Thermal Burn

Burns classification
Stop the burning process
All clothing and any garments and jewelry from the affected areas should
be removed to stop the burning process
Synthetic fabrics can ignite, burn rapidly at high temperatures, and melt
into hot residue that continues to burn the patient
Any clothing that was burned by chemicals should be removed carefully
Dry chemical powders should be brushed from the wound, with the
individual caring for the patient avoiding direct contact with the chemical
Burns should be cooled with room temperature water
In patients with large burns careful monitoring of core body temperature is
recommended to avoid hypothermia
 Most blisters should be left intact however, very large or tense blisters
located over joints should probably be ruptured to ease local wound
care
The burns should be covered with a clean dressing to minimize
further trauma and reduce pain associated with air currents
Airway
Larynx protects the subglottic airway from direct thermal injury, but the upper
airway is extremely susceptible to obstruction
Clinical indications of inhalation injury include:
Face and/or neck burns
Singeing of the eyebrows and nasal vibrissae
Carbon deposits in the mouth and/or nose and carbonaceous sputum
Acute inflammatory changes in the oropharynx, including erythema
Hoarseness
History of impaired mentation and/or confinement in a burning environment
Explosion with burns to head and torso
Carboxyhemoglobin level greater than 10% in a patient who was involved in a fire
Breathing
Breathing concerns arise from three general areas: hypoxia, carbon
monoxide poisoning, and smoke inhalation injury
Hypoxia may be related to inhalation injury, inadequate ventilation
due to circumferential chest burns, or traumatic thoracic injury
unrelated to the thermal injury -> supplemental oxygen with or
without intubation should be administered
The diagnosis of CO poisoning is made primarily from a history of
exposure and direct measurement of carboxyhemoglobin (HbCO) ->
receive high-flow oxygen via a non-rebreathing mask
 If the patients hemodynamic condition permits and spinal injury has
been excluded, elevation of the head and chest by 30 degrees helps
to reduce neck and chest wall edema
If a full-thickness burn of the anterior and lateral chest wall leads to
severe restriction of chest wall motion, chest wall escharotomy may
be required
Intravenous Access
Monitoring of hourly urinary output can reliably assess circulating
blood volume -> indwelling urinary catheter
Any patient with burns over more than 20% of the body surface
requires fluid resuscitation
Large-caliber (at least 16-gauge) intravenous lines should be
introduced immediately in a peripheral vein
The upper extremities are preferable to the lower extremities as a site
for venous access Infusion with an isotonic crystalloid solution,
preferably lactated Ringers solution
 2 to 4 mL of Ringers lactate solution per kilogram of body weight per
percentage BSA during the first 24 hours to maintain an adequate
circulating blood volume and provide adequate renal perfusion
example
a 50 kg man with 80% total BSA burns
2 - 4 * 80 * 50 = 8000 to 16000 mL in 24 hours.
Half of that volume 4000 to 8000 mL should be provided in the first 8
hours, so the patient should be started at a rate of 5001000 mL/hr.
The remaining half of the total fluid is administered during the
subsequent 16 hours
 After starting at this target rate, the amount of fluids provided should
be adjusted based on the urine output target of 0.5 mL/ kg/hr for
adults and 1 mL/kg/hr for children
Pharmacologic Therapies
Minor pain :
Oral acetaminophen (1 g in adults or 15 mg/kg in children every 4 to 6 hours)
or
an NSAID such as ibuprofen (400-800 mg in adults or 10 mg/kg in children)
every 6 to 8 hours.
Moderate to severe burn pain is managed with parenteral opioids;
Morphine sulfate 0.05-0.1 mg/kg
Chemical Burn
Chemical injury can result from exposure to acids, alkalies, and
petroleum products
Alkali burns are generally more serious than acid burns, because the
alkalies penetrate more deeply
Rapid removal of the chemical is essential -> immediately flush away
the chemical with large amounts of water, for at least 20 to 30
minutes, using a shower or hose
If dry powder is still present on the skin, brush it away before
irrigating with water
Electrical Burn
Electrical burns result when a source of electrical power makes
contact with a patients body
The body can serve as a volume conductor of electrical energy, and
the heat generated results in thermal injury to tissue
Different rates of heat loss from superficial and deep tissues allow for
relatively normal overlying skin to coexist with deepmuscle necrosis
The current travels inside blood vessels and nerves and thus may
cause local thrombosis and nerve injury
 Immediate treatment of a patient with a significant electrical burn
includes attention to the airway and breathing, establishment of an
intravenous line in an uninvolved extremity, ECG monitoring, and
placement of an indwelling bladder catheter
Electricity may cause cardiac arrhythmias that may require chest
compressions
No arrhythmias within the first few hours of injury, prolonged
monitoring is not necessary
Rhabdomyolysis results in myoglobin release, which can cause acute
renal failure
Fluid administration should be increased to ensure a urinary output
of 100 mL/hr in adults or 2 mL/ kg/hr in children
Criteria transfer to burn center
1. Partial-thickness and full-thickness burns on greater than 10% of the BSA in any patient
2. Partial-thickness and full-thickness burns involving the face, eyes, ears, hands, feet, genitalia, and
perineum, as well as those that involve skin overlying major joints
3. Full-thickness burns of any size in any age group
4. Significant electrical burns, including lightning injury (significant volumes of tissue beneath the surface
can be injured and result in acute renal failure and other complications)
5. Significant chemical burns
6. Inhalation injury
7. Burn injury in patients with preexisting illness that could complicate treatment, prolong recovery, or
affect mortality
8. Any patient with a burn injury who has concomitant trauma poses an increased risk of morbidity or
mortality, and may be treated initially in a trauma center until stable before being transferred to a burn
center
9. Children with burn injuries who are seen in hospitals without qualified personnel or equipment to
manage their care should be transferred to a burn center with these capabilities
10. Burn injury in patients who will require special social and emotional or long-term rehabilitative support,
including cases involving suspected child maltreatment and neglect
Spinal Cord Injury
Spine trauma
Trauma to the spine can cause a vertebral spinal column injury, a
spinal cord injury or both
Functional anatomy :
Vertebral column
Spinal cord

Tintinallis Emergency Medicine 8th edition

 Pre hospital care :
Recognition of patients at risk
Appropriate immobilization
Triage to an appropriate facility

Tintinallis Emergency Medicine 8th edition

 Initial ED stabilization :
Airway
Hypotension
Spine immobilization

Tintinallis Emergency Medicine 8th edition

 Clinical features :
History pay particular attention to any symptoms indicating present or
impending respiratory compromise, including dyspnea, palpitations,
abdominal breathing, and anxiety high cervical spine injury
Physical examination :
Presence or absence of midline neck or back tenderness
Test motor function for muscle groups
Sensory loss and investigate proprioception
Saddle anesthesia
Deep tendon reflexes

Tintinallis Emergency Medicine 8th edition

Tintinallis Emergency Medicine 8th edition
 Guidelines for ScreeningPatients with
Suspected Spine Injury
Suspected Cervical Spine Injury
1. The presence of paraplegia or quadriplegia is presumptive evidence of
spinal instability.
2. Patients who are awake, alert, sober, and neurologically normal, and
have no neck pain or midline tenderness, or a distracting injury: These
patients are extremely unlikely to have an acute c-spine fracture or
instability. With the patient in a supine position, remove the c-collar and
palpate the spine. If there is no significant tenderness, ask the patient to
voluntarily move his or her neck from side to side. Never force the patients
neck. When performed voluntarily by the patient, these maneuvers are
generally safe. If there is no pain, have the patient voluntarily flex and
extend his or her neck. Again, if there is no pain, c-spine films are not
necessary.
 3. Patients who are awake and alert, neurologically normal,
cooperative, and do not have a distracting injury and are able to
concentrate on their spine, but do have neck pain or midline
tenderness: The burden of proof is on the clinician to exclude a spinal
injury. Where available, all such patients should undergo multi-
detector axial CT from the occiput to T1 with sagittal and coronal
reconstructions. Where not available, patients should undergo lateral,
AP, and openmouth odontoid x-ray examinations of the c-spine with
axial CT images of suspicious areas or of the lower cervical spine if not
adequately visualized on the plain films
 Assess the c-spine films for:
bony deformity
fracture of the vertebral body or processes
loss of alignment of the posterior aspect of the vertebral bodies (anterior extent of
the vertebral canal)
increased distance between the spinous processes at one level
narrowing of the vertebral canal
increased prevertebral soft tissue space
If these films are normal, remove the c-collar. Under the care of a
knowledgeable clinician, obtain flexion and extension, and lateral cervical
spine films with the patient voluntarily flexing and extending his or her
neck. If the films show no subluxation, the patients c-spine can be cleared
and the c-collar removed. However, if any of these films are suspicious or
unclear, replace the collar and obtain consultation from a spine specialist.
 4. Patients who have an altered level of consciousness or are too young to
describe their symptoms: Where available, all such patients should
undergo multi-detector axial CT from the occiput to T1 with sagittal and
coronal reconstructions. Where not available, all such patients should
undergo lateral, AP, and open-mouth odontoid films with CT
supplementation through suspicious areas (e.g., C1 and C2, and through
the lower cervical spine if areas are not adequately visualized on the plain
films). In children, CT supplementation is optional. If the entire c-spine can
be visualized and is found to be normal, the collar can be removed after
appropriate evaluation by a doctor/consultant skilled in the evaluation/
management of patients with spine injuries. Clearance of the c-spine is
particularly important if pulmonary or other care of the patient is
compromised by the inability to mobilize the patient.
 5. When in doubt, leave the collar on
6. Consult: Doctors who are skilled in the evaluation and
management of patients with spine injuries should be consulted in all
cases in which a spine injury is detected or suspected.
7. Backboards: Patients who have neurologic deficits (e.g.,
quadriplegia or paraplegia) should be evaluated quickly and removed
from the backboard as soon as possible. A paralyzed patient who is
allowed to lie on a hard board for more than 2 hours is at high risk for
pressure ulcers.
 8. Emergency situations: Trauma patients who require emergency
surgery before a complete workup of the spine can be accomplished
should be transported carefully, assuming that an unstable spine
injury is present. The c-collar should be left on and the patient
logrolled when moved to and from the operating table. The patient
should not be left on a rigid backboard during surgery. The surgical
team should take particular care to protect the neck as much as
possible during the operation. The anesthesiologist should be
informed of the status of the workup.
 Suspected Thoracolumbar Spine Injury
1. The presence of paraplegia or a level of sensory loss on the chest or
abdomen is presumptive evidence of spinal instability.
2. Patients who are awake, alert, sober, neurologically normal, and
have no midline thoracic or lumbar back pain or tenderness: The
entire extent of the spine should be palpated and inspected. If there
is no tenderness on palpation or ecchymosis over the spinous
processes, an unstable spine fracture is unlikely, and thoracolumbar
radiographs may not be necessary.
 3. Patients who have spine pain or tenderness on palpation,
neurologic deficits, an altered level of consciousness, or in whom
intoxication is suspected: AP and lateral radiographs of the entire
thoracic and lumbar spine should be obtained. Thin-cut axial CT
should be obtained through suspicious areas identified on the plain
films. All images must be of good quality and interpreted as normal
by an experienced doctor before discontinuing spine precautions.
4. Consult a doctor skilled in the evaluation and management of spine
injuries if a spine injury is detected or suspected.
Thoracic Trauma
Primary Survey
The principal aim of the primary survey is to identify and treat
immediately life-threatening conditions. The life-threatening chest
injuries are:
Tension Pneumothorax
Massive Haemothorax
Open Pneumothorax
Cardiac Tamponade
Flail chest
Secondary Survey
The secondary survey is a more detailed and complete
examination, aimed at identifying all injuries and planning
further investigation and treatment. Chest injuries identified on
secondary survey and its adjuncts are:
Rib Fractures & flail chest
Pulmonary contusion
Simple pneumothorax
Simple haemothorax
Blunt aortic injury
Blunt myocardial injury
 monitoring adjuscts
oxygen Saturation
End-tidalCO2(if intubated)
diagnostic adjuscts
Chest X-ray
FAST ultrasound
Arterial Blood Gas
Intervention
chest drain
Thoracotomy
 Chest injuries
TENSION PNEUMOTHORAX :
Pathophysiology one-way valve :
Penetrating / blunt chest injury
Parenchymal lung injury fails to seal
Inspiration: air pleural
Expiration: air stucked in pleural

Signs :
Chest pain, Tachycardia, Hypotension
Tracheal deviation away from the affected side
Lack of/decreased breath sound on affected side
Subcutaneous emphysema on the effected side
 Chest injuries
TENSION PNEUMOTHORAX :
Management :
Immediate decompression
14-gauge angiocatheter in the 2nd ICS in the midclavicular
line of the affected side
Repeated reassessment is necessary
Definitive treatment : insertion of a chest tube
Tension pneumothorax
Needle decompression
 Chest injuries
Open Pneumothorax :
Large defects of the chest wall that remain open
results in an open pneumothorax ( sucking chest
wound )
Pathophysiology :
If wound is 2/3 of the tracheal chest wall defect
with each respiratory effort effective ventilation
is impaired
Signs : Hypoxia, Hypercabia
Open Pneumothorax :
Management :
Closing the deffect
Sterile oclusive dressing
Large, overlap the wound
Taped securely on 3 side
Inspiration: prevented air entering
Expiration: air escape from pleural
Definitive treatment: surgical closure
Open pneumothorax
Dressing for treatment
Massive Hemothorax
Accumulation of blood >1500 mL or 1/3 or more of the patients
blood volume in chest cavity
Sign and symptoms:
Neck veins may be flat or distended
Dullness
Hypotension
Absence of breath sounds
Management
Large caliber IV line and crystalloid
Type specific blood is adminiestered
Chest tube (at the nipple level, just anterior to the midaxillary line)
Flail Chest and Pulmonary Contusion
Occurs when a segment of the chest wall does not have bony
continuity with the rest of the thoracic cage.
This condition results from trauma associated with multiple rib
fractures.
Diagnosis :
Inspection :Flail chest may not be apparent initially if patients chest wall
has been splinted move air poorly, movement of the thorax will be
asymmetrical and uncoordinated.
Palpation : abnormal respiratory motion and crepitation of rib or cartilage
fractures
Chest x-ray multiple rib fractures
Initial treatment of flail chest includes adequate ventilation,
administration of humidified oxygen, and fluid resuscitation.
Definitive treatment is to ensure adequate oxygenation, administer
fluids judiciously, and provide analgesia to improve ventilation.
Cardiovascular trauma
Blunt cardiac trauma
Myocardial concussion
Myocardial rupture
Miscellaneous cardiac injury
Penetrating cardiac injury
Acute pericardial tamponade
Blunt aortic injury
Blunt cardiac trauma
Usually results from high speed MCV in which the chest wall strikes
the steering wheel.
Myocardial concussion

The term myocardial concussion or commotio cordis is used to

describe an acute form of blunt cardiac trauma that is usually
produced by a sharp, direct blow to the midanterior chest that stuns
the myocardium and results in brief dysrhythmia, hypotension, and
loss of consciousness
There is no histopatologic change, if the patient cant survive the
initial dysrhythmia sudden death with no histopatologic change
demonstrated in autopsy
Myocardial contusion

Several mechanism
Compressed heart between sternum and vertebrae, or elevated diaphragm
Compression of the abdomen and pelvis may displace abdominal viscera
upward
Histologically characterized by intramyocardial hemorrhage, edema,
and necrosis of myocardial muscle cells (similar finding in acute MI)
decrease in ventricular compliance cardiac dysfunction
Most myocardial contusions heal spontaneously, with resolution of
cellular infiltrate and hemorrhage leading to scar formation. (50%
leads to small pericardial effusion that require no therapy)
 the majority of patients with myocardial contusion have external
signs of thoracic trauma (e.g., contusions, abrasions, palpable
crepitus, rib fractures, or visible flail segments)
The most sensitive but least specific sign of myocardial contusion is
sinus tachycardia (70%)
Diagnostic strategies
ECG (no significant changes)
Laboratory finding ( first screening tools for detecting myocardial
injury): cardiac troponin serum, CK-MB level??
Echocardiography (direct visualization of cardiac structures and
chambers)
If patient have painfull wall injury (transesophageal echocardiography)
 Management:
Out of hospital evaluation: vital signs, level of consciousness, cardiac rhythm,
presence of chest wall trauma
Hospital:
Minor injuries and asymptomatic: elevated troponin level and minor ECG abnormalities
(no carefully monitoring needed)
 On admission, treatment of a suspected myocardial contusion should be
similar to that of an MI: intravenous line, cardiac monitoring, and
administration of oxygen and analgesic agents.

Thrombolytic agents and aspirin are contraindicated in the setting of acute

trauma. In rare instances there may be an acute MI associated with
trauma, which can arise from lacerations or blunt injury to the coronary
arteries. (manage using PCI and surgery)

Depressed CO: fluid administration dobutamine (after optimal preload

ensued)
Myocardial Rupture
Acute traumatic perforation of ventricle or atria, but may also include
othe part of heart
Delayed rupture may occur as a result of necrosis or infarcted
myocardium
 A rupture occurs during closure of the outflow track when there is
ventricular compression of blood-filled chambers by a pressure sufficient to
rupture the chamber wall, septum, or valve. (occurs in diastole or early
systole)

The atria are most susceptible to rupture by sudden compression in late

systole when these chambers are maximally distended with venous blood
and the atrial ventricular valves are closed

The immediate ability of the patient to survive cardiac rupture depends on

the integrity of the pericardium. Two thirds of patients with cardiac rupture
have an intact pericardium and are protected from immediate
exsanguination.
 In a review of survivors of myocardial rupture, common symptoms
and signs included hypotension (100%); elevated CVP (95%);
tachycardia (89%); distended neck veins (80%); cyanosis of the head,
neck, arms, and upper chest (76%); unresponsiveness (74%); distant
heart sounds (61%); and associated chest injuries (50%).
 The following findings are suggestive of pericardial rupture:
1. Hypotension disproportionate to the suspected injury
2. Hypotension unresponsive to rapid fluid resuscitation
3. Massive hemothorax unresponsive to thoracostomy and fluid
resuscitation
4. Persistent metabolic acidosis
5. The presence of pericardial effusion on echocardiography or
elevation of CVP and neck veins with continuing hypotension despite
fluid resuscitation
Tracheobronchial tree injury
If tracheobronchial injury is suspected, immediate
surgical consultation is warranted.
*Such patients typically present with hemoptysis,
subcutaneous emphysema, or tension pneumothorax.
Incomplete expansion of the lung after placement of
a chest tube suggests a tracheobronchial injury, and
placement of more than one chest tube often is
necessary to overcome a significant air leak.
Bronchoscopy confirms the diagnosis.
Temporary intubation of the opposite mainstem
bronchus may be required to provide adequate
oxygenation.
Advanced Trauma Life Support, 9th Edition
 Traumatic aortic disruption
A high index of suspicion prompted by a history of decelerating force and
characteristic findings on chest x-ray films should be maintained, and the
patient should be further evaluated.
Adjunctive radiologic signs on chest x-ray, which may or may not be present,
indicate the likelihood of major vascular injury in the chest and include:
- Widened mediastinum
- Obliteration of the aortic knob
- Deviation of the trachea to the right
- Depression of the left mainstem bronchus
- Elevation of the right mainstem bronchus
- Obliteration of the space between the pulmonary artery and the aorta
(obscuration of the aortopulmonary window)
- Deviation of the esophagus (nasogastric tube) to the right
- Widened paratracheal stripe
- Widened paraspinal interfaces
- Presence of a pleural or apical cap
- Left hemothorax Advanced Trauma Life Support, 9th Edition
 Helical contrast-enhanced computed tomography
(CT) of the chest has been shown to be an accurate
screening method for patients with suspected blunt
aortic injury.
A qualified surgeon should treat patients with blunt
traumatic aortic injury and assist in the diagnosis.
The treatment is either primary repair or resection of
the torn segment and replacement with an
interposition graft. Endovascular repair is now an
acceptable alternative approach.

Advanced Trauma Life Support, 9th Edition

Traumatic diaphragmatic injury
The appearance of an elevated right
diaphragm on chest x-ray may be
the only finding of a right-sided
injury.
If a laceration of the left diaphragm
is suspected, a gastric tube should
be inserted.
The appearance of peritoneal lavage
fluid in the chest tube drainage also
confirms the diagnosis.
Operation for other abdominal
injuries often reveals a
diaphragmatic tear. Treatment is by
direct repair.
Advanced Trauma Life Support, 9th Edition
Blunt esophageal rupture
The clinical picture of patients with blunt esophageal rupture is
identical to that of postemetic esophageal rupture.
Treatment consists of wide drainage of the pleural space and
mediastinum with direct repair of the injury via thoracotomy, if
feasible. Repairs performed within a few hours of injury lead to a
much better prognosis.

Advanced Trauma Life Support, 9th Edition

Other Manifestations of
Chest Injuries
Several manifestations of thoracic trauma are indicative of a greater
risk of associated injuries:
- Subcutaneous emphysema
- Crush injuries of the chest
- Injuries to the upper ribs (13), scapula, and sternum

Advanced Trauma Life Support, 9th Edition

Abdominal Trauma
Injury
Abdominal trauma
Abdominal trauma accounts for 15% to 20% of all trauma deaths
The most common mechanism for blunt abdominal trauma is a motor
vehicle collision
Patient who survive the initial traumatic insult are at risk for infection
and suffer mortality or morbidity secondary to sepsis

Tintinallis Emergency Medicine 8th edition

 Blunt abdominal trauma :
Motor vehicle collision compressive, shearing or stretching, and
acceleration/deceleration forces impact the abdominal cavity differently
abdominal wall, solid organ or hollow viscous injuries

Tintinallis Emergency Medicine 8th edition

 Penetrating abdominal trauma :
Stab and gunshot wounds and the transmitted energy of the blast; secondary
missiles as fragmented bone traumatic burden

Tintinallis Emergency Medicine 8th edition

 Clinical features :
Physical examination :
Inspect the abdomen for external signs of trauma
Palpate the abdomen in all quadrants tenderness, tympany, or rigidity
Abdominal wall injuries :
Direct blow or indirectly via a sudden muscular contraction contusions of the
abdominal wall musculature

Tintinallis Emergency Medicine 8th edition

 Solid organ injuries :
Due to blood loss increase pulse pressure, tachycardia, hypotension
Splenic injuries referred pain into the left shoulder or arm
Hollow viscous and mesenteric injuries :
Combination of blood loss and peritoneal contanmination by Gi contents

Tintinallis Emergency Medicine 8th edition

 Retroperitoneal injuries :
Pancreatic injuries from rapid deceleration
Duodenal injuries asymptomatic on presentation and a small hematoma of
the duodenum may go undiagnosed gastric outlet obstruction develop
Diaphragmatic injuries :
Spasm secondary or direct blow to the epigastrium
Rupture penetrating injury or blunt trauma

Tintinallis Emergency Medicine 8th edition

 Diagnosis :
USG (FAST) accurate, rapid, noninvasive, repeatable, and portable and
involves no nephrotoxic contrast material or ionizing radiation exposure to
the patient
CT scan with IV contrast gold standard

Tintinallis Emergency Medicine 8th edition

 Treatment :
Laparotomy gold standard therapy

Tintinallis Emergency Medicine 8th edition

Pelvic Trauma
PELVIC TRAUMA
What Type Of Fracture(s) Is It?
Lateral Compression Injuries
The most common type of pelvic fracture
The causative force is delivered laterally, as might occur in a Tbone
motor vehicle crash or when a pedestrian is struck from the side.
Laterally directed forces cause inward displacement of the ipsilateral
hemipelvis, hinging on the sacroiliac joint.

https://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=279&seg_id=5263
Anterior-Posterior Compression Injuries
Anterior-posterior compression fractures account for
20% to 30% of pelvic ring injuries.51 The force vector is
delivered directly to the front of the patient, as might
occur during a head-on motor vehicle crash or when a
pedestrian is struck in the same manner.
A force vector delivered to the anterior elements of the
pelvic ring causes diastasis of the symphysial ligaments
and/or fracture of the pubic rami. With progressive
disruption of the anterior elements of the pelvis, the
posterior ring is pulled apart, usually through the
sacroiliac joint. These injuries are often referred to as
open book pelvic fractures.
Vertical Shear Injuries
Vertical shear injuries may result from a fall on the
extended extremity or from a headon motor
vehicle crash in which the occupant has the leg
braced against the brake pedal or the floorboard.
Significant vertically oriented forces cause
disruption of both the anterior and posterior
pelvic rings, forcing one hemipelvis up relative to
the other. Severe ligamentous injury is the rule.
Pelvic injuries
Clinical presentations :
Tenderness, laxity, or instability on palpation of the bony pelvis
Hematuria
A hematoma over the ipsilateral flank, inguinal ligament, proximal thigh, or in
the perineum
Neurovascular deficits in the lower extremities
Rectal bleeding
Pelvic injuries
Complications :
The incidence of deep venous thrombosis
Continued bleeding from fracture or injury to pelvic vasculature
GU problems from bladder, urethral, prostate, or vaginal injuries : the
incidence of urethral injuries varies by the type of pelvic fracture
Sexual dysfunction, infections from disruption of bowel or urinary system,
chronic pelvic pain ( more so if the sacroiliac joints are involved )
TRIAGE
SORTING
By using triage, patients are sorted based on objective criteria on how
they present. The severity of injury and therefore treatment and/or
transport priority in triage is sorted by color code. Triage tags contain
these colors so treatment and transport crews can see at a glance
which patients have been triaged to which level
COLOR CODES
GREEN - Minor injury (walking wounded)
YELLOW - Delayed- can wait
RED - Immediate!
BLACK - Deceased
SCENE SIZE UP
1. Conduct a scene size up.
a. Assure well being of responders
b. Determine if (or render as possible) the scene
safe prior to entering
2. Take BSI
3. Determine the number of patients. If there are
multiple or mass casualties, communicate that fact
through the proper channels, establish command,
and establish a medical officer and triage officer
Now its time to start triage.
You may encounter people self evacuating the scene as you arrive.
Direct these people to an appropriate area of refuge so they can be
monitored and evaluated.
These people would be considered non-injured or walking
wounded
As you approach the actual scene, you may encounter people with
a variety of injuries from superficial to life threatening.
Your first step is to clear out the remaining walking wounded. Do
this by simply announcing if any of you are well enough to stand
up and walk out of here, do so now
Do not let then wander aimlessly These victims shall be
categorized GREEN. If you believe some of the uninjured victims are
capable of assisting you, keep them near you to help if needed.
Now all you should be left with are those victims who are injured
severely enough to not be able to get up and walk out on their own.
But where do you start? Who do you go to first? The loudest? The
bloodiest? The youngest? None of the above
START WHERE YOU STAND.
R. P. M.
R = Respiratory
P = Perfusion
M = Mental Status
RESPIRATORY
The first thing we check for is
presence of respiration.
Respirations:
NONE?
Open the airway
Still none?
Tag BLACK, deceased
Were respirations restored?
Tag RED, immediate
Respirations:
PRESENT?
Assess respiratory rate
RATE ABOVE 30 breaths per minute?
Tag RED, immediate
RATE BELOW 30 breaths per minute?
Move on to assess perfusion criteria
PERFUSION
Radial Pulse Absent or Capillary Refill > 2 secs
Tag RED, immediate
Radial Pulse Present or Capillary Refill < 2 secs
Move on to assess mental status
MENTAL STATUS
Cannot follow simple commands?
(unconscious or altered mental status)
Tag RED, immediate
CAN follow simple commands.
Tag YELLOW delayed
Now that the patients have been triaged, more focused treatment can
begin.
Moving victims to treatment areas may be needed. Those tagged RED
or immediate are trated (or moved to treatment areas) first, followed
by those tagged YELLOW or delayed.
Patients tagged BLACK can be left in place