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When bone is exposed, care must be taken to prevent further injury and infection. A good rule of thumb for the use of moist, sterile dressings is as follows: If the protruding part is normally on the inside of the body, cover it with a moist sterile dressing. Do not attempt to reinsert or reduce the exposed bone back into the body.
The most common spinal injury is injury to the cervical spine. Improper lifting techniques, however, often result in lumbar injuries. Common lumbar injures are bulging and/or compressed vertebra. You must remember to lift with your legs and knees and not your back.
The patient is most likely experiencing a full thickness burn with disruption of the soft tissue through the nerve root. They are typically painless, with the exception of the penumbra, because of the lack of nerve stimulation.
Pain is generally the most obvious sign of a crush injury and tends to present earliest out of all of the other associated signs and symptoms.
Of the 4 choices, the patient with a laceration on her thigh has an isolated injury and can be effectively managed by a non-trauma center. The other 3 patients require a more thorough assessment and therefore should be evaluated at a trauma center.
Treatment of a gunshot wound to the thorax would include taking necessary spinal precautions. The open wound should be covered with an occlusive dressing. The respiratory distress should be treated with high flow oxygen with consideration of positive pressure ventilation and possible intubation. In addition, an IV should be started for a fluid route if hypotension worsens. Rapid transport is indicated for pericardiocentesis and possible surgery.
This patient has an unstable face and an unstable airway. Ultimately, this patient needs to have his airway protected as quickly as possible with an endotracheal tube. With facial instability, it is imperative that an adjunct be placed to ensure that the airway is not occluded by the pressure on the jaw created with the application of the Bag-Valve-Mask.
The patient with a femur fracture should be secured to a backboard and padded appropriately. Inflating both leg sections of the PASG is not indicated for this patient. Secure femur while helping to tamponade any blood loss. Traction splinting is only appropriate if the femur fracture is mid shaft. Padded board splints will not provide sufficient stabilization.
Holding pressure on the nares is the proper technique to control epistaxis while leaning the patient forward to prevent blood from draining down the throat. Leaning the patient forward should not be performed if spinal precautions are necessary.
The last part of immobilizing the arm fracture (or any suspected fracture for that matter), is the assessment of distal motor, sensory, and perfusion status. This is done to assure there was no additional trauma from the immobilization process, and to assure the splint was not put on incorrectly (for example an air splint inflated too high). If there is a loss in the motor, sensory, perfusion findings following immobilization, the paramedic should immediately reassess the splinting process and correct any errors.
Checking the central and peripheral pulses in the unresponsive patient will give the paramedic a rough estimate of peripheral perfusion. In this instance, where there is no peripheral pulse and a weak central pulse, the inference can be made that there is poor peripheral perfusion. Another expected finding in this patient then would be cool and pale skin from the diminished peripheral blood flow.
Pericardial tamponade causes decreased cardiac output as seen by pale skin and hypotension. In addition, jugular vein distention may be seen along with a narrowed pulse pressure. Other signs and symptoms include tachycardia, respiratory difficulties, and cyanosis of the face, neck, and arms. With tension pneumothorax or a significant hemothorax, decreased or absent breath sounds will be present.
An inhalation injury inferior to the glottis can result in wheezing and bronchospasm. An inhalation injury superior to the glottis can cause a hoarse voice and stridor. Inhalation of the byproducts of combustion can cause wheezing but this would still be classified as an inhalation injury to the lower airway.
Primary Blast Injuries are caused by the compression of air filled organs by an overpressure wave, typically affecting the tympanic membranes, lungs, stomach, intestines, and sinuses. Toxic Exposure to Natural Gas may cause nausea, diarrhea, dizziness, headache, and labored breathing, but would not explain diminished hearing or acute abdominal pain. Secondary Blast Injury refers to trauma caused by flying shrapnel or debris, while Tertiary Blast Injury refers to trauma caused when a patient is thrown from the blast area and strikes an object or the ground.
Direct pressure and fluids are this patient's best chance for survival and prevention of decompensated shock. ALS should be activated to administer fluids as soon as possible.
