Signs and Symptoms 4

Signs and Symptoms Notebook Block 4 Cardiac Tamponade (Pericardial Tamponade) ● Definition: Cardiac tamponade occurs when an obstructive force (blunt or penetrating trauma) causes blood to leak into the space between the pericardium and pericardial sac. As the hemorrhage worsens, pressure increases on the outer walls of the heart, limiting the heart’s ability to beat effectively. In addition, the pericardium has a limited ability to stress, so the increased fluid in the pericardial space also puts pressure on the pericardium. All this pressure results in decreased flow of blood in and out of the heart. If not treated, this condition can lead to obstructive shock. ● Risk Factors ○ Acute condition- traumatic origin ○ Structural ■ Large pericardial effusions ■ Cancer ■ Autoimmune diseases ● Signs & Symptoms ○ Beck triad ■ Jugular vein distention ■ Muffled heart sounds ■ Narrowing pulse pressure (merging of blood pressure) ■ Deteriorating mental status ● Field Treatment ○ High flow oxygen ○ Immediate transport via position of comfort Flail Chest ● Definition: Flail chest is a condition in which a segment of rib(s) get detached from the rest of the ribs. This is dangerous because during inhalation and exhalation, the separated segment will move in paradoxical motion. Paradoxical motion means moving opposite to normal. This is a dangerous condition because it hinders the patient’s ability to breathe efficiently and comfortably, while threatening a puncture of the lungs. ● Risk Factors ○ Acute condition- traumatic origin ● Signs & Symptoms ○ Paradoxical movement of ribs ○ Difficulty breathing (painful and ineffective) ○ Hypoxemia ○ Altered level of consciousness ○ Bruising around chest ● Field Treatment ○ Maintain the airway ○ Give oxygen as needed ○ Reassess for pneumothorax and other respiratory complications ○ Positive pressure ventilation with BVM ○ Immediate transport via position of comfort Traumatic Asphyxia Definition: Traumatic Asphyxia is a condition in which the patient receives a sudden compression to the chest, causing immediate increase of pressure in the thoracic cavity. Common causes of this condition include unrestrained drivers that slam against the driving wheel or patients compressed under a vehicle. When you come across this condition, don’t hesitate to transport as fast as possible, because it can also signal damage to the heart or possible pulmonary contusion. ● Risk Factors ○ Acute condition- traumatic origin ● Signs & Symptoms ○ Distended neck veins ○ Cyanosis in head and face ○ Hemorrhage in sclera of eye (blood vessels bursting in the eye) ● Field Treatment ○ BVM or oxygen as needed ○ Monitor vitals closely ○ Immediate transport via position of comfort ● Myocardial Contusion ● Definition: A myocardial contusion is a condition in which the heart muscle is bruised. This results in abnormal rhythm of the heart, resulting in inadequate pulse and blood pressure. This condition is usually caused by some sort of blunt trauma to the chest. ● Risk Factors ○ Acute condition- traumatic origin ○ Structural ■ Severe blunt injury to the chest ● Signs & Symptoms ○ Change in blood pressure ○ Change in pulse ○ Chest pain ○ Difficulty breathing ● Field Treatment ○ Supplemental oxygen as needed ○ Immediate transport via position of comfort Hemothorax ● Definition: This condition occurs when the pleural spaces start filling with blood, preventing the effective inhalation and expiration of air. It also inhibits adequate gas exchange within the pulmonary capillaries. The signs and symptoms to this condition may not occur right away, as a traumatic origin may take time to develop signs and symptoms. ● Risk Factors ○ Acute condition- traumatic origin ○ Structural ■ Hemopneumothorax ● Signs & Symptoms ○ Shock-like symptoms ○ No obvious external bleeding ○ Decreased breath sounds on one side ● Field Treatment ○ Give supplemental oxygen as needed ○ Immediate transport via position of comfort Abdominal Evisceration ● Definition: An abdominal evisceration occurs when a patient receives an open wound to the abdominal cavity. The organs will protrude through the opening, resulting in exposed organs. This is dangerous because the open abdomen radiates body heat quickly, and organs can lose fluids extremely fast. ● Risk Factors ○ Acute condition- traumatic origin ● Signs & Symptoms ○ Exposed organs escaping open wound ● Field Treatment ○ Cover organs with sterile gauze compress moistened with sterile saline solution ○ Place occlusive dressing over compress and take all 4 sides ○ Treat for shock ○ Place patient in supine position ○ High flow oxygen via nonrebreather mask ○ Immediate transport to nearest trauma center Burns (Chemical and Thermal) ● Definition: A burn can be defined as a soft-tissue injury that spreads out over a large area due to the transfer of radiation, thermal or electrical energy. If not treated, the patient can be at risk for infection, hypothermia, hypovolemia, acidosis and shock. Burns to the airway can cause an obstruction of airway. ● ● ● ● Complications include compromise breathing and compartment syndrome, which can lead to neurovascular compromise and irreversible damage. ○ Thermal burn: These occur when the skin is exposed to a temperature of higher than 111℉ (44℃). The severity of these burns depends on the temperature, concentration, substance, duration of exposure, or amount of heat energy applied to the skin. ○ Chemical burn: These can occur when strong alkalis or acids come in contact with the skin. These can be particularly dangerous, because it is difficult to remove them in an efficient manner in prehospital care. In addition to chemicals, strong fumes can also cause chemical burns. Risk Factors ○ Acute condition- traumatic origin ○ Structural ■ Abuse Signs & Symptoms ○ Significant bleeding ○ Discoloration of burn area ○ Severe pain in burn area ○ Shock ○ Swelling ○ Stridor ○ Altered mental status ○ Inadequate breathing Field Treatment (Thermal) ○ Wear gloves and eye protection ○ Move patient away from burning area ○ Remove thermal burning agent according to protocols ○ Per protocol, submerge burn area in cool, sterile water or solution for no more than 10 minutes ○ Irrigate burn area until pain subsides ○ Apply sterile dressing ○ High flow oxygen via nonrebreather mask ○ Estimate severity of burn ○ Check for other traumatic injuries ○ Treat for shock ○ Consider manual spinal stabilization ○ Be sure to document amount of body surface area involved, depth of burn, and location ○ Immediate transport (do not delay) Field Treatment (Chemical) ○ Consider HazMat ○ Make sure you are wearing appropriate chemical-resistant gloves and eye protection ○ Consider a protective gown if needed ○ Remove the chemical from the patient ■ Brush off dry chemicals to avoid additional damage ■ Flush liquid chemicals with large amounts of water (gallons) for 15-20 minutes or until patient’s pain has subsided. ○ ○ ○ ○ ○ ○ ■ If eyes are affected, flush from inner corner to out Estimate severity of burn Consider manual spinal stabilization Check for other traumatic injuries Be sure to document amount of body surface area involved, depth of burn, and location Treat for shock Immediate transport (do not delay) Commotio Cordis ● Definition: Commotio cordis occurs when a blunt chest injury occurs during a critical portion of a person’s heartbeat. This injury is usually associated with sports, and can cause life-threatening conditions such as cardiac arrest and ventricular fibrillation. Ventricular fibrillation can be improved if defibrillation occurs within the first two minutes. The force to the chest is commonly at speeds of 35-40 mph. ● Risk Factors ○ Acute condition- traumatic origin ○ Structural ■ Playing sports without chest protectors ● Signs & Symptoms ○ Unconscious ○ Unresponsive after blow to the chest ● Field Treatment ○ CPR/AED ○ Immediate transport Simple (Tension) Pneumothorax ● Definition: Pneumothorax is an acute condition that develops because of a collapsed lung. Air builds up into the chest cavity, preventing the lung from expanding again. This pressure increases greatly on the mediastinum. If not treated, pneumothorax can be fatal. The pressure on the lungs will also cause increased compression on the superior and inferior vena cava, significantly reducing blood flow back to the heart. If pneumothorax is not treated, dangerous things like hypoxia and obstructive shock can occur. In addition, the heart may stop beating, resulted from increased pressure. ● Risk Factors: ○ Acute Condition- Developed or sudden ○ Structural ■ Lung tissue damage ■ Chest injury ■ Pulmonary trauma (contusions and hemorrhages) ■ Pneumonia ■ Cystic fibrosis ■ Mechanical ventilation (increased pressure on the lungs) ○ Metabolic ■ Chronic Obstructive Pulmonary Disease (COPD) ■ Great pressures on the lung ■ Pulmonary Embolism ● Signs & Symptoms ○ Cyanosis ○ Sudden chest pain ○ Low blood pressure ○ Increased tidal volume (inadequate rise and fall of the chest) ○ Anxiety ○ Dyspnea (shortness of breath) ○ Decreased lung sounds on one side of the chest ○ Respiratory rates drop ○ Pulse rates drop ○ Tracheal deviation (trachea shifts to opposing side of conflict) ○ Wound sites ○ Subcutaneous emphysema ○ Bulging intercostal muscles and muscles in supraclavicular ○ Sucking sound during inhalation, rushing air during exhalation ● Field Treatment ○ Loosely bandage chest wounds to prevent further infections (if any) ○ Supplemental oxygen via nonrebreathing mask with reservoir ■ Be careful to not increase pressure on the affected side of the lung ○ Immediate transport in high Fowler position or position of comfort Pulmonary Contusion ● Definition: A pulmonary contusion occurs when severe blunt trauma to the chest causes injury and bruising to the lung. The alveoli fill with blood, leaving the patient at risk for hypoxia and inadequete gas exchange. ● Risk Factors ○ Acute condition- traumatic origin ○ Structural ■ Flail chest ● Signs & Symptoms ○ Difficulty breathing Contusion of chest Hypoxia ○ Cyanosis ● Field Treatment ○ Provide high flow oxygen ○ BVM ○ Immediate transport ○ ○ Basilar Skull Fracture ● Definition: A basilar skull fracture occurs when a linear fracture occurs at the base of the skull. These fractures are usually associated with high energy trauma, such as a car crash or severe fall. ● Risk Factors ○ Acute condition- traumatic origin ● Signs & Symptoms ○ CSF fluid flowing through the ear ■ At risk for bacterial meningitis ○ Ruptured tympanic membrane in the ear ○ Bleeding through the ear ○ Raccoon eyes (bruising) ○ Battle Sign (bruising behind the ear) ○ Delayed signs and symptoms (up to 24 hours) ● Field Treatment ○ Spinal immobilization by backboarding ○ C-spine ○ High flow oxygen via nonrebreather mask ○ Control any other bleeding ○ Treat any other injuries ○ Immediate transport Compartment Syndrome ● Definition: Compartment syndrome occurs when internal edema and swelling result in dangerous increased pressure in a closed soft tissue compartment. This is dangerous because tissue have a limited ability to stretch, which can increase pressure. Pressure leads to interference with circulation, which puts the patient at risk for limited perfusion. This condition commonly develops in extremities, and may accompany open/closed injuries, as well as restrictive immobilization. ● Risk Factors ○ Acute condition- traumatic or developed origin ● Signs & Symptoms ○ Severe contusion to affected area ○ Cyanosis ● ○ Pain/pressure Field Treatment ○ Check for signs of shock and internal bleeding ■ Treat shock and internal bleeding first ○ Provide high flow oxygen ○ Immediate transport