulder ? Tib/Fib ? Or Femur ?

An unstable trauma pt needs surgery. Extricate, fix any life threats you can and get on your way to the hospital or intercept.
Do not delay on scene time to splint and bandage an unstable pt.

 

[NomadicMedic]

Backboard for moving them. Don't screw around. Drive to the hospital. Splint whatever you can while en route.

 

[mycrofft]

Agree with both. But don't do any treatment blindly. Every splint is manipulation of an injury aggravated by manipulation; then field splint is removed (manipulated) at the ED. And if some helpful bystander already splinted it, you removed that splint before you applied your own….

OP, good opportunity: what are these signs of "internal injuries" you speak of? What is the scenario? Ask yourself "How much time am I going to spend with this patient between here and the hospital?". Can a crucially useful history be extracted while you are "doing something!" ?

 

[Bullets]

the mechanism of injury suggests

I suggest you delete this from your vocabulary. If you are at the point in your assessment where you are using MOI to provide some clue as to the nature of injury, then the patient is most likely not that serious. Remember where MOI falls in the trauma triage algorithm....after vital signs and after physical assessment.

Focus on your physical assessment. If you are finding multiple long bone fractures, you arent going to have time or need to individually splint everything. The patient needs a surgeon more than anything.

Secure the airway, stop the bleeding, drive


Unless youre in Maryland...then youre stuck with the chopper for everything

 

[Akulahawk]

I am a new EMT student looking for some advice on packaging the major trauma patient. When you have an unstable patient with multiple fractures, and the mechanism of injury suggests severe internal trauma- Would you take time splinting a radius/ulna ? Obvious dislocated shoulder ? Tib/Fib ? Or Femur ?

I'm going to say that unless you have some fairly advanced education (and therefore EMT certification/school would be largely redundant), you lack the education necessary to be able to "read" what MOI suggests. It can tell you a lot, but you have to know what it all means.

 

[mycrofft]

I suggest you delete this from your vocabulary. If you are at the point in your assessment where you are using MOI to provide some clue as to the nature of injury, then the patient is most likely not that serious. Remember where MOI falls in the trauma triage algorithm....after vital signs and after physical assessment.

Focus on your physical assessment. If you are finding multiple long bone fractures, you arent going to have time or need to individually splint everything. The patient needs a surgeon more than anything.

Secure the airway, stop the bleeding, drive


Unless youre in Maryland...then youre stuck with the chopper for everything

Roger that.


Good question though, OP!

 

[Brandon O]

Remember where MOI falls in the trauma triage algorithm....after vital signs and after physical assessment.

Eh? By what algorithm?

Things might've changed since my EMT class, but considering mechanism/nature of illness is part of the initial assessment in my book.

 

[chaz90]

Eh? By what algorithm?

Things might've changed since my EMT class, but considering mechanism/nature of illness is part of the initial assessment in my book.

Trauma triage algorithm, meaning trauma center destination or not (also sometimes what level TC). In that case, vital signs are considered first, with physical exam findings second and MOI a distant third before "special considerations."

 

[Akulahawk]

Trauma triage algorithm, meaning trauma center destination or not (also sometimes what level TC). In that case, vital signs are considered first, with physical exam findings second and MOI a distant third before "special considerations."

I put MOI with the "special considerations" because it's so far down the list... It's part of what I consider, well after physiological or anatomical criteria.

 

[Brandon O]

Trauma triage algorithm, meaning trauma center destination or not (also sometimes what level TC).

Oh. I believe the OP is asking about the assessment itself. Trauma diversion criteria is its own world.

 

[chaz90]

Hmm. That's how I read the initial quoted response, but I guess the OP does seem to be asking more about the trauma assessment in general. I'd still say that it's fine to think about MOI first as you're responding to the call and then move on to more important findings once you're on scene.

You're right though, the EMT class creed does recite "MOI/NOI" right after "BSI/Scene Safety."

 

[mycrofft]

I am a new EMT student looking for some advice on packaging the major trauma patient. When you have an unstable patient with multiple fractures, and the mechanism of injury suggests severe internal trauma- Would you take time splinting a radius/ulna ? Obvious dislocated shoulder ? Tib/Fib ? Or Femur ?

Just remembered , actually had one once (slid down the elevator ropes in a grain elevator, sixteen floors). Spineboard, then OP airway, suction and cervical immob in the unit, go like hell (about eight minutes to local ER).

 

[Handsome Robb]

I suggest you delete this from your vocabulary. If you are at the point in your assessment where you are using MOI to provide some clue as to the nature of injury, then the patient is most likely not that serious. Remember where MOI falls in the trauma triage algorithm....after vital signs and after physical assessment.

Focus on your physical assessment. If you are finding multiple long bone fractures, you arent going to have time or need to individually splint everything. The patient needs a surgeon more than anything.

Secure the airway, stop the bleeding, drive


Unless youre in Maryland...then youre stuck with the chopper for everything

While I do agree and understand what you're saying, knowing the kinematics of trauma can definitely aid in helping target your assessment. We need to be doing a good head to toe but once that's done understanding the physics of the accident can definitely help guide you.

 

[NPO]

Remember what the trauma assemenst says. As you do the assessment treat immediate life threats. If there are all internal threats the best treatment they can get is bright lights and cold steel in an OR.