Trauma Objectives

Upon completion of this lecture, you will

be better able to:
Discuss how mechanism of injury affects
your evaluation of an injured student
Describe special assessment considerations
for injured students of various ages
Based on assessment findings, develop and
prioritize a plan of care for selected injuries

TRAUMA

MECHANISM OF INJURY

Kinetic
Thermal
Electrical
Chemical
Radiant
Asphyxiation
3

KINETIC ENERGY FORCES

BLUNT
CRUSH
ACCELERATION/DECELERATION
PENETRATING

INJURY SEVERITY FROM FALLS

Fall >10 feet or 3 times the

persons height
Yielding vs. nonyielding surface
Body area striking the ground
first

CRUSH INJURIES

Energy
concentrated in
one body area

Usually involves
nerves, muscle,
bone, and
tendons
9

10

ACCELERATION AND
DECELERATION FORCES

Whiplash injury
Aortic tear
Hepatic artery
tear

11

12

PENETRATING INJURIES

High velocity

Guns

Low velocity

Knives, pencils

13

BALLISTICS

Caliber
Tumble
Yaw
Fragmentation
Cavitation
Range
Weapon
14

ASSESSMENT OF THE
INJURED STUDENT
Initial assessment
Detailed assessment
Triage and transport

15

INITIAL ASSESSMENT
Airway/Cervical Spine
Control
Breathing
Circulation
Disability (neurological)
Expose

16

PURPOSE OF THE INITIAL

ASSESSMENT

Identification of
LIFE-THREATENING
emergencies

Initiation of LIFE-SAVING
measures (CPR)
17

AIRWAY ASSESSMENT
Stridor
Debris in oropharynx
Airway obstruction

18

AIRWAY INTERVENTIONS
Jaw thrust
AVOID HYPEREXTENSION
OR FLEXION OF THE
NECK
Log roll to side for emesis

19

CERVICAL SPINE
STABILIZATION

Place hands on either

side of the head
Maintain neck midline

20

BREATHING ASSESSMENT
Look, listen, and feel
Observe chest symmetry
Note work of breathing
Jugular vein distention
Tracheal deviation

21

BREATHING INTERVENTIONS
If breathing is absent, begin
mouth to mask ventilations
If breathing is shallow or
labored, maintain airway
control

22

CIRCULATORY ASSESSMENT
Level of consciousness
Carotid pulse (absent or present)
Capillary refill
Skin color
Skin temperature
Sites of bleeding

23

CIRCULATORY
INTERVENTIONS

If pulse is absent, begin

CPR
Apply direct pressure to
open wounds

24

NEUROLOGICAL ASSESSMENT
Level of consciousness
AVPU scale

Awake
Verbal response
Pain response
Unresponsive

25

26

NEUROLOGICAL INTERVENTIONS

Provide reassurance
Tell student what is
happening

27

EXPOSE
Remove clothing to
observe the chest
Observe the chest for bruises,
penetrations, and symmetry
Auscultate breath sounds
Auscultate heart sounds

28

DETAILED ASSESSMENT
Fahrenheit (keep person warm)
Get vital signs
Head-to-toe assessment
Inspect the back

29

HEAD-TO-TOE
ASSESSMENT
Palpate the head and face
Observe for fluid from the nose
and ears
Assess for pupillary response
Reassess the mouth
Palpate the jaw

30

BATTLES SIGN

31

RACCOON EYES

32

NECK

Palpate for pain or

tenderness
Observe for tracheal
deviation
Observe for jugular
vein distention
Observe for impaled
objects and open
wounds
33

CHEST

Auscultate breath sounds

in all lobes
Auscultate chest sounds
Observe work of breathing
Palpate for pain/tenderness

34

ABDOMEN

Observe for bruising,

impaled objects,
open wounds
Palpate lightly for
pain, tenderness, and
distention
Observe for guarding
35

PELVIS

Apply pressure on pelvis to

determine its stability
Perform genitalia exam at
ones discretion

36

37

EXTREMITIES

Observe for deformities,

impaled objects, open wounds
Palpate for pulses, crepitus, or
swelling
Determine capillary refill, skin
color, temperature
Assess for pain/tenderness
38

INSPECT THE BACK

Log roll student with

assistance
School nurse must maintain
cervical spine control
Inspect and palpate the
back for bruising, impaled
objects, pain and tenderness
39

40

HISTORY

SAMPLE

Symptoms
Allergies
Medications
Past history
Last meal
Events leading to the illness or
injury
41

OTHER CONSIDERATIONS

Stop the assessment if there

are changes in the students
airway, breathing, or circulation
Stabilize impaled objects
Apply pressure to open wounds
Apply ice to fractures
Remove any restrictive clothing
42

TRIAGE DECISIONS

EMERGENT (life threatening

injuries)
URGENT (fractures, head
injuries)
NON-URGENT (minor bruises)

43

EXPECTED OUTCOMES

Maintenance of airway, cervical

spine alignment, adequate
respiratory effort, adequate
circulation to brain and vital
organs

Absent or minimal pain,

discomfort, and anxiety
44

DOCUMENTATION

School health record

Prehospital providers

45

SELECTED TRAUMA
EMERGENCIES
Head injuries
Spinal cord injuries
Chest injuries
Abdominal injuries
Musculoskeletal injuries
Amputations

46

CONSIDERATIONS IN
PEDIATRIC HEAD TRAUMA

Scalp is large and vascular

Cranium is thin and pliable
Head size is larger in
proportion to body

47

INTERVENTIONS IN
HEAD TRAUMA

Continuous monitoring of
neurological status

pupil size and reactivity

LOC
body movement

Use direct pressure on open wounds

DO NOT PACK nose or ears if
drainage is present!

48

CONSIDERATIONS IN
SPINAL TRAUMA

Energy forces associated with spinal

trauma (hyperextension,
hyperflexion, and axial loading)
Usually occurs during sports or MVC
Pediatric spine is malleable and
flexible
Pediatric spine is adult by age 8
SCIWORA diagnosed in younger
children
49

50

INTERVENTIONS IN
SPINAL TRAUMA

Keep student immobilized

or lying down

Use the jaw thrust to keep

the airway open

A spinal cord injury should

ALWAYS be suspected in a
student with a head injury!

51

CONSIDERATIONS IN
CHEST TRAUMA

Ribs are cartilaginous, allowing

energy to be transferred to the
heart and lungs
In younger children, the liver is
not protected by the rib cage,
making liver injuries common

52

INTERVENTIONS IN
CHEST TRAUMA

Keep airway open

Initiate mouth to mask
ventilations
Stabilize impaled objects
Use 3 sided occlusive dressing
for open chest wounds
Apply pressure to stop bleeding
wounds
53

CONSIDERATIONS IN
ABDOMINAL TRAUMA

Most abdominal injuries involve

blunt trauma
Abdominal muscles are thin and
weak
Abdominal organs are not well
protected
Liver and spleen are particularly
susceptible
54

INTERVENTIONS IN
ABDOMINAL TRAUMA

Maintain the ABCs with

simultaneous spinal stabilization if
spinal injury suspected
Cover open abdominal wounds with
a sterile dressing moistened with
sterile saline
If abdominal contents have
extruded, DO NOT attempt to push
them back in
55

CONSIDERATIONS IN
MUSCULOSKELETAL
Epiphyseal plate area is weaker
TRAUMA

and more prone to injury

Epiphyseal injuries are of concern
since they may inhibit growth and
cause deformity
In children with multiple injuries,
musculoskeletal injuries can
contribute to hypovolemic shock
56

INTERVENTIONS IN
MUSCULOSKELETAL
Apply sterile dressings to any open
TRAUMA

wounds
Stabilize fracture to prevent further
injury
Apply splint as appropriate

57

CONSIDERATIONS IN
AMPUTATIONS

Emergent
Requires EMS
Vasoconstriction may occur,
minimizing blood loss
It is critical to locate the
amputated part and prepare it
for transport with EMS
58

INTERVENTIONS IN
AMPUTATIONS

Rinse amputated part with saline (if

available), wrap in saline moistened
gauze, place in plastic bag and place
bag on cold pack, label bag with
name, date and time
Apply direct pressure to the site
Avoid use of a tourniquet
Apply new dressings over old
dressings
59

60

SPECIAL NEEDS
CHILDREN
Assess usual positioning,
LOC and ability to
communicate
Provide reassurance
Follow the same
sequence of
care (ABCs)

61

FOLLOW-UP AFTER
TRAUMA
Note changes in
students school routines
Update school health
record
Facilitate care plan
development

62

TRAUMA PREVENTION
Encourage safe
behaviors
Take legislative action
Note dangerous areas
in school

63

SUMMARY
Injuries are the leading cause of
death in school-aged children.
Appropriate assessment and
management of injured students is
one of your more important roles.
Track school injuries and use the
resulting data as part of your
injury prevention efforts.
64

ANY QUESTIONS??

65

PERTOLONGAN
PERTAMA
PATAH TULANG
LEPAS SENDI
CEDERA JARINGAN LUNAK

66

FUNGSI
TULANG
MENOPANG

TUBUH AGAR
DAPAT BERDIRI TEGAK
TEMPAT

BERSANDAR ATAU
BERGANTUNGNYA JARINGAN
TUBUH
67

FUNGSI
SENDI
TEMPAT

PERTEMUAN DUA
BUAH TULANG
MEMBANTU

MEMPERMUDAH
PERGERAKAN
68

KEMUNGKINAN
TERJADI

PATAH

TULANG (FRAKTUR)

LEPAS

SENDI (DISLOKASI)

CEDERA

JARINGAN LUNAK
69

 FRAKTUR
TERPUTUSNYA KONTINUITAS
ATAU KELANGSUNGAN
PERMUKAAN TULANG

70

YANG SERING
PATAH
TULANG

- TULANG
PANJANG

SEMUA

TULANG BISA

PATAH
71

TULANG2
PANJANG
TULANG

SELANGKA
TULANG LENGAN ATAS
TULANG LENGAN BAWAH
TULANG PAHA
TULANG BETIS
TULANG LEHER /
BELAKANG
72

JENIS
PATAH TULANG
PATAH

TULANG TERBUKA
PATAH TULANG TERTUTUP
PATAH TULANG SEDERHANA
PATAH TULANG KOMPLIKATA
PATAH TULANG GREENSTIK
73

PATAH TULANG
TERBUKA
TULANG

ATAU FRAGMEN
TULANG MENEMBUS
JARINGAN KULIT LUAR

74

BAHAYA PATAH
TULANG TERBUKA
TERJADI

INFEKSI JARINGAN
(OTOT,KULIT)

TERJADI

INFEKSI TULANG
(OSTEOMYLITIES)
75

PATAH TULANG
TERTUTUP
JARINGAN

KULIT
DISEKITAR TULANG YANG
PATAH TETAP UTUH
TULANG TIDAK TAMPAK
DARILUAR / TIDAK
MENEMBUS

76

FRAKTUR
SEDERHANA
PATAHAN ATAU
RETAKAN
TULANG MASIH
PADA
TEMPATNYA

77

FRAKTUR
KOMPLIKATA
TULANG
YANG
PATAH
MENJADI
BEBERAPA
BAGIAN
78

FRAKTUR
GREENSTIK
PATAHNYA
TULANG YANG
MASIH MUDA DAN
BELUM MATANG
ANAK - ANAK

79

FRAKTUR AKIBAT
TEKANAN TIDAK
LANGSUNG
TEKANAN TAK
LANGSUNG
YANG TERJADI
KETIKA
MENAHAN
JATUH DENGAN
TANGAN
15
80

HAL YANG
DITAKUTKAN DARI
PATAH TULANG
NEUROGENIC

SHOCK (SHOCK
KARENA TERLALU SAKIT)

HYPOVOLEMIC

SHOCK
(SHOCK KARENA KEHABISAN
DARAH)
81

TANDA PATAH TULANG

KELAINAN

BENTUK
SUKAR DIGERAKKAN
GANGGUAN FUNGSI
BENGKAK
NYERI TEKAN SUMBU
KREPITASI
TULANG / SENDI KELUAR
82

PENATALAKSANAAN
JANGAN

PANIK

ATASI:

D
R
A
B
C

= DANGER BAHAYA
= RESPONSE REAKSI
= AIR WAY JALAN NAPAS
= BREATHING BERNAPAS
= CIRCULATION PEREDARAN DARAH

18
83

KURANGI
ATASI

PERGERAKAN

LUKA/PERDARAHAN

IMOBILISASI/BALUT/SPALK
KIRIM

KE CLINIC/RUMAH

SAKIT
84

IMOBILISASI
2

SENDI TIDAK BERGERAK

SENDI DIATAS TULANG
YANG PATAH
SENDI DIBAWAH TULANG
YANG PATAH

85

PERALATAN
SPALK

/ SPLINT / BIDAI
KASA, ANTI SEPTIC
VERBAN ELASTIC / KAIN
SEGI TIGA
ALAT ANGKUT
APA SAJA DAPAT
DIPAKAI
86

TINDAKAN PADA
FRAKTUR

87

FRAKTUR KAKI
BAGIAN ATAS

88

FRAKTUR KAKI
BAGIAN BAWAH

89

FRAKTUR
LENGAN BAWAH

90

FRAKTUR
LENGAN ATAS

91

FRAKTUR DI
SEKITAR SIKU

92

FRAKTUR TULANG
SELANGKA

93

FRAKTUR
TENGKORAK
TIMBUNAN DARAH

KESADARAN MENURUN

TIDAK SADAR

GANGGUAN AKTIVITAS OTAK

94

MENILAI
TINGKAT REAKSI
A ALERT
WASPADA
V VOICE
RESPON TERHADAP SUARA
P PAIN
RESPON TERHADAP NYERI
U UNRESPONSIVE
TIDAK MEMBERI RESPON
95

MENILAI
TINGKAT REAKSI
MATA
TERBUKA SPONTAN?

TERBUKA BILA
DIEPERINTAH?
TERBUKA BILA RASA NYERI
TIDAK ADA REAKSI

96

BICARA
NORMAL

BINGUNG
KACAU
SUKAR DIMENGERTI
TIDAK BEREAKSI

GERAKAN
MEMATUHI PERINTAH

BERGERAK SEBAGAI RESPON

ATAS NYERI
TIDAK BEREAKSI
97

PERTOLONGAN
ATASI:

DR A B C
MEMERIKSA ULANG TINGKAT
REAKSI
LAKUKAN SECONDARY
SURVEY

98

 LEPAS SENDI
/DISLOKASI
AKIBAT
TEKANAN
YANG
MEMUTAR

99

DISLOKASI
BAHU

100

CEDERANYA
JARINGAN LUNAK
GERAKAN YANG
KUAT
ATAU TIBA - TIBA

101

PENATALAKSANAAN
REST
ICE

ISTIRAHATKAN

KOMPRES

COMPRESS
ELEVATE

TEKAN

TINGGIKAN
102

REST

ISTIRAHATKAN

ICE

KOMPRES

103

COMPRESS
TEKAN

ELEVATE
TINGGIKAN

104

SISTEM
SIRKULASI

SISTEM
SARAF

TULANG
BELULANG

105

TERIMA KASIH
ATAS
PERHATIANNYA

106