My assignment for PBL class this week is “triage for penetrating trauma”. I’m supposed to learn about how this type of trauma is treated in the field by EMS. I have searched and searched the web, but all I can find are regulations for assessing trauma, etc. Nothing about what is actually done.
The case in question is a 54yo with a GSW to the chest.
If anyone can point me to a good source (or if you ARE a good source!) please help! Appreciate it!
I think looking at the Advanced Trauma Life Support guidelines would be helpful (ATLS) because they have a triage decision tree which includes 'penetrating trauma'.
IT starts with looking at GCS and LOC and evaluating the trauma is actually step 2. Transfer to trauma center is immediate for a low Glascow and all penetrating trauma of head/neck/chest/torso and extremities prox. to elbows/knees.
Overall this is a rather ambiguous assignment b/c your triage plan (after doing the abcd's and trying to control blood loss etc) it going to be different based on where the GSW is.
I found some info by searching on ATLS. I'll go to the medical library tomorrow and see if they have the guidelines.
Thanks a bunch!
Hi there Pam,
I don’t remember if it was Sabiston’s or Greenfield (my two big Surgery texts) but one of them has the algorthm for pre-hospital transport of penetrating trauma. I have been reading both in tandem and I am in the ICU at present so I can’t check. I am fairly sure that it was in Greenfield so go to that one first.
P.S. The reference is in Greenfield (Surgery: Scientific Principles and Practice). Also, check the guidelines published by the American College of Surgeons(Advanced Trauma Life Support Program for Physicians). You should find everything that you need.
|QUOTE (spacecadet @ Sep 25 2003, 03:21 AM)|
|My assignment for PBL class this week is "triage for penetrating trauma".|
If you're looking for information about how EMS triages patients in the field, look for something called START triage. While it certainly isn't universally used, it is very common. It stands for Simple Triage And Rapid Transport.
As the EMS unit arrives on the scene, they ask anyone who can walk to move to a certain area. Then they apply the following algorithm to the remaining victims.
Are they breathing?
If NO, they open the airway and reassess.
If still NO, they're dead. If YES they are triaged as IMMEDIATE
If they are breathing, they look at the rate.
If > 30 they are IMMEDIATE
If < 30, they look at perfusion
If there is no radial pulse or the capillary refill is > 2 seconds, they are IMMEDIATE
If there is a radial pulse or capillary refill is < 2 seconds, assess mental status.
If they can not follow simple commands, they are immediate.
If they can follow simple commands, they are delayed.
This gives you simple three category triage system. Patients are treated/transported in this order: Immediate > Delayed > Deceased. You should be able to apply this triage system to each patient in under 60 seconds.
Here is a URL for a commerical triage tag that is used with this system (its the first I found with a google search) http://www.triagetags.com/start_triage.jpg
If you were looking for how to treat this patient, the two main 'authorities' on EMS treatment of trauma are BTLS (the EMS version of ATLS perviously mentioned) and PHTLS (prehospital trauma life support). Both have websites at www.btls.org and www.phtls.org. I was an instructor for both and they are both fine courses.
The gist of field treatment for a GSW to the chest is:
1) Stabilize the spine if needed
2) Open and secure the airway
3) Occlude any open chest wounds
4) Decompress any tension pneumothoracies
5) Secure to a long spine board
6) Begin transport to the closest appropriate trauma center
7) Intubate enroute if needed and not already done
8) Establish two large bore IVs and infuse NS or LR titrated to maintaining radial pulses
Many of these steps are done concurrently so the order will get a bit out of step. The key objectives are to secure the patient's ability to oxygenate and ventilate, not cause further spinal damage if present, and get them to the resources they need (cold, hard steel or...Natalie) as quickly and safely as possible. We try to do everything possible enroute instead of on the scene to minimize the "time to steel".
Hope this helps.
Thanks so much guys! You have saved me a ton of digging through the medical library! I found the BTLS, which is really great. And Jeff - your information is so awesome. I owe you one.
Thanks again. OPM’s rule.