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Crush Injuries and Blunt Trauma on the Fireground: Concepts

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Crush Injuries and Blunt Trauma on the Fireground: Concepts of Initial Management Travis R. Welch, EMS Director Zionsville Fire Department References Fire Service ... – PowerPoint PPT presentation

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Title: Crush Injuries and Blunt Trauma on the Fireground: Concepts


1
Crush Injuries and Blunt Trauma on the
Fireground Concepts of Initial Management
  • Travis R. Welch, EMS Director
  • Zionsville Fire Department

2
References
  • Fire Service Emergency Care, Brady
  • Essentials of Emergency Care, Delmar
  • ZFD/BCEMS BLS protocols

3
Objectives
  • At the completion of this block of instruction,
    the participant will be able to competently
  • Identify possible mechanisms of injury resulting
    in fireground crush injury.
  • Assess a patient with a possible crush injury
  • Initiate proper initial BLS care for a patient
    with crush injury
  • Demonstrate a basic understanding of the
    pathophysiology of crush injuries, the required
    treatment, and resources available.

4
Crush Injury Defined
  • Injuries in which damaging forces are passed from
    the exterior of the body to internal structures
    because the body or some part of it has been
    compressed between to or more surfaces.
  • May result in open or closed wounds

5
Patient Assessment
  • Scene Size up
  • Primary Survey treat immediate life threats
  • Secondary Survey prioritize and treat other
    injuries, reassess all interventions done
    previously

6
How can it occur?
  • What are some of the mechanisms by which we as
    responders, or the victims on our emergency
    scenes may receive crushing injuries?

7
Size-up
  • Ensure scene/responder safety
  • Determine possible mechanisms of injury
  • Immediate life threats?
  • Do you need additional resources?

8
Primary Survey
  • A-airway with C-Spine control
  • B-Breathing, rate and quality
  • C-Circulation (pulses)
  • D-Disability (mental) Is the Pt alert?
  • E-Expose You cant treat it if you dont see it
  • F-Full set of vitals

9
Secondary Survey
  • Head to toe, review as you go
  • Detailed physical exam from head to toe
  • Prioritize injuries
  • Reassess aspects of primary survey and any
    treatment started during primary survey
  • Continuous process

10
What types of injuries might you see? How do you
treat them?
  • Musculoskeletal
  • Fractures
  • Dislocations
  • Soft tissue
  • Lacerations
  • Puncture wounds
  • Avulsions/eviscerations
  • Multi-system trauma or vascular injury
  • And many more
  • all for 3 easy payments of 19.95!

11
MS Injuries
  • Fractures
  • Dislocations
  • Sprains
  • Strains

12
Fractures
  • Closed
  • Open
  • Non-displaced
  • Displaced

13
Signs of Bone Fracture
  • Deformity
  • Tenderness
  • Splinting
  • Swelling
  • Bruising
  • Crepitus
  • False motion
  • Exposed fragments
  • Pain
  • Locked joint

14
Emergency CareFractures
  • Dress open wounds.
  • Apply appropriate splint.
  • If swelling is present, apply ice packs.
  • Prepare patient for transport.

15
Amputations
  • Apply dressing and immobilize.
  • Wrap amputated part in sterile dressing.
  • Place in plastic bag.
  • Follow local protocol for preserving amputated
    part.
  • Transport with patient.

16
Soft Tissue Injuries
  • Closed
  • Open
  • Burns

17
Closed Injuries
  • Contusion
  • Ecchymosis
  • Hematoma
  • Compartment syndrome

18
Closed InjuriesEmergency Care
  • Use BSI techniques.
  • Ice or cold pack
  • Compression
  • Elevation
  • Splinting
  • Treat for shock if necessary.

19
Open Injuries
  • Abrasion
  • Laceration
  • Avulsion
  • Penetrating wound
  • Amputation

20
Open InjuriesEmergency Care
  • Use BSI techniques.
  • Ensure airway.
  • Assess wound and control bleeding.
  • Apply sterile dressing.
  • Immobilize impaled objects.

21
Splinting (1 of 2)
  • Apply unless patients life is in immediate
    danger.
  • Prevents further damage to injured area
  • Prevents an open fracture from occurring
  • Prevents excessive bleeding

22
Splinting (2 of 2)
  • Maintains circulation in extremity
  • Reduces pain
  • Prevents neurological damage to injured area

23
Principles of Splinting (1 of 3)
  • Expose the injury.
  • Assess and record neurovascular status.
  • Cover all open wounds.
  • Avoid moving patient before splinting.

24
Principles of Splinting (2 of 3)
  • Immobilize joint above and below site.
  • Immobilize bones above and below joint.
  • Pad all rigid splints.

25
Principles of Splinting (3 of 3)
  • Align the extremity.
  • If you encounter resistance, splint as is.
  • Immobilize suspected spinal injuries in a
    neutral in-line position.
  • If the patient shows signs of shock, align in
    normal position and transport.
  • When in doubt, splint.

26
Spinal Injuries
  • Motor vehicle crashes
  • Pedestrian-motor vehicle collisions
  • Falls
  • Penetrating trauma to the head, neck, or torso
  • Motorcycle crashes
  • Hangings
  • Diving accidents
  • Recreation and sport trauma

27
Assessment of Spinal Injuries (1 of 2)
  • Evaluate mechanism of injury (MOI).
  • Always assume spinal injury when MOI unknown.
  • Use manual immobilization and spinal precautions.
  • Tell patient to keep head and injured areas still.

28
Assessment of Spinal Injuries (2 of 2)
  • Gentle palpation of affected area.
  • Minimize movement.
  • Determine extremity strength by squeezing hands
    test.
  • Gently push each foot against hands.

29
Assessment QuestionsPossible Spinal Injury
  • Neck or back hurt?
  • What happened?
  • Where does it hurt?
  • Able to wiggle fingers and toes?
  • Able to sense with fingers and toes?

30
Signs and SymptomsSpinal Injury
  • Pain, tenderness and/or deformity
  • Pain along spinal column
  • Paresthesia and/or numbness below site
  • Paralysis below injury site
  • Trauma to the shoulders, back, or abdomen

31
Emergency CareSpinal Injuries (1 of 2)
  • Maintain airway.
  • Use jaw-thrust maneuver to stabilize spine in a
    neutral, in-line position.
  • Perform manual in-line immobilization.
  • Apply cervical collar.

32
Emergency CareSpinal Injuries (2 of 2)
  • Immobilize supine patients on backboard.
  • Use short backboard on sitting patients.
  • Use standing backboard on standing or walking
    patient.

33
Specific Considerations
  • Compartment Syndrome
  • Traumatic Asphyxia

34
Compartment Syndrome
  • Characterized by the "five P's"--pain,
    paresthesia, paralysis, pallor, and
    pulselessness--although pulselessness and
    abnormal capillary refill are late signs.
  • Requires surgical intervention
  • Occurs when trauma produces swelling into
    internal spaces in extremitieswhich puts
    pressure on vital structures such as nerves or
    blood vessels

35
Traumatic Asphyxia
  • Characterized by cyanosis of upper body
  • Requires immediate transport, aggressive
    oxygenation
  • Poor prognosis

36
Questions?
  • Now, break into groups and practice
    immobilization techniques, including a patient in
    PPE and SCBA.
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