Title: Crush Injuries and Blunt Trauma on the Fireground: Concepts
1Crush Injuries and Blunt Trauma on the
Fireground Concepts of Initial Management
- Travis R. Welch, EMS Director
- Zionsville Fire Department
2References
- Fire Service Emergency Care, Brady
- Essentials of Emergency Care, Delmar
- ZFD/BCEMS BLS protocols
3Objectives
- 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. -
4Crush 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
5Patient Assessment
- Scene Size up
- Primary Survey treat immediate life threats
- Secondary Survey prioritize and treat other
injuries, reassess all interventions done
previously
6How 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?
7Size-up
- Ensure scene/responder safety
- Determine possible mechanisms of injury
- Immediate life threats?
- Do you need additional resources?
8Primary 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
9Secondary 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
10What 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
12Fractures
- Closed
- Open
- Non-displaced
- Displaced
13Signs of Bone Fracture
- Deformity
- Tenderness
- Splinting
- Swelling
- Bruising
- Crepitus
- False motion
- Exposed fragments
- Pain
- Locked joint
14Emergency CareFractures
- Dress open wounds.
- Apply appropriate splint.
- If swelling is present, apply ice packs.
- Prepare patient for transport.
15Amputations
- Apply dressing and immobilize.
- Wrap amputated part in sterile dressing.
- Place in plastic bag.
- Follow local protocol for preserving amputated
part. - Transport with patient.
16Soft Tissue Injuries
17Closed Injuries
- Contusion
- Ecchymosis
- Hematoma
- Compartment syndrome
18Closed InjuriesEmergency Care
- Use BSI techniques.
- Ice or cold pack
- Compression
- Elevation
- Splinting
- Treat for shock if necessary.
19Open Injuries
- Abrasion
- Laceration
- Avulsion
- Penetrating wound
- Amputation
20Open InjuriesEmergency Care
- Use BSI techniques.
- Ensure airway.
- Assess wound and control bleeding.
- Apply sterile dressing.
- Immobilize impaled objects.
21Splinting (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
22Splinting (2 of 2)
- Maintains circulation in extremity
- Reduces pain
- Prevents neurological damage to injured area
23Principles of Splinting (1 of 3)
- Expose the injury.
- Assess and record neurovascular status.
- Cover all open wounds.
- Avoid moving patient before splinting.
24Principles of Splinting (2 of 3)
- Immobilize joint above and below site.
- Immobilize bones above and below joint.
- Pad all rigid splints.
25Principles 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.
26Spinal 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
27Assessment 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.
28Assessment 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.
29Assessment 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?
30Signs 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
31Emergency 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.
32Emergency CareSpinal Injuries (2 of 2)
- Immobilize supine patients on backboard.
- Use short backboard on sitting patients.
- Use standing backboard on standing or walking
patient.
33Specific Considerations
- Compartment Syndrome
- Traumatic Asphyxia
34Compartment 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
35Traumatic Asphyxia
- Characterized by cyanosis of upper body
- Requires immediate transport, aggressive
oxygenation - Poor prognosis
36Questions?
- Now, break into groups and practice
immobilization techniques, including a patient in
PPE and SCBA.