Trauma In Special Populations: Geriatrics, Bariatrics, Pediatrics, and Pregnant-atrics
Title: It Takes All Kinds: Trauma Care in Special Populations Description: Caring for patients with severe traumatic injuries can be difficult enough but what do you do when your patient is very young, very old or very pregnant or very large? “Special populations” is the term we use to identify patients for whom we need new tools and different rules for trauma care. This program shows you how to ensure an informed size-up, systematic assessment and delivery of effective, prioritized trauma care for the most challenging patients that you’ll encounter. Teaching Formats: -Lecture -Case Study -Question and Answer Learning Objectives: Students will learn: - Current and emerging recommendations for prehospital trauma care for all patient popu-lations. - The special considerations and dangers of traumatic injuries specific to pediatric, geriat-ric, bariatric and pregnant patient populations. - Rapid identification, assessment, prioritization and care for traumatic injuries to pediat-ric, geriatric and pregnant patients. Meets requirements of NREMT Core Content for Trauma SEE MORE AT: WWW.ROMDUCK.COM WWW.RESCUEDIGEST.COM
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Trauma In Special Populations: Geriatrics, Bariatrics, Pediatrics, and Pregnant-atrics
- 1. Geriatrics, Bariatrics, Pregnant Patients & Peds Special Patients / Special Questions
- 10. Proximal > Distal Arterial > Venous Stacked Dressings
- 15. OPA /NPA / Suction SGA (King,LMA,etc.) ET Special Techniques Cricothyrotomy
- 23. High WOB / Apnea Flail Chest Sucking Chest Wound Tension Pneumothorax
- 25. If the Heart Rate ≥ Systolic BP that’s BAD Normal is HR around ½ of SBP ( 60bpm /120mm/hg ) 0.5 HR ¾ of SBP still ok ( 90bpm /120mm/hg ) .75 If HR ≥ SBP ( 100 bpm /100mm/hg ) SI ≥ 1.0 is BAD • >2x chance for a need for transfusion Massive Shock is ≥ 1.3 ( 120 bpm /90mm/hg ) • 9x chance for a need for transfusion
- 26. –The formula changes at higher heart rates. –MAP of 70 - 110 : Normal –Target MAP >65
- 30. IV / IO Access Fluids: NS, RL, Blood Permissive Hyptnsn
- 32. AVOID BOMBS!
- 33. AVOID Hypoxia Keep sat above 90%
- 34. AVOID Hyperventilation Vent @ 10 per min. Keep etCO2 35-45
- 37. Hypothermia Hypocoagulability H+ Acidosis < 95 deg pH <7.2 Lactate > 5
- 48. If the Heart Rate ≥ Systolic BP that’s BAD Normal is HR around ½ of SBP ( 60bpm /120mm/hg ) 0.5 HR ¾ of SBP still ok ( 90bpm /120mm/hg ) .75 If HR ≥ SBP ( 100 bpm /100mm/hg ) SI ≥ 1.0 is BAD • >2x chance for a need for transfusion Massive Shock is ≥ 1.3 ( 120 bpm /90mm/hg ) • 9x chance for a need for transfusion
- 50. Assessment • Comorbidity/History • Medications • Geri Neuropathy • Averse to Tx / Trans • Assess Shock Index Treatment • Watch your fluids • Medical Tx Too!
- 54. Assessment • Gain Access • Comorbidities Treatment • Priority Airway • Advanced • ET • Priority Breathing • O2 • CPAP • BVM • Transport Resources
- 69. Assessment • Compensating Mom=Dying Baby • Premature Labor Treatment • LLR >30% • Priority Airway • Priority Breathing • O2 • CPAP • BVM https://www.flickr.com/photos/54182871@N04/5037518578
- 72. Adapted from the AAP’s Pediatric Education for Prehospital Professionals (PEPP) course. Critical= QUICK Not Critical= Not QUICK
- 73. T Tone I Interactiveness C Consolability L Look/gaze S Speech/cry
- 74. Be W Work A Abnormal Sounds R Retractions E Extreme Nasal Flaring
- 75. T Temperature - Skin T Time - Capillary Refill P Pulse
- 76. Any single RED FLAG = SICK Critical= QUICK Not Critical= Not QUICK
- 81. Infant 0-1 y/o Toddler 1-3 y/o Pre-School 3-6 y/o School Age 6-12 y/o Adolescent 12-18 y/o
- 83. Infants SpO2 >90% Children SpO2 >90% Older Kids SpO2 >90%
- 84. Infants 25 bpm (1:2 seconds) Children 20 bpm (1:3 seconds) Older Kids 10 bpm (1:6 seconds)
- 85. Infants SBP >70 Children SBP >80 Older Kids SBP >90
- 86. Infants AbGt >70 D5% Children AbGt >70 D10% Older Kids AbGt >70 D10%
- 92. If the Heart Rate ≥ Systolic BP that’s BAD Normal is HR around ½ of SBP ( 60bpm /120mm/hg ) 0.5 HR ¾ of SBP still ok ( 90bpm /120mm/hg ) .75 If HR ≥ SBP ( 100 bpm /100mm/hg ) SI ≥ 1.0 is BAD • >2x chance for a need for transfusion Massive Shock is ≥ 1.3 ( 120 bpm /90mm/hg ) • 9x chance for a need for transfusion 6y/o to 12 y/o shock is > 1.0 4y/o to 6 y/o shock is > 1.2
- 94. Assessment • Evaluate for Head Injury • Priority chest & abdominal assessment • Modified GCS in Peds • Assess Shock Index Treatment • Head Injury H-Bombs • Specialty Transport • Shock