Trauma Systems & Kinematics
A restrained passenger in a high-speed MVC has seatbelt marks and abdominal tenderness but is stable. What injuries are likely and what is the best transport decision?
Hollow organ injury; high suspicion for internal bleeding—transport to trauma center.
A patient with blunt chest trauma shows increased work of breathing and JVD. Lung sounds are diminished on one side. What condition and intervention?
Tension pneumothorax; decompress with needle thoracostomy if indicated.
A child has an angulated forearm fracture with no radial pulse. What is the best course of action?
Gentle realignment to restore perfusion before splinting.
A hiker is found confused, tachycardic, and hot to touch with dry skin. What is the concern and best course of action?
Classic heatstroke; best action is active cooling and rapid transport.
Baby is born cyanotic, with weak cry and HR of 80 bpm. What is the best course of action?
PPV with BVM and reassess HR in 30 seconds.
A fall from a second-story window results in foot and spinal pain. What kinematic principle is at play, and what injuries must be ruled out?
Axial load; rule out calcaneal, spinal, and pelvic fractures.
After hitting his head, a football player has unequal pupils and becomes combative. What condition and intervention?
Increased ICP; best course is airway control, oxygenation, and transport with head elevated.
A patient has abdominal pain, guarding, and bruising post-MVC, but stable vitals. What is the best course of action?
Suspect splenic injury; monitor vitals closely, transport to trauma center.
A patient has facial burns, hoarseness, and carbonaceous sputum. RR is 28, SpO2 91%. What is the concern and best course of action?
Airway burns—prepare for early intubation and oxygen therapy.
Mother postpartum has heavy bleeding and feels dizzy. Uterus is soft. What is the concern and best course of action?
Suspect uterine atony; massage fundus, monitor vitals, rapid transport.
A motorcyclist struck a guardrail and flipped over it. He is alert but complains of back pain and numbness in both legs. What is the best immediate course of action?
Spinal motion restriction and transport to a Level I trauma center.
You suspect spinal injury in a fall victim who is alert but has tingling extremities and priapism. What condition and intervention?
High spinal cord injury; full immobilization and rapid transport.
A geriatric fall patient has right lower quadrant pain and ecchymosis over the iliac crest. What's the concern and best course of action?
Pelvic fracture with internal bleeding; stabilize pelvis and transport supine.
Lightning strike victim is pulseless and apneic. Several others were also hit. What is the concern and best course of action?
Reverse triage—treat those who appear dead first; CPR and defib if indicated.
Shoulder dystocia occurs during delivery. What is the best course of action?
Perform McRoberts maneuver and apply suprapubic pressure.
A pedestrian was hit from behind by a car traveling at 30 mph. No visible trauma, but patient is disoriented. What internal injuries are likely and what evaluation is critical?
Coup-contrecoup brain injury; neuro eval and trauma center transport.
An assault victim has chest bruising, low BP, muffled heart sounds, and weak pulses. What condition and intervention?
Cardiac tamponade; rapid transport, ALS support en route.
Trauma patient with femur fracture, chest tightness, and confusion. What is the concern and best course of action?
Suspect fat embolism syndrome; support oxygenation and rapid transport.
Patient with chemical burn to face and chest, screaming in pain. What is the best course of action?
Brush off dry chemical, copious irrigation, protect yourself, rapid transport.
Pregnant woman involved in MVC becomes hypotensive in supine position. What is the best course of action?
Supine hypotensive syndrome; reposition on left side.
A worker is impaled by a metal rod in the thigh, stable vitals. What’s the best course of action before and during transport?
Stabilize impaled object, control bleeding, rapid transport with ALS support.
A patient has rib fractures, decreased oxygen sat, and progressive dyspnea. What condition and intervention?
Pulmonary contusion; support breathing and transport with monitoring for respiratory failure.
A patient with abdominal evisceration is awake and panicking. What is the best course of action?
Cover eviscerated organs with moist sterile dressings, do not push organs in, transport supine.
Hypothermic patient pulled from a lake is unresponsive and bradycardic. What is the best course of action?
Remove wet clothes, prevent further heat loss, CPR if pulseless, rewarm during transport.
Cord prolapse is noted during crowning. What is the best course of action?
Elevate presenting part off cord, knee-chest position, rapid transport with ongoing support.