Remaining treatment for trauma is keeping the patient comfortable and following the directions given to you by Aircare Access. Monitor changes in level of consciousness as well as the patient’s CABDs.
SPECIFIC TRAUMATIC
INJURIES There are several other specific traumatic injuries that warrant mentioning. Among them, nose bleeds, chest injuries, impaled objects, dental injuries and open abdominal injuries. Each injury requires special attention and has its own level of seriousness and method of treatment.
You will notice that a few of the remaining injuries require no emergency medical intervention; however, many trauma patients won’t limit their injuries to just one type. Most traumatic injuries come in groups; some will be very serious, requiring a medical evaluation and others will be treated in the first aid setting.
NOSE BLEEDS
A common problem for many is a nose bleed. Although they can be quite dramatic, the possibility for a serious situation is unlikely. Nose bleeds can occur for many reasons. The most common factor is trauma, but events such as altitude changes, medications or infections can also cause a nose bleed.
First aid for a nose bleed is simple. Put direct pressure on the wound by pinching the bridge of the nose. After about one minute, the bleeding will subside. The important thing to remember is, with any bleeding control, maintain pressure for several more minutes.
A common mistake in the care of nose bleeds is releasing pressure too soon. After 5-7 minutes, release pressure but discourage the patient from nose-blowing. If bleeding resumes, repeat direct pressure. Nose bleeds rarely require emergency intervention but your PIC should be notified. If nose bleeds are a common occurrence, a medical evaluation may be warranted.
CHEST INJURIES
Chest injuries can be categorized two ways: blunt trauma or penetrating trauma. Blunt trauma is usually
70 Trauma
caused by a car accident or fall. The majority of penetrating wounds result from guns and knives. Your concern lies with injured structures below the surface of the skin and difficulty breathing that may result from those injuries.
The most unique aspect of blunt trauma is large surface area involvement with no opening into the actual chest area. Due to the surface area involved, a variety of body parts may be injured. Ribs may be broken and organs may be damaged, including the heart, lungs, liver and pancreas.
Your main treatment priority for a closed chest trauma is to ensure the PIC has been notified and Aircare Access has been contacted. From your mechanism of injury evaluation, you may suspect a spinal cord injury. If that is the case, keep the patient flat on his or her back, neutral spine position. The patient’s back should be straight and flat, with no twists or bends.
If you do not suspect a spinal cord injury, the patient can remain in the position which is most comfortable. Continue your assessment and monitor the patient’s level of responsiveness, paying close attention to airway and breathing.
A common side effect of blunt chest trauma is broken ribs. This may manifest as one broken rib, several broken ribs or a full segment of broken ribs. The term “flail chest” refers to one or more ribs broken in more than one spot. In this case, the chest wall may bulge in and out with each breath, due to the broken portion floating separately from the other ribs. A flail chest is a very serious injury, not only because of the fractured ribs, but because of potential damage to the lungs underneath.
SUCKING CHEST WOUND
Penetrating trauma to the chest wall is a potential life threat. The PIC and Aircare Access should be notified immediately. These wounds can quickly result in difficulty breathing. The patient is also at increased risk of infection due to the open wound. This injury may not only penetrate the chest wall, but may create a hole in the lung. This dramatic injury is called a sucking chest wound and can cause breathing problems as well as bleeding.
To treat any penetrating chest wound, make certain
you cover it with an airtight dressing that will seal the wound. This will allow your patient to breathe easier and can help prevent a collapsed lung. Your gloved hand, plastic wrap or tin foil will work nicely to create this occlusive (airtight) dressing.
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