Trauma Overview: the Trauma Patient And

Detailed Lesson Plan

Chapter 27

Trauma Overview: The Trauma Patient and

the Trauma System

100–120 minutes

1. Present The Dispatch and Upon Arrival information from the chapter.
2. Discuss with students how they would proceed.

• How do speed and direction of impact affect the potential for patient injuries?
• Other than injuries to the knees, are there other injuries that you should look for in this patient based on the type of impact?

1. Mechanism of injury (MOI)</KT> refers to how a person was injured.
2. Kinetics of trauma is the science of analyzing mechanisms of injury.
3. Kinetic energy is the energy contained in a moving body.

1. Kinetic energy is directly proportional to mass.
2. Kinetic energy is directly proportional to the square of velocity.

1. During scene size-up, get the best estimate you can of the speed the vehicle or vehicles were going at the time of collision.
2. The kinetic energy of two moving bodies that collide will be combined.

1. The motion of an object will not change unless a force acts upon it.

1. Acceleration is an increase in speed.
2. Deceleration is a decrease in speed.
3. A faster acceleration or deceleration results in a greater force on the human body.

1. Vehicle collision—The vehicle is suddenly stopped and gets bent out of shape.
2. Body collision—The patient comes to a quick stop on some part or parts of the inside.
3. Organ collision—The patient’s internal organs come to a quick stop.

• Explain the three impacts that occur in a motor vehicle collision. What law of motion accounts for the three collisions?
• How do mass and velocity each affect the amount of energy transferred to the human body?

1. Death of another occupant of the vehicle
2. An unresponsive patient or patient with an altered mental status
3. Intrusion of greater than 12 inches for the occupant site or greater than 18 inches anywhere to the vehicle
4. Ejection from the motor vehicle

1. Frontal impact

1. Abdomen
2. Chest
3. Face, head, and neck
4. Rear-end impact

1. Head
2. Neck
3. Lateral impact

1. Head and neck
2. Chest and abdomen
3. Pelvis
4. Rotational or rollover crash

1. Multiple systems injury is common.
2. Ejection is common.
3. Crushing injuries to ejected occupants are common.
4. Vehicle-pedestrian collision

1. The speed of the vehicle
2. What part of the pedestrian’s body was hit
3. How far the pedestrian was thrown
4. The surface the pedestrian landed on
5. The body part that first struck the ground
6. Restraints—A cause of hidden injuries

1. Air bags
2. Seat belts
3. Considerations for infants and children

1. Any parts of the body that are not restrained continue to move forward.
2. Children should always be restrained in the back seat to avoid injury from air bag deployment.
3. Motorcycle collisions

1. Head-on impact
2. Angular impact
3. Ejection
4. “Laying the bike down”

• What injuries are predicted in frontal motor vehicle collisions?
• What are the variables that affect severity and patterns of injury in vehicle-pedestrian collisions?

1. Distance
2. Surface
3. Body part impacted first
4. Objects that interrupt the fall

1. Fractures of the heels and fractures or dislocations of the ankles are common.
2. The spine will absorb the force at every curve of the lumbar.
3. In falls of more than 20 feet, the internal organs are likely to be injured from deceleration forces.
4. A fracture of the wrist bones is common.
5. If the body is thrown backward, the most common injuries are to the head, back, and pelvis.

1. Injury begins with the arms and extends up to the shoulders.
2. The head may be forcibly hyperextended, hyperflexed, or compressed.
3. Extensive damage to the cervical spine can occur.
4. Chest, lower spine, and pelvic injuries are also common.

1. Drag
2. Profile
3. Cavitation
4. Fragmentation

1. Of fatal wounds, 90 percent involves the head, thorax, and abdomen.
2. Wounds also occur to the neck and extremities.

1. Head
2. A projectile entering the skull causes the brain tissue to be compressed.
3. A projectile entering the face threatens the airway.
4. Chest
5. Pneumothorax is a common result of injury to the chest and/or lung.
6. The outer covering of the heart may be able to seal itself off from low-velocity projectile wounds, but medium- and high-velocity projectiles are likely to cause significant wounds.
7. Suspect both thoracic and abdominal injury if the entrance wound is between the nipple line and the waist.
8. Abdomen
9. The abdomen is often secondarily injured when the chest is injured.
10. The majority of abdominal wounds are not rapidly fatal but need surgical repair.
11. Extremities
12. Bone injury from a projectile results in bony fragments becoming secondary missiles.
13. Muscle expands, resulting in capillary tears and swelling.
14. Vessels can be severed, ripped, buckled, and/or obstructed.

1. Mechanisms of Injury—Blast Injuries

1. The Multisystem Trauma Patient

1. The Golden Period

1. The Trauma System

1. Level 1—Regional Trauma Center
2. Level II—Area Trauma Center
3. Level III—Community Trauma Center
4. Level IV—Trauma Facility

1. Golden Principles of Out-Of-Hospital Trauma Care—Special Considerations in Trauma Care

1. Ensure at all times the safety of the EMS personnel, patients, and bystanders.
2. Quickly determine the need for additional resources at the scene.
3. Determine the mechanism of injury and kinematics involved in producing real or potential injuries.
4. Provide a primary assessment.
5. Establish and maintain spine stabilization for patients suspected of having a vertebral or spinal cord injury.
6. Establish and maintain a patent airway.
7. Establish and maintain adequate oxygenation in the patient with an adequate rate and adequate tidal volume.
8. Provide positive pressure ventilation.
9. Control external hemorrhage with direct pressure.
10. Treat for shock.
11. Consider the application of the PASG.
12. Maintain manual spine stabilization until the patient is completely immobilized on a backboard.
13. Transport critically injured or multisystem trauma patients within ten minutes to the appropriate trauma facility.
14. Obtain a history from the patient, relatives, or bystanders.
15. Perform a secondary assessment.

1. Your personal safety is of utmost importance.
2. Airway management and adequate ventilation and oxygenation are key elements in managing the trauma patient.
3. Stop significant bleeding.
4. Assessment of the trauma patient is conducted in a sequence that promotes a systematic approach to the patient.
5. Rapid transport of the severely injured patient is essential to his survival.
6. A backboard can serve to secure suspected fractures in an unstable patient who requires rapid transport.
7. Do not develop tunnel vision and become focused on dramatic injuries or dramatic patients.

1. Answer student questions.
2. Case Study Follow-Up

1. Review the case study from the beginning of the chapter.
2. Remind students of some of the answers that were given to the discussion questions.
3. Ask students if they would respond the same way after discussing the chapter material. Follow up with questions to determine why students would or would not change their answers.
4. Follow-Up Assignments
5. Review Chapter 27 Summary.
6. Complete Chapter 27 In Review questions.
7. Complete Chapter 27 Critical Thinking.
8. Assessments

1. Handouts
2. Chapter 27 quiz

• Under what circumstances would Mike have been a candidate for rapid extrication?
• Explain the mechanism by which Mike may have sustained an injury to the cervical spine.

• Answers to In Review and Critical Thinking questions are in the appendix to the Instructor’s Wraparound Edition. Advise students to review the questions again as they study the chapter.
• The Instructor’s Resource Package contains handouts that assess student learning and reinforce important information in each chapter. This can be found under mykit at

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 27 PAGE 1