Determine more exactly what the mechanism of injury was; driver/passenger, etc?
Pitfalls of 2-ary Assess
1. Alcohol and drugs (intoxication) limits Hx and PE findings
2. Head/spine injury - poor mentation, lack of sensory/motor function
3. Elderly, beta blockers, very young - not same tachycardic response
Special considerations for managing abdominal trauma
position as necessary, not necessarily on back; give nothing by mouth; secure penetrating objects in place
Genitourinary trauma: male
blood in meatus, high concern for urethra injury; tx as soft tissue injuries
Genitourinary trauma: female
can bleed significantly; try to contain blood as necessary
Sensory impairments: what are common?
hearing impairments, deafness, visual (galucoma, DM retinopathy, cataracts, acute or slow onset), voice-production, language disorders, fluency disorders (stutter, cadence issues)
ASL, write things down, lip-read?
learning not at normal rate (faster or slower), systems involved: brain, spine, nerve
Things to remember with patients
Treat with respect, may eed to rely on care-giver to obtain pt's Hx relative to emergency, Pt may be wary of strangers, avoid loud noises or extreme changes in lighting!
Tx homeless and poor
community resources, assess as always, maintain empathy
action or failure to act that results in unreasonable suffering, harm, or misery to a person, whether physical or mental
How do you report abuse?
Social workers! (must be reported)
Technology dependency care in emergency
Try not to be overwhelmed; keep approach to ABC's; CPAP/BiPAP
Medical oxygen types
oxygen cylinder, oxygen concentrator (most common - think COPD or CHF in elderly, blue baby; HLHS, etc), liquid oxygen
Questions for monitoring sats on young special needs
What is baseline? Where is it taken?
portable, length of time of alert, interventions done by care giver, t pt not the monitor
used for suction, don't do on fresh stomas, err to smaller size; some pts have "go-bags" for trach tube sizes; suction upon withdrawal, not on way down; BBG
Home mechanical ventilators: what do you do if having problems?
Can always bag them yourself
Vascular Access Devices
PICC line; designed to deliver meds, length of stay in body is several weeks to months; sit in SVC or RA; risks: clost, air embolism, infection; emergency medical care: stop bleeding (CAT), occlusive dressings
Renal failure and dialysis
kindeys are one of first organs to shut down (urinary output?); never take BP in extremity with shunt! (low BP); direct pressure from AV shunt bleed, or CAT
OGs, NGs, etc
do not want them to leak; can be single or double, temp or perm
can be clogged, infected; if external check color, otherwise find it in head assessment in PE; CSF should be clear and colorless
Special considerations in trauma pts: Pregnant pts
left lateral recumbent on backboard; observe for vaginal bleeding; take pts to appropriate facility; anticipate vomiting (always have suction available)
Special considerations in trauma pts: PEDs
pad body when boarding child to raise head; shock signs may be subtle; bad thermoregulation (reduces clotting ability), so keep them warm;
Special considerations in trauma pts: geris
decreased proprioception; decreased ability to compensate for shock (comorbidities, meds, physio);
Special considerations in trauma pts: multisystem trauma
ID lifethreats, ABC, cervical spine, ventilation and oxygen, treat for shock (warm, O2, etc.)
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