Protocol 2-451 - General Trauma Management

CMH EMS & MIH Protocols

EMD:

• No specific protocol.

EMR:

• Hemorrhage:
• Consider direct pressure.
• Consider Oxygen 100%.
• Consider Hemostatic Agent.
• Consider bandage.
• Epistaxis:
• Squeeze nose for 10-15 min continuously.
• If unsuccessful: Repeat for another 15 min.
• Remind and assist patient to avoid swallowing blood.
• Post-partum: Refer to Protocol 2-462 - Gynecologic Emergencies.
• Chest trauma:
• Consider Oxygen 100%.
• Consider occlusive dressing to open wounds.
• Chest crush injury: Immediate release and rapid transport.
• Consider SMR
• Maintain patient Temperature between 91-99 ℉. Consider active re-warming.
• Consider splint.
• Consider stabilizing impaled object.
• Superficial penetration: Small penetrating objects such as Taser probes and fish hooks may be removed on the scene...
• If all of the following apply:
• The object is embedded superficially below the nipple line (not the genital area),
• Cooperative patient,
• Little to no pain,
• Isolated injury, AND
• Not grossly contaminated.
• To remove:
• Taser probe: Stabilize skin and remove by hand with a single, quick motion.
• Fish hook: Wrap or cut off sharp points and remove without causing further injury.
• Wipe wound(s) with antiseptic wipe and apply a dressing.
• Instruct patient to follow up with their primary physician or public health agency for tetanus vaccination and infection monitoring.
• Cardiac monitoring after Taser deployment is only required if the patient has an ALOC or cardiac symptoms.

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• Refer to specific trauma protocols as appropriate:
• Protocol 2-286 - Drowning / Near Drowning
• Protocol 2-396 - Extremity Trauma
• Protocol 2-418 - Eye Trauma
• Protocol 2-484 - Head Trauma
• Protocol 2-814 - Spinal Cord Trauma
• Protocol 2-836 - Spinal Immobilization Clearance
• Protocol 2-902 - Trauma Arrest

EMT:

• Ensure completion of applicable items above.
• Hemorrhage:
• Upper extremity hemorrhage: Consider Tourniquet on humerus until occlusion of distal pulse.
• Lower extremity hemorrhage: Consider two Tourniquets side-by-side on femur until occlusion of distal pulse.
• Chest trauma:
• Flail chest: Consider assisting respirations with positive pressure BVM or assisting ALS with CPAP.
• Ensure receiving facility/staff are aware if the patient is on a blood thinner. Common blood thinners include:

Aggrastat (Tirofiban) Apixaban (Eliquis) Arixtra (Fondaparinux) Aspirin (if greater than 81 mg per day) Brilinta (Ticagrelor) Cilostazol (Pletal) Clopidogrel (Plavix) Coumadin (Warfarin, Jantoven) Dabigatran (Pradaxa) Dalteparin (Fragmin) Dipyridamole (Persantine) Edoxaban (Savaysa)

Effient (Prasugrel) Eliquis (Apixaban) Enoxaparin (Lovenox) Eptifibatide (Integrilin) Fondaparinux (Arixtra) Fragmin (Dalteparin) Heparin (Innohep) Innohep (Heparin) Integrilin (Eptifibatide) Jantoven (Warfarin, Coumadin) Lovenox (Enoxaparin) Persantine (Dipyridamole)

Plavix (Clopidogrel) Pletal (Cilostazol) Pradaxa (Dabigatran) Prasugrel (Effient) Rivaroxaban (Xarelto) Savaysa (Edoxaban) Ticagrelor (Brilinta) Tirofiban (Aggrastat) Vorapaxar (Zontivity) Warfarin (Coumadin, Jantoven) Xarelto (Rivaroxaban) Zontivity (Vorapaxar)

AEMT:

• Ensure completion of applicable items above.
• Consider IV LR bolus to maintain SBP above 100.

RN:

• Ensure completion of all applicable items above.
• Chest trauma with dyspnea: Suspect tension pneumothorax. Consider Decompression Needle.
• 5th intercostal space, anterior axillary line OR
• 2nd intercostal space, mid-clavicular line.
• Major injury or hemorrhage with signs of shock
  • Consider IO LR bolus to maintain MAP above 65 or SBP above 100 .

  Adult:	Pediatric:
  Consider TXA 1 g in 100 ml NS/LR over 10 min.

• Possible fracture: Consider Protocol 2-660 - Pain Control.
• Open fracture:

Adult:	Pediatric:
< 120kg Ancef 2 g over 5 min OR 2g over 10 min in 100ml NS. > 120kg Ancef 3 g over 5 min OR 3g over 10 min in 100ml NS	Consider Ancef 35 mg/kg (max 2 g) over 5 min. Click "calculate" to get dose.

• Epistaxis that does not resolve with 15 minutes of pressure: Consider Neo-Synephrine 2 sprays in each nare, then continued pinching of the nose for an additional 15 minutes.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.
• Refer to MIH Protocol 4-666 - Chronic Wound Management.

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