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Emergency Care
CHAPTER
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
THIRTEENTH EDITION
Multisystem Trauma
30
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Topics
• Multisystem Trauma
• Managing the Multisystem-Trauma
Patient
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Multisystem Trauma
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Multisystem Trauma
• Multiple-trauma patient
 More than one serious injury
• Multisystem-trauma patient
 One or more injuries serious enough to
affect more than one body system
• Teamwork, timing, and transport
decision are key to proper
management.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Determining Patient Severity
• Most critical decisions
 Patient priority/severity
 Whether to limit scene time or not
 Which hospital or transport method is
best for your patient
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Determining Severity:
Physiologic Criteria
• Altered mental status (GCS < 14)
 Head injury
• Hypotension (systolic < 90 mm Hg)
 Shock, internal bleeding
• Abnormally slow respiratory rate
 Head injury, later stages of shock
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Determining Severity:
Anatomic Criteria
• Penetrating injuries to head, neck,
torso, and extremities proximal to
elbow and knee
• Chest wall instability or deformity
• Two or more proximal long-bone
fractures
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Determining Severity:
Anatomic Criteria
• Crushed, degloved, mangled, or
pulseless extremity
• Amputation proximal to wrist or ankle
• Pelvic fractures
• Open or depressed skull fracture
• Paralysis
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Determining Severity:
Mechanism of Injury
• In absence of anatomic or physiologic
signs, MOI is considered if severe.
• Falls
• Intrusion
• Ejection from automobile
• Death in same passenger compartment
• Vehicle telemetry data consistent with
high risk of injury
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Determining Severity: Special
Patients and Considerations
• Older adults do not efficiently
compensate for shock.
• Children may benefit by transport to a
pediatric specialty facility.
• Patients with certain conditions
 Taking anticoagulants
 Pregnant
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Managing the Multisystem-
Trauma Patient
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
A Typical Call
• Practice with crew.
 Determine roles.
• En route to call, review roles each
member of the crew will have.
• Ensure scene safety.
 Auto crash will have passing traffic.
 Penetrating trauma
• Assailant may still be on the scene.
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
A Typical Call
• Perform the primary assessment.
• Ensure an open airway.
• Perform urgent or emergency moves.
• Transport.
• Give a report to the trauma team at the
emergency department during
handover.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Analysis of the Call
• In a scenario with critical injuries
 Follow priorities determined by
assessments.
 Do not delay transport by performing
treatments that would waste time.
 Show good judgment.
• Postpone taking vital signs until en route
when appropriate.
• Give the hospital staff time to prepare.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
General Principles of Multisystem-
Trauma Management
• Follow priorities determined by primary
assessment.
• Attend to immediate threats to life.
• Reassess what to treat on scene and
what needs definitive care.
• Call hospital so they can prepare.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
General Principles of Multisystem-
Trauma Management
• Depending on your primary
assessment, you may postpone taking
vital signs until you are en route to the
hospital.
• As you reassess your patient in the
vehicle, call the hospital as necessary
to update the vital signs.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
General Principles of Multisystem-
Trauma Management
• Limit scene treatment
 Stabilize cervical spine.
 Suction airway.
 Insert oral or nasal airway.
 Restore patent airway.
 Ventilate with bag-valve mask.
 Administer high-concentration oxygen.
 Control bleeding.
 Immobilize patient.
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
General Principles of Multisystem-
Trauma Management
• Scene safety is paramount.
• Ensure an open airway.
• Perform urgent or emergency moves as
necessary.
• Adapt to the situation.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Trauma Scoring
• Numerical rating system for trauma
• Assigns number to certain patient
characteristics to create a score
• Objectively describes severity
• Helps determine transport to a trauma
center or local hospital
• Helps trauma centers evaluate the care
of similar patients
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Trauma Scoring
• Revised Trauma Score (RTS)
 Components
• Glasgow Coma Scale (GCS)
• Systolic blood pressure
• Respiratory rate
 Follow local protocol for use of the
trauma scoring system.
 Do not let it interfere with patient care.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Sample RTS Form
Revised Trauma Score. Source: Champion, H. R., Sacco, W. J., Copes, W.S., et al. “A
Revision of the Trauma Score,” J Trauma 29(5): 623–9, 1998.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Chapter Review
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Chapter Review
• Multisystem trauma is a serious
condition in which two or more major
body systems are injured or affected.
• Recognizing multisystem trauma,
triaging properly, transporting
promptly, and choosing the correct
destination are vital for the survival of
your patient.
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Chapter Review
• The CDC has issued guidelines for
trauma triage and transport. These are
a guide and should be used in
conjunction with your protocols.
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Chapter Review
• The Revised Trauma Score (RTS) is one
method of classifying trauma patients
by severity and includes the Glasgow
Coma Score (GCS), systolic blood
pressure, and respiratory rate.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Remember
• Your primary assessment should
determine whether your patient is
seriously injured or potentially seriously
injured.
• Limit scene treatment to life-
threatening conditions.
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Remember
• Use patient severity (physiologic
criteria, anatomic criteria, MOI) to
decide whether to transport to a
trauma center or local hospital.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Questions to Consider
• Is my patient seriously injured or
potentially seriously injured?
• Should I expedite my scene time?
• What is the most appropriate transport
destination for my patient?
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Critical Thinking
• A patient was involved in a car crash
with significant intrusion into the area
where the patient was sitting. The
patient is alert and complains of pain in
the ribs. Pulse: 96 and regular;
respirations: 30 and adequate; blood
pressure: 100/62; pupils: equal and
reactive; skin: cool and dry.
continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Emergency Care, 13e
Daniel Limmer | Michael F. O'Keefe
Critical Thinking
• Your partner says the patient is stable
and could be easily transported to the
community hospital nearby. You think
the patient should be transported to
the trauma center. How would you
justify your decision to your partner?

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Ch30 trauma

  • 1. Emergency Care CHAPTER Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe THIRTEENTH EDITION Multisystem Trauma 30
  • 2. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Topics • Multisystem Trauma • Managing the Multisystem-Trauma Patient
  • 3. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Multisystem Trauma
  • 4. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Multisystem Trauma • Multiple-trauma patient  More than one serious injury • Multisystem-trauma patient  One or more injuries serious enough to affect more than one body system • Teamwork, timing, and transport decision are key to proper management.
  • 5. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining Patient Severity • Most critical decisions  Patient priority/severity  Whether to limit scene time or not  Which hospital or transport method is best for your patient continued on next slide
  • 6. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining Severity: Physiologic Criteria • Altered mental status (GCS < 14)  Head injury • Hypotension (systolic < 90 mm Hg)  Shock, internal bleeding • Abnormally slow respiratory rate  Head injury, later stages of shock continued on next slide
  • 7. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining Severity: Anatomic Criteria • Penetrating injuries to head, neck, torso, and extremities proximal to elbow and knee • Chest wall instability or deformity • Two or more proximal long-bone fractures continued on next slide
  • 8. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining Severity: Anatomic Criteria • Crushed, degloved, mangled, or pulseless extremity • Amputation proximal to wrist or ankle • Pelvic fractures • Open or depressed skull fracture • Paralysis continued on next slide
  • 9. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining Severity: Mechanism of Injury • In absence of anatomic or physiologic signs, MOI is considered if severe. • Falls • Intrusion • Ejection from automobile • Death in same passenger compartment • Vehicle telemetry data consistent with high risk of injury
  • 10. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining Severity: Special Patients and Considerations • Older adults do not efficiently compensate for shock. • Children may benefit by transport to a pediatric specialty facility. • Patients with certain conditions  Taking anticoagulants  Pregnant
  • 11. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Managing the Multisystem- Trauma Patient
  • 12. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe A Typical Call • Practice with crew.  Determine roles. • En route to call, review roles each member of the crew will have. • Ensure scene safety.  Auto crash will have passing traffic.  Penetrating trauma • Assailant may still be on the scene. continued on next slide
  • 13. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe A Typical Call • Perform the primary assessment. • Ensure an open airway. • Perform urgent or emergency moves. • Transport. • Give a report to the trauma team at the emergency department during handover.
  • 14. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Analysis of the Call • In a scenario with critical injuries  Follow priorities determined by assessments.  Do not delay transport by performing treatments that would waste time.  Show good judgment. • Postpone taking vital signs until en route when appropriate. • Give the hospital staff time to prepare.
  • 15. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe General Principles of Multisystem- Trauma Management • Follow priorities determined by primary assessment. • Attend to immediate threats to life. • Reassess what to treat on scene and what needs definitive care. • Call hospital so they can prepare.
  • 16. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe General Principles of Multisystem- Trauma Management • Depending on your primary assessment, you may postpone taking vital signs until you are en route to the hospital. • As you reassess your patient in the vehicle, call the hospital as necessary to update the vital signs.
  • 17. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe General Principles of Multisystem- Trauma Management • Limit scene treatment  Stabilize cervical spine.  Suction airway.  Insert oral or nasal airway.  Restore patent airway.  Ventilate with bag-valve mask.  Administer high-concentration oxygen.  Control bleeding.  Immobilize patient. continued on next slide
  • 18. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe General Principles of Multisystem- Trauma Management • Scene safety is paramount. • Ensure an open airway. • Perform urgent or emergency moves as necessary. • Adapt to the situation.
  • 19. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Trauma Scoring • Numerical rating system for trauma • Assigns number to certain patient characteristics to create a score • Objectively describes severity • Helps determine transport to a trauma center or local hospital • Helps trauma centers evaluate the care of similar patients continued on next slide
  • 20. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Trauma Scoring • Revised Trauma Score (RTS)  Components • Glasgow Coma Scale (GCS) • Systolic blood pressure • Respiratory rate  Follow local protocol for use of the trauma scoring system.  Do not let it interfere with patient care.
  • 21. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Sample RTS Form Revised Trauma Score. Source: Champion, H. R., Sacco, W. J., Copes, W.S., et al. “A Revision of the Trauma Score,” J Trauma 29(5): 623–9, 1998.
  • 22. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe
  • 23. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Chapter Review
  • 24. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Chapter Review • Multisystem trauma is a serious condition in which two or more major body systems are injured or affected. • Recognizing multisystem trauma, triaging properly, transporting promptly, and choosing the correct destination are vital for the survival of your patient. continued on next slide
  • 25. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Chapter Review • The CDC has issued guidelines for trauma triage and transport. These are a guide and should be used in conjunction with your protocols. continued on next slide
  • 26. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Chapter Review • The Revised Trauma Score (RTS) is one method of classifying trauma patients by severity and includes the Glasgow Coma Score (GCS), systolic blood pressure, and respiratory rate.
  • 27. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Remember • Your primary assessment should determine whether your patient is seriously injured or potentially seriously injured. • Limit scene treatment to life- threatening conditions. continued on next slide
  • 28. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Remember • Use patient severity (physiologic criteria, anatomic criteria, MOI) to decide whether to transport to a trauma center or local hospital.
  • 29. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Questions to Consider • Is my patient seriously injured or potentially seriously injured? • Should I expedite my scene time? • What is the most appropriate transport destination for my patient?
  • 30. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Critical Thinking • A patient was involved in a car crash with significant intrusion into the area where the patient was sitting. The patient is alert and complains of pain in the ribs. Pulse: 96 and regular; respirations: 30 and adequate; blood pressure: 100/62; pupils: equal and reactive; skin: cool and dry. continued on next slide
  • 31. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Critical Thinking • Your partner says the patient is stable and could be easily transported to the community hospital nearby. You think the patient should be transported to the trauma center. How would you justify your decision to your partner?

Editor's Notes

  1. Planning Your Time: Plan 60 minutes for this chapter. Multisystem Trauma (30 minutes) Managing the Multisystem-Trauma Patient (30 minutes) Note: The total teaching time recommended is only a guideline. Core Concepts How to balance the critical trauma patient's need for prompt transport against the time needed to treat all of the patient's injuries at the scene How to determine the severity of the trauma patient's condition, priority for transport, and appropriate transport destination How to select the critical interventions to implement at the scene for a multiple-trauma patient How to calculate a trauma score
  2. Teaching Time: 30 minutes Teaching Tips: Use examples and scenarios to describe the trauma decision-making process. Discuss the Center for Disease Control Trauma Triage Guidelines. Discuss the guidelines of your local trauma center. Integrate this type of decision making into scenarios throughout class. Make it more than a one-time lesson.
  3. Covers Objective: 30.1 Points to Emphasize: The multisystem-trauma patient has one or more injuries that are serious enough to affect more than one body system. Care for multisystem trauma is different from that for isolated trauma. Teamwork, timing (moving patient to definitive care as soon as possible), and transport (decision about appropriate destination) are essential. Discussion Topics: Define multisystem trauma. Discuss how the treatment and transportation of a multisystem-trauma patient is different from that of an isolated trauma patient. Knowledge Application: Have students work in small groups. Ask each group to discuss the different roles that would be necessary to treat and transport a multisystem-trauma patient. What would be the components of teamwork? Critical Thinking: Is there isolated trauma that requires similar decision making and teamwork when compared to multisystem trauma? Give examples.
  4. Covers Objective: 30.3 Points to Emphasize: EMTs must look at actual physiologic injuries, anatomic locations, and mechanism of injury to adequately judge patient severity and transport priority. Special considerations, such as age and underlying medical condition, may alter the initial severity decisions.
  5. Covers Objective: 30.3 Knowledge Application: Using local geography, describe a trauma scene. Ask students to make severity decisions and to plan appropriate transportation.
  6. Covers Objective: 30.3 Discussion Topic: What special considerations might alter the decision-making process when dealing with a trauma patient? Class Activities: Hand out four written scenarios as a take-home assignment. Ask students to read each scenario and then to write out an initial treatment and transport plan.
  7. Covers Objective: 30.3
  8. Covers Objective: 30.3 Discussion Topic: Describe the information needed to judge the severity of a multisystem trauma patient. Class Activity: Discuss local trauma resources. Where are the local trauma centers? What transport options are present? Knowledge Application: Use a programmed patient and simulate trauma scenarios. Have groups of students practice assessment, decision making, and teamwork.
  9. Covers Objective: 30.3 Discussion Topic: Describe the information needed to judge the severity of a multisystem trauma patient. Class Activity: Discuss local trauma resources. Where are the local trauma centers? What transport options are present? Knowledge Application: Use a programmed patient and simulate trauma scenarios. Have groups of students practice assessment, decision making, and teamwork.
  10. Teaching Time: 30 minutes Teaching Tips: Use multimedia graphics to demonstrate multisystem trauma scenes. The scenario in the chapter is a helpful example of a trauma scene. Use it as a basis for discussion or as a framework for other scenarios. Relate this lesson to previous lessons. Discuss the context of airway management, bleeding control, and spinal immobilization in multisystem trauma patients. Describe how the primary assessment will guide these steps. Add context to scenarios. By now, students will be familiar with standardized skill sheets. Begin to teach flexibility and adaptation by using atypical situations.
  11. Covers Objective: 30.2 Point to Emphasize: The best way to prepare for multisystem trauma is to practice and develop teamwork before the call. Discussion Topic: Describe the process of preparing for a multisystem trauma situation. What steps can you take before the call? Knowledge Applications: Have students work in small groups. Ask each group to preplan multisystem trauma. Discuss roles and teamwork and compare notes among groups. Using the same groups and a programmed patient, create a multisystem trauma patient scenario. Discuss whether preplanning helped and how students might preplan differently.
  12. Covers Objective: 30.5 Point to Emphasize: Scene safety considerations are an essential component of multisystem trauma management. The EMT must adapt to unusual circumstances in multisystem trauma management. Expect the unexpected. Discussion Topic: What safety hazards might be present at a multisystem trauma scene? Use examples to discuss why it is important to be flexible and to adapt at a multisystem trauma scene. Class Activity: Use multimedia graphics to illustrate unusual trauma scenes. Discuss examples that show how traditional response and treatment might not be appropriate. Demonstrate flexibility.
  13. Covers Objective: 30.5
  14. Covers Objective: 30.5 Points to Emphasize: The best way to prepare for multisystem trauma is to practice and develop teamwork before the call.
  15. Covers Objective: 30.5 Talking Points: Depending on your primary assessment, you may postpone taking vital signs until you are en route to the hospital. Alert hospital that you are on your way, and give them the information you have so that they can prepare the trauma team. As you reassess your patient in the vehicle, call the hospital as necessary to update the vital signs.
  16. Covers Objective: 30.5 Point to Emphasize: Limit scene treatment to airway management, breathing control, administering high-concentration oxygen, controlling bleeding. and spinal immobilization. Discussion Topic: What interventions are reasonable to conduct on scene with a multisystem trauma patient? Knowledge Application: Use programmed patients to practice multisystem trauma scenarios. Time "on-scene interventions" and discuss decision making. Critical Thinking: How might transport time affect the interventions completed at a scene? Might there be more on-scene interventions in the event of a long transport time? Might there be fewer?
  17. Covers Objective: 30.5 Point to Emphasize: Limit scene treatment to airway management, breathing control, administering high-concentration oxygen, controlling bleeding. and spinal immobilization. Discussion Topic: What interventions are reasonable to conduct on scene with a multisystem trauma patient? Knowledge Application: Use programmed patients to practice multisystem trauma scenarios. Time "on-scene interventions" and discuss decision making. Critical Thinking: How might transport time affect the interventions completed at a scene? Might there be more on-scene interventions in the event of a long transport time? Might there be fewer?
  18. Covers Objective: 30.6
  19. Covers Objective: 30.6
  20. Covers Objective: 30.6
  21. Talking Points: There are many different types of trauma situations, and decision-making in each will be determined by the conditions.
  22. Talking Points: Since the patient complains of pain in the rib area and the potential for considerable blunt injury trauma due to the crash, you should be alert for unseen internal injuries and the possibility that the patient may need critical care that is better supplied at a specialized trauma center than at a community hospital.