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Scott Kujath, MD, FACSClinical Associate Professor, University of Missouri—Kansas CityClinical Associate Professor, Kansas UniversityClinical Associate Professor, Kansas City University
Aboutme:� Medical Credentials
� Midwest Aortic and Vascular Institute, founding partner� Board Certified Vascular Surgeon� Board Certified Undersea and Hyperbaric Medicine� Board Certified General Surgeon
� Service� Living Room Ministries International, Board Treasurer� Mission of Hope Clinic, Board Chair� MetroCare, Board of Directors� Kansas City Medical Society, Board of Directors
Aboutme:� Mission Trips:
� Jamaica—Won by One to Jamaica� Mauritania—Mercy and Truth Medical Missions� Kenya—Living Room Ministries International� Turkey—Tom Cox World Ministries� Raytown, Missouri—Mission of Hope Clinic
� Husband, father of three teens
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Disclaimer
�I avoid trauma while traveling whenever possible!
Definitions:� Trauma: injury; physical injuries of sudden onset
requiring medical attention, possibly requiring immediate resuscitation.� Lacerations, fractures, burns, head injury, solid organ
injury, multi-system injury (MVC, etc.)� The leading cause of mortality worldwide
� Trauma Management: helping the patient who has a traumatic injury. Starts with “First Aid”
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Definitions:� First Aid: help given to injured until full medical
treatment is available
� Limited Resource Setting: typically in developing countries, but also certain situations in developed countries when expert help and supplies are not immediately available.
KnowtheLocalResources� What resources does the team have?� What transportation is available?� Where is the nearest hospital or clinic?� How is care paid for?
Jacob� A teacher’s apartment invaded by armed thieves� Shot through torso and left to die� Neighbors placed him in a taxi to the hospital� He sat in the Emergency Room until morning before
anyone attended to him� 1 year later admitted to inpatient hospice with multiple pressure ulcers secondary to paraplegia, ready to die.
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KnowtheLocalResources� What resources does the team have?� What transportation is available?� Where is the nearest hospital or clinic?� How is care paid for?
TypesofTrauma� Open Wounds� Fractures� Burns� Head injury� Shock
FirstAid� Basic medical aid� Basic Life Support (BLS), CPR� Psychological support
� Remain calm!
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PrimarySurvey� Airway assessment and protection� Breathing and ventilation� Circulation/hemorrhage� Disability, basic neuro exam� Exposure, with environmental control
VitalBodyFunctions� Breathing process� Respiration� Airway� Lungs� Rib cage
� Blood circulation� Heartbeat� Pulse
� Carotid� Femoral� Radial� Posterior tibial
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Adverseconditions� Lack of oxygen� Bleeding� Shock� Infection
Evaluationofinjured� Send for help� Check for responsiveness
� “Are you OK?”� Check for breathing
� Clear airway and ventilate
� Check for pulse� CPR?
� Check for bleeding� Evaluate for wounds� Treat as required
� Immobilize fractures
Evaluationofinjured� Check for shock
� Clammy� Pale� Restless or nervous� Thirst� Bleeding
� Confusion� Fast breathing� Blotchy or bluish skin� Nausea or vomiting
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Checkforfractures� Back or neck injury
� Pain� Cuts� Bruises� Paralysis� Numbness
� Immobilize neck/back
� Open� Bleeding� Bone protruding� Check pulse
� Closed� Swelling� Discoloration� Deformity� Check for pulse
Check forburns� Reddened� Blistered� Charred� Singed clothing
Checkforheadinjury� Unequal pupils� Fluid from ears, nose,
mouth or wound� Slurred speech� Confusion� Sleepiness� Loss of memory or
consciousness
� Staggering� Headache� Dizziness� Nausea or vomiting� Paralysis� Convulsions or twitching� Bruising around eyes or
ears
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AirwayandBreathing� Check for responsiveness� Call for help� Position on back, if unconscious and injuries allow
� “log roll” if necessary� Open airway
� Head-tilt/chin-lift� Clear debris—finger sweep� Jaw-thrust
AirwayandBreathing
Breathing� Look, chest rise and fall� Listen, air escaping from mouth and nose� Feel, for air flow� Perform, rescue breathing if required
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AirwayandBreathing
ObstructedAirway� Abdominal thrusts� Chest thrusts
ProtectWound� Expose wound� Do not tear clothing from wound� Evaluate for multiple wounds� Apply dressing
� Cleanest material available� Sterile� Clean� Clothing
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StopBleeding� Manual pressure
� 5-10 minutes� Injured may hold pressure
� Elevate limb above heart� After splinting, if required
� Pressure dressing� On top of initial dressing
� Digital pressure (pressure points)� Femoral, popliteal� Axillary, brachial� Carotid, temporal
� Tourniquet� Last resort� Severed limb
Improvisedtourniquets� Pad the skin under the tourniquet� Gauze, clothing, canvas
� Do NOT use wire or shoestring� Stick � Do not release once placed� Keep tourniquet visible
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Shock� Cardiovascular collapse
� Cardiogenic� Cardiac injury
� Hemorrhagic/hypovolemic� Traumatic injury� Dehydration
� Vasodilation� Allergic reaction� Sight of blood� Neurologic injury
Shock� Clammy� Pale� Restless or nervous� Thirst� Bleeding
� Confusion� Fast breathing� Blotchy or bluish skin� Nausea or vomiting
Shock—FirstAid� Position
� Under cover� Lay on back
� Reposition only as injuries allow
� If breathing difficulty, sitting up may be better tolerated
� IV fluids, if available� Avoid food or drink
� Elevate feet� Loosen clothing� Prevent chilling or
overheating� Maintain calm� Seek medical aid
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HeadInjuries� Scalp injuries
� Abrasions and lacerations� Depressed skull fractures� Assume spinal injury
HeadInjuries� Unequal pupils� Fluid from ears, nose,
mouth or wound� Slurred speech� Confusion� Sleepiness� Loss of memory or
consciousness� Blurred vision
� Staggering� Headache� Dizziness� Nausea or vomiting� Paralysis� Convulsions or twitching� Bruising around eyes or
ears� Deformity of the head
Neckinjuries� Apply pressure above and below� Do not compress airway� Evaluate for cervical spine injury
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Facialinjuries� Soft tissue injury is common� Bleeding can be severe� Evaluate for underlying boney injury
Head,Neck, FaceFirstAid� Clear airway� Control bleeding� Treat shock� Maintain temperature� Protect wound� Do not force tissue back into skull� Do not apply pressure dressing� Concussion
Eyeinjuries� Lacerated/torn eyelids
� Cover with sterile dressing� Do NOT use pressure
� Lacerated eyeball/extruded eyeball� Cover with loose sterile dressing� NO pressure� Bandage both eyes
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Eyeburns� Chemical
� Flush with copious amounts of water� Acid
� Flush for 5-10 minutes� Alkali
� Flush at least 20 minutes
� Bandage eyes
EyeBurns� Thermal
� Do NOT apply a dressing� Do NOT touch
� Light burns� Loosely bandage eyes to protect from bright lights
Convulsions� Ease to ground� Support head and neck� Maintain airway� Protect from further injury� Do NOT forcefully hold limbs� Do NOT force anything between teeth
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ChestWounds� Expose wound
� Remove clothing� Don’t remove from within wound
� Evaluate for “sucking” wound� Pneumothorax
� 3 sided occlusive dressing� Remove and replace for
respiratory distress
� Position on injured side
From Combat Medic Advanced Skills Training
From Combat Medic Advanced Skills Training 44
NeedleChestDecompression
Abdominalwounds� Position on back with knees up
� Relieves abdominal pain� Relieves pressure� Treats shock� Prevents further exposure of bowel
� Expose wound� Gently place organs on abdomen with cleanest avaialable
material; do NOT force back in body� Dress with cleanest material avilable
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Burn Injuries� Thermal� Electrical� Chemical� Laser (eye injury)
ThermalBurn� Eliminate source of burn� Stop, drop and roll� Cold water for 20 minutes if available� Cover with clean non-synthetic material
� Synthetics may melt into wounds
Electrical Burn� Turn off electrical current� Remove patient from electrical source using non-
conductive material� Wood� Cloth� Dry rope
� Body-to-body contact may cause injury to rescuer� Entrance and exit wounds� Deep injury is likely with high voltage
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ChemicalBurn� Use water to flush away liquid chemicals� Brush away dry chemicals� Flush away chemicals with copious amounts of water� If large amounts of water are not available, then use
NO water
LaserBurn� Remove from source� Never look directly at source
BurnDressings� Use the cleanest dressing material available� Do NOT cover face or genitals� Do NOT break blisters� Do NOT apply grease or ointments
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Fractures� Closed
� No break in skin� Open
� Bone may protrude� Penetrating injury may break skin
Signs andSymptomsofFractures� Deformity� Tenderness� Swelling� Pain� Inability to move injured part� Protruding bone� Bleeding� Discolored skin at injury site� Sharp pain with attempts to move injured site
ImmobilizeFractures� Keep bone from moving
� Protect tissue, muscle, nerves, blood vessels� Reduce pain� Decrease of creating an open wound
© 2014 Doom and Bloom (TM)
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ImmobilizeFractures� Splints� Bandages� Slings� Swathes
Splints� Immobilize the joint above and below the fracture� Use sticks secured with cloth strips� Boots should not be removed unless there is a foot
injury to evaluate� Pad the boney prominences� Check circulation distal to injury� Remove any jewelry� Dress open wounds� Do NOT attempt reduction of fracture
SlingandSwathe
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Spinalcolumnfractures� Immobilize� Log roll
HeatInjury� Heat cramps
� Muscle Cramps� Drink water
� Heat exhaustion� Signs and symptoms
� Excessive sweating with pale, cool skin
� Headache� Weakness� Dizziness� Chills� Tingling� Confusion
� Drink water� Pour water on and fan patient� Rest for rest of day
� Heat Stroke� Stops sweating� May pass out� Medical emergency� Drink water if conscious� Active cooling� Massage extremities to
increase circulation� Elevate legs
ColdInjury� Signs and Symptoms
� Numbness or tingling� Discoloration of skin� Reddened, paleness or
grayness to skin� Swelling and blisters
with rewarming
� Treatment� Gradually rewarm� Use body heat� Avoid
� Massaging� Fire or stove� Soaking in cold water� Rubbing with snow
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Hypothermia� Prevent any further heat loss� Rewarm� Warm liquids may be helpful if conscious
SnakeBites� Identify the snake� Remain calm and still� Do NOT elevate the limb� Place a band proximal to the bite� Remove jewelry� Seek medical attention� Tetanus update
Humanbites� Cleanse with soap and water� Cover with sterile dressing� Seek medical attention
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AnimalBites� Capture or kill animal for testing� Cleanse with soap and water� Cover with sterile dressing� Immobilize extremity
Insect bites/stings� Remove stinger� Remove jewelry� Ice or cold compress� Meat tenderizer or calamine lotion� Constricting bands for more serious reactions� Identify insect� Anaphylaxis—Epi pen
Resource
� First Aid, Field Manual No.4-25.11, 23 December 2002
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AirwaySupport� Spinal immobilization� Jaw thrust� Neck immobilization
Hemorrhagecontrol� Direct pressure� Pressure points� Tourniquet
OpenWounds� Stop bleeding
� Direct pressure� Pressure points/digital pressure� Tourniquet
� Expose wound to evaluate extent of injury� Wash wound
� Saline� Water
� Dress wound with sterile/clean dressing
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Fractures� Obvious deformity� Bones through skin� Unusual body position� Deformity � Discoloration� Swelling� Check for pulse
Burns� 6 million people seek medical attention annually
worldwide� Children ~50%� Mechanism of injury
� Thermal (scald, flame, contact)—95%� Electrical, chemical—5%
Burns� Zone of coagulation/necrosis
� No tissue perfusion� Irreversible damage
� Zone of stasis� Decreased perfusion� Chance of tissue recovery
� Zone of hyperemia� Good perfusion� Likely tissue recovery http://generalsurgery-fkui.blogspot.com/2011/06/luka-bakar.html?m=1
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Burns� Systemic response
� Greater than 20-30% TBSA� Extensive inflammatory mediator release� Hypotension� Bronchoconstriction� Increased basal metabolic rate� Reduced immune response
Burns� Initial management, within 3 hours
� Limit damage and mortality� Check that the scene is safe� Stop the burning process� Remove the patient to safe place� Remove non-adherent clothing� Cool the wound (not the patient)
� Cool water irrigation� Within 20 minutes� For up to 30 minutes
� NOT ice
Burns� Cover the burn
� Prevent infection and desiccation� Relieve pain� Plastic wrap for thermal burns
� Not circumferential� Cotton sheets for chemical burns and if plastic not
available� Avoid overly saturated dressings
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Burns� Estimating size of burn
� Palmer surface of hand is ~1% body surface area� Rule of nines
� Refer if� >10-15%� Circumferential� <10 y/o� >50 y/o
https://myhealth.alberta.ca/Health/_layouts/15/healthwise/media/medical/hw/h5551003.jpg
HeadInjury� Quality of speech� Confusion � Unequal pupils� Sleepiness� Staggering
� Dizziness� Paralysis� Nausea or vomiting� Bruising around eyes
or ears
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Resources� First Aid, Field Manual No.4-25.11, 23 December 2002� International Best Practice Guidelines: Effective Skin and
Wound Management of Non-Complex Burns, Wounds International, 2014 www.woundsinternational.com
� Mock C, Lormand JD, Goosen J, Joshipura M, Peden M. Guidelines for essential trauma care. Geneva, World Health Organization, 2004
Questions?