| SYSTEM Assessment/Findings |
Interventions |
| RESPIRATORY Avoid Hypoxemia, excessive hyperventilation |
- Airway Obstruction
- AMS: Agitation, obtundation
- UAO: Snoring, gurgling, stridor, hoarseness, tracheal deviation
- WOB: Retractions, use of accessory muscles
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- Airway, C-spine, Breathing
- Head-tilt/jaw-thrust maneuver for airway opening
- Small shoulder roll to compensate for large occiput
- Clear secretions/foreign body/debris
- Bag mask ventilate until airway is established
- Consider oral (OP) or nasal (NP) airway or laryngeal mask (LM) airway
- OP length = distance from teeth to angle of mandible
- NP length = distance from nose to angle of mandible
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- TENSION Pneumothorax
- Hemodynamic instability, respiratory distress, hypoxia
- Decreased/ipsilateral breath sounds
- Tracheal deviation & neck vein distension
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- Needle decompression
- Chest tube placement
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- Suspected Pneumothorax
- Dyspnea, unilateral decreased breath sounds, hypoxia
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- STAT chest X-ray (CXR), chest tube insertion
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- Pulmonary Contusion
- Hypoxemia, density on CXR, +/- chest wall contusion
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- Oxygen, judicious fluid resuscitation
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- Smoke Inhalation
- Grey/soot to oropharynx or nares, altered voice-hoarseness
- Hypoxemia, respiratory distress, increased WOB
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- Early intubation as indicated
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| CIRCULATION Maintain Euvolemia, Avoid Hypotension |
- Hemorrhagic Shock
- Observed blood loss
- Tachycardia, poor perfusion
- Waxing, waning MS
- Hypotension late sign
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- Internal or External Causes of Hemorrhagic Shock
- Consider mechanism of injury
- Solid organ injury
- Abdominal tenderness, distention, hematuria
- Hollow viscus injuries may present late (> 24 hrs)
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- Penetrating Trauma
- Consider mechanism of injury, presence of foreign bodies
- Wound trajectory and possible injury
- Symptoms based on location
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- CT vs OR
- Roll patient quickly, check axilla and count wounds
- XR of chest & pelvis to establish trajectory of suspected injuries
- Mark ballistic wounds prior to radiologic intervention with a paperclip
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- Long Bone Fracture
- Deformity of long bone (open or closed fracture)
- Changes in sensation/mobility/circulation to affected limb
- Obvious hemorrhage
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- Immobilize to control hemorrhage (splint affected limb)
- Early consultation w/Orthopedics
- Dedicated imaging of affected limb
- Tetanus prophylaxis for open fractures
- Fracture, Open Long Bone Pathway
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- Vascular Injury
- Obvious hemorrhage
- Prolonged capillary refill, coolness distal to injury
- Diminished pulses
- Cold, pale, pulseless limb
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- Apply direct pressure or tourniquet to control bleeding
- Vascular injury to LE: Consult Vascular LE
- Vascular injury to UE distal to elbow: Consult Ortho – Hand, Micro
- Special considerations for Transfer
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- Massive Hemothorax
- Asymmetric/absent breath sounds
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- Cardiac Tamponade
- Hypotension, muffled heart sounds, distended neck
veins - Beck’s triad
- Narrow pulse pressure, EKG abnormalities
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- Ultrasound-guided subxiphoid needle decompression
- Consider ED thoracotomy
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OR |
| NEUROLOGIC Recognize and Treat Increased ICP, Appropriate Immobilization |
- Head/Intracranial Injury
- Altered mental status
- Focal neurologic deficits, pupil asymmetry (elevated ICP)
- Cushing’s triad: Hypertension, bradycardia, abnormal breathing
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- Spinal Cord Trauma
- Focal sensory, motor deficits
- Signs of external injury
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- Immobilization for spinal protection
- Neurosurgery, Ortho Consultation, imaging or OR as indicated
- Evaluation by specialist w/removal of long backboard in under 2 hours
- Spinal Cord Injury Pathway
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- Spinal Shock
- Hypotension with associated bradycardia
- Neurologic deficits
- Signs of external injury
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