Trauma life threats and treatments:
I have covered trauma assessment and the rapid trauma survey in other posts. Here I am going to specifically walk through the life threats we are looking for, and how we can treat them in the pre-hospital environment. While many traumatic injuries appear quite dramatic upon discovery, there are only a few that can rapidly kill us, and that number is even smaller when we narrow it to threats that can be addressed by first responders on scene. Starting from the top:
Head:
Airway obstruction: While the most common obstruction in all situations is the tongue, there are many other possible issues in trauma. Blood, vomit, teeth, and foreign objects can all be present and need to be cleared. Treatment is a standard BLS approach. Suction fluids, and finger sweep visible solids from the oral cavity. Once clear, place an airway adjunct. In the setting of head trauma, we have to consider the possibility of basal skull fracture; this means no nasal airways.
Cervical spine fractures or dislocations: Palpation of the cervical spine may reveal tenderness or step deformity. Application of a cervical collar is appropriate in this case, as is the undertaking of spinal motion restriction protocol (No standing or walking, lie flat on the stretcher).
Open skull fractures: In the case of open skull fracture, the best we can do is limit further damage by applying a non-adherent dressing at the site and wrapping loosely with cling. SMR is indicated.
Chest/Back:
Flail chest: If you note paradoxical chest wall movement, it is best not to attempt to restrict chest wall mobility. Assisted ventilations are indicated, and monitoring for the development of pneumothorax is key.
Sucking chest wound: In the event of penetrating trauma with a bubbling chest wound, rapidly apply a commercial chest seal or 3 sided occlusive at the site.
Tension pneumothorax: Assist ventilations with a reduced tidal volume, monitoring BP closely. An ACP can provide needle decompression.
Abdomen:
Evisceration: Cover eviscerations with a moist abdominal pad and secure with a dry dressing.
Pelvis:
Fracture: In an unstable pelvis we want to apply a pelvic binder or sheet wrap.
Femur:
Open or closed fractures: In either an open or closed, midshaft, femur fracture, we want to consider a traction splint, provided that the hip and lower leg are stable.
These are the most immediately threatening things we might find during the rapid trauma survey. They need to be addressed immediately to prevent sudden deterioration or death. Everything else can be dealt with second, with the exception of one thing: Gross Hemorrhage. If at any point you find profound bleeding, it must be addressed.
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