4. TRAUMA EMERGENCIES
4.6 SOFT TISSUE / CRUSH INJURIES
Trauma to the skin may include abrasions, lacerations, hematomas, punctures, avulsions, contusions, incisions, amputations, crush injuries and compartment syndromes. In general, such injuries rarely threaten life. However, soft tissue injuries may damage blood vessels, nerves, connective tissue and other internal structures. Crush and compartments syndromes can be devastating to the patient. Early recognition and prompt therapy are essential to achieve a favorable outcome. Delay in diagnosis and treatment can result in permanent and severe disability.
Crush injury is associated with severe trauma and most commonly occur in multiple casualty disasters, such as bombings, earthquakes, building collapse, train accidents and mining accidents. It is the result of prolonged compression or pressure on various parts or all of the human body. Crush injuries may result in fatal injury or severe metabolic abnormalities that may result in death. Careful monitoring of these patients is essential.
Compartment syndrome is usually due to a crush injury and is a surgical emergency. It occurs most commonly in the forearm and leg, gluteal region, thigh, and lumbar paraspinous muscles. Compartment syndrome may result in ischemic swelling, muscle infarction, nerve injury and permanent loss of extremity function.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Assure scene safety, including safety for the patient(s) and rescuer(s), if indicated.
3. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Determine patient's hemodynamic stability and symptoms. Continually assess Level of
Consciousness, ABCs and Vital Signs.
6. Treat all life threatening conditions as they become identified.
7. Assess the function of the injured area above and below the injury site: check pulses, sensation, and motor function distal to the injury. Splint/immobilize injured areas as indicated.
8. When multiple patients are involved, they need to be appropriately triaged.
9. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance Abuse.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Place dry sterile dressing on all open wounds and bandage as needed:
- If wound is grossly contaminated irrigate with normal saline or lactated ringers solution.
- Stabilize all protruding foreign bodies (impaled objects) if noted.
6. If suspect severe crushing injury/compartment syndrome:
- Remove all restrictive dressings.
- Close monitoring of distal pulse, sensation, and motor function (CSM).
7. Splint/immobilize injured areas as indicated.
8. Activate ALS intercept, if deemed necessary and if available.
9. Initiate transport as soon as possible with or without ALS.
10. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Place dry sterile dressing on all open wounds and bandage as needed:
- If wound is grossly contaminated irrigate with normal saline or lactated ringers solution.
- Stabilize all protruding foreign bodies (impaled objects) if noted.
6. If suspect severe crushing injury/compartment syndrome:
- Remove all restrictive dressings.
- Close monitoring of distal pulse, sensation, and motor function (CSM).
7. ALS STANDING ORDERS
a. Provide advanced airway management if indicated.
b. Initiate IV Normal Saline if indicated and titrate to patient condition.
8. Splint/immobilize injured areas as indicated.
9. Contact MEDICAL CONTROL. Medical control may order:
a. IV Normal Saline 250 cc -500 cc bolus or wide open titrated to patient's condition.
10. Activate Paramedic intercept, if deemed necessary and if available
11. Initiate transport as soon as possible with or without Paramedics.
12. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Place dry sterile dressing on all open wounds and bandage as needed:
- If wound is grossly contaminated irrigate with normal saline or lactated ringers solution.
- Stabilize all protruding foreign bodies (impaled objects) if noted.
6. If suspect severe crushing injury/compartment syndrome:
- Remove all restrictive dressings.
- Close monitoring of distal pulse, sensation, and motor function (CSM).
7. ALS STANDING ORDERS
a. Provide advanced airway management if indicated.
b. Initiate IV Normal Saline if indicated and titrate to patient condition.
8. Splint/immobilize injured areas as indicated.
9. Contact MEDICAL CONTROL. Medical control may order:
a. IV Normal Saline 250 cc -500 cc bolus(es), wide open or titrate to patient's hemodynamic status.
10. Initiate transport as soon as possible.
11. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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