Transcript Traumatically Injured Patient

The Traumatically
Injured Patient
April 2014 CE
Condell Medical Center
EMS System
Site Code: 107200E-1214
Prepared by: Sharon Hopkins, RN, BSN, EMT-P
Rev 5.23.14
1
Objectives
Upon successful completion of this module, the EMS
provider will be able to:
1. Describe the purposes of data collection in injury
prevention, trauma registry, and quality improvement.
2. Describe the association between mechanism of
injury and anticipated injury patterns.
3. Describe trauma assessment process
4. Describe trauma assessment priorities.
5. Describe the capabilities of a Level I and Level II
Trauma Centers.
2
Objectives cont’d
6. Describe the procedure for instituting critical
invasive interventions to the critically injured
patient.
7. Given a variety of scenarios, assign the
appropriate trauma triage criteria to the patient
8. Actively participate in review of selected
Region X SOP’s.
9. Actively participate in review of a variety of
EKG rhythms and 12 lead EKG’s.
10. Actively participate in case scenario
discussion.
3
Objectives cont’d
11. Actively participate in return demonstration
of insertion of IO, King airway, and Quick
Trach at the paramedic level.
12. Actively participate in ventilating a patient
via a BVM at the EMT-Basic level.
13. Review responsibilities of the preceptor role.
14. Discuss the use of tourniquets and QuikClot
tools in Region X.
15. Successfully complete the post quiz with a
score of 80% or better.
4
Data Collection
 Processes used to identify
problems/issues and remedy them
 Process of gathering and measuring
information
 Accurate data is essential

Results drive decision making
 Focus is on objective, not subjective
information
5
Focus of Data Collection
 Move from “I think there is a problem” to
“Data indicates the problem is…”
 In past, medical practices have been
based on medical knowledge, intuition,
and judgment
 Care provided needs to be “best
practice” (“evidenced based practice”)

Based on best available clinical and
scientific evidence available in literature
6
Data Collection –
Injury Prevention
 Changes over the years driven by data

Restraints consisted of lap belt in the front seat
only (early 1900’s)
 Now
lap and shoulder belts are positioned throughout vehicle
 Early air bags for driver only
 Now air bags all around vehicle

Opposing roadways had no separation; head on
collisions more common
 Hard
to find a major roadway without some
separation (i.e.: concrete barrier, grass)
7
Data Collection –
State Trauma Registry
 Hospitals submit data to the State of Illinois
specifically for patients with traumatic
injuries
 Again, data drives change
 Without specific, accurate data, evidence
based changes difficult to formulate
8
Trauma Transports By The
Numbers*
 Volume of trauma transports in Region X



Total transports reported to IDPH 2011 = 5914
Total transports reported to IDPH 2012 = 6084
Total transports reported to IDPH 2013 = 4454**
 Snapshot of CMC totals reported to IDPH



•
•
Total 2012 – 1361 (Cat I 208; Cat II 729)
Total 2013 – 1256 (Cat I 181; Cat II 792)
Dec 2013 total - 144 (Cat I - 12; Cat II - 54)
* Patients included IF admitted or transferred out
**First 3 quarters 2013 reported*
9
Mechanism of Injury (MOI)
 Refers to how a person was injured
 Kinetics is the science of analyzing the MOI
 Documentation describing the MOI is the data
used to drive decisions

Needs to be detailed
 i.e.:


Why and how patient fell
MOI can influence assessment and interventions
Changes to product design/structure and use
can be generated after review of data
10
MOI
 Due to collected data, energy patterns
can be predicted and allow the rescuer
to focus on probable and most likely
injuries anticipated




Vehicle collisions
Falls
Penetrating trauma
Explosions
11
MOI
 Falls most common but…
 Over 1/3 of deaths result from MVC
 Best you could do for a patient???

Maintain a high index of suspicion
12
Trauma Assessment Process
 Scene safety and size up
 Primary or initial assessment

AVPU, ABC’s and c-spine control
 Transport decision
 Rapid trauma assessment or focused
exam
 Detailed secondary assessment
 Ongoing assessment
13
Trauma Assessment Process
 Be methodical
 Be repetitive
 Perform the same steps on all calls



Can modify steps based on type of call
Builds muscle memory
If you always do something, you’ll never
NOT do something
14
Trauma Intervention Priorities
 Identify life threats in primary assessment

Continue to look for life threats with every
additional assessment
 Correct airway problems

Establish adequate oxygenation & ventilation
 Control external hemorrhage
 Direct pressure, pressure points, tourniquets,
hemostatic agents
 Expedite transport to appropriate facility

Need to determine category trauma to make this
decision
15
Category I Trauma Patient –
Unstable Vital Signs
 GCS <13 with blunt head injury

Trying to avoid categorizing all patients with
altered level of consciousness NOT due to
trauma (i.e.: under the influence of ETOH and
drugs
 Respiratory rate <10 or >29
16
Category I Trauma Patient –
Anatomy of Injury
 Penetrating injuries to head, neck, torso, groin
 Combination trauma with burns >20%
 2 or more proximal long bone fractures
 2 or more body regions with potential life or
limb threats
 Unstable pelvis
 Flail chest
17
Category I Trauma Patient –
Anatomy of Injury cont’d
 Limb paralysis and/or sensory deficits
above wrist or ankle
 Open or depressed skull fracture
 Amputation proximal to wrist or ankle
18
Category II Trauma Patient –
Mechanism of Injury
 Ejection from auto
 Death in same passenger compartment
 Motorcycle crash >20 mph or with
separation of rider from bike
 Rollover unrestrained
 Falls >20 feet

Peds falls >3x body length
 Pedestrian thrown or run over
19
Category II Trauma Patient –
Mechanism of Injury cont’d
 Auto vs pedestrian/bicyclist with > 5mph
impact
 Extrication > 20 minutes
 High speed MVC



Speed >40 mph
Intrusion >12 inches
Major deformity >20 inches
 Basically, a very lucky patient with significant
MOI which increases the risk of injury
20
Category II Trauma Patient –
Co-morbid Factors
Increased risk of morbidity or mortality
related to co-existing factors
 Age <5 without car/booster seat
 Bleeding disorders or on anticoagulants
 Pregnancy >20 weeks
 Renal disease requiring dialysis
21
Anticoagulants
 Why are these an issue with trauma?

Increases the risk of bleeding internal and
external
 Can you name the 6 more commonly used
anticoagulant medications that can increase
the risk of bleeding for trauma patients?
Coumadin / Warfarin
 Xarelto
 Pradaxa
 Elaquis
 Lovenox
(Note: Plavix & ASA are antiplatelets)

22
Transportation Destination
Who Goes Where???
 Highest level Trauma Center within 25
minutes of transport time

Unstable systolic B/P on 2 consecutive
readings
 Adult
< 90 systolic
 Peds < 80 systolic

Category I trauma patient
 Closest Trauma Center
 Category II trauma patient
The lucky patient with a significant MOI!
23
Transport Destination cont’d
 Closest appropriate comprehensive ED

Patient NOT categorized as I or II but who
has suffered a traumatic injury
 Closest comprehensive ED

The patient with NO airway

This includes GEC and Vista’s
Emergency Center in Lindenhurst
24
Level I and Level II Trauma
Centers
 IDPH has printed Administrative Code
(i.e.: Rules and Regulations) designating
criteria to be met by hospitals

Staffing availability
 By




title, department, and hours available
Staff training
Equipment
Performance QI program
Operating Protocols
25
Trauma Center Operations
 IDPH Rules and Regs require

Staffing availability requirements by specialty
 Immediate,




Transfer agreements for unique cases (ie: burns)
List of equipment per level trauma center
Minimum performance QI to be performed
Guidelines for contents of operating protocols
 Including

30 minutes, 60 minutes response
measures to avoid going on by-pass
Type of public education performed
26
IO Access
 When there is a need to have access for
medication administration and alternative
peripheral sites have failed or are not
available
 Needle inserted into bone marrow cavity
27
Treatment – Interventions - IO
 Indications



Shock, arrest, or impending arrest
Unconscious/unresponsive or conscious
critical patient without IV access
2 unsuccessful IV attempts or 90 second
duration or no visible sites
28
IO cont’d
 Contraindications



Insertion into extremity with fracture
Infection at insertion site
Previous orthopedic procedure



Knee replacement, previous IO within 480
Pre-existing medical condition
Inability to locate landmarks

Significant edema
29
IO Sites
 Primary site – proximal tibia
 Secondary site for adults – proximal humerus
 Not developed anatomically in children <5,
therefore not recommended < 5y/o

If you are anticipating humeral site in the
pediatric patient over 5 years-old, contact
Medical Control for guidance
30
Proximal Tibia Insertion Site
 Flat surface below growth plate and
medial to tibial tuberosity
 Palpate 2 fingers below patella to tibial
tuberosity (approx. 2 cm)


Leg needs to be straight
Not always palpable in very young
 Palpate 1 finger width medially

“EZ IO to big toe”
31
Humeral Insertion Site
 Place patient’s hand over navel and
elbow adducted to body (tucked back in
line with spine)
 Palpate with thumb moving up the
humeral bone
 Palpate to the most prominent rounded
protrusion – greater tubercule


Rotate fingers around site to confirm
Site is anterior to midline of arm
32
Humeral Site
Alternate Methods to Identify
 Keep hand over navel, elbow adducted
 Using heel of your hand, strike at
prominence top of arm

Site feels like golf ball
OR
 Slide fingers down from top of shoulder

As soon as drop off palpated, come down
1 finger breadth and anterior 1 finger
breadth
33
IO Sizing
 Pink – 15 mm; 15 G
 Blue – 25 mm; 15 G
 Yellow – 45 mm; 15 G
 15 mm – if you can feel bone just under
skin; generally for infants 3-39 kg (6.5-88#)
 25 mm – general population for tibial
placement
 45 mm – adult humeral site and obese leg
34
IO Equipment
 IO needle package



IO needle
EZ-connect tubing
Florescent arm band
 Driver
 Syringe with NS for flushing
 Primed normal saline (NS) IV bag
 Material to cleanse site
 Pressure bag
 Material to secure needle
35
IO Needles
 What’s with the black
hash marks???
 Purpose – to validate appropriate length of
needle for site chosen


Advance needle into site until bone touched
If you can see a black hash mark, you have
enough needle left to be secured into bone
 If
no hash mark visible, withdraw needle from
skin, move to next size needle and resume
placement
36
Confirming IO Placement
 Needle stands up by self
 Flushes without resistance
 No evidence of infiltration
 Fluid flows with pressure bag

Can squeeze bag manually until pressure bag
in place but may not be enough pressure
37
Pain Control For IO Infusion
 What causes pain during fluid infusion?

Infusion of fluids into a non-expandable space
 How do you fix it?

Lidocaine 50 / 60 / 60
 50
mg over 60 seconds; wait 60 seconds
 For peds: 1mg/ kg up to 50 mg


Company recommended to inject Lidocaine
before initial flush if anticipated
Infusion can be stopped any time to instill
Lidocaine for pain control
38
Why Do IO’s Fail???
 Catheter not flushed following insertion
 Pressure bag not in place

FYI - Manually squeezing IV bag may not
produce high enough pressure
 Wrong size needle chosen


Too short and not entered into bone
Drilled too deep and punctures through the
bone
39
Treatment – Interventions –
King Airway
 Indications


Cardiac or respiratory arrest
Inability to place ETT in unresponsive
patient without a gag reflex
 Contraindications




Height less than 4 feet
Presence of gag reflex
Ingestion of caustic substance
Known esophageal disease
40
Gag Reflex
 Purpose

Protects the airway
 How to test for presence

Stroke eyelashes or tap space between eyes
looking for blink reflex
 Blink and gag reflexes are protective
 Disappear at same time
 Testing for one sheds light on other one
 Note: about 1/3 of adults have  gag reflex
41
King Airway Sizing
 Color coded sizes



Size 3 – yellow
Size 4 – red
Size 5 - purple
 Based on patient's height



Yellow size 3 for 4 – 5 foot height
Red size 4 for 5 – 6 foot height
Purple size 5 for over 6 foot height
42
King Airway Equipment
 King airway – properly sized
 Large syringe



Yellow size 3 initial balloon inflation 50 ml air
Red size 4 initial balloon inflation 70 ml air
Purple size 5 initial balloon inflation 80 ml air
 Water soluble lubricant

Avoid smearing lubricant over distal air
passages on airway
43
King Airway Confirmation
 Begin by attempting to start ventilating
patient – you should meet resistance
 Perform usual steps


Observe bilateral rise and fall of chest
5 point auscultation
 Absent
epigastric sounds
 Bilateral breath sounds

Capnography
 Qualitative/colormetric
- yellow
 Note: This is a blind insertion

You will not visualize vocal cords
44
Why do King Airways Fail???
 Failure to choose correct size airway
 Failure to initially insert airway deep enough
 Failure to inflate cuff sufficiently
 Failure to pull King airway out far enough
45
Treatment – Interventions –
Quick Trach
 Indications

All other conventional methods to ventilate
patient have failed
 Contraindications


Tracheal transection
Other less invasive techniques allows
ventilation of patient (i.e.: they are
successful)
46
Quick Trach Sizing
 Size 4.0 mm ID – patients >77# (35 kg)
 Size 2.0 mm ID – patients between
22 and 77# (10 – 35 kg)
 Needle cricothyrotomy – patients < 22#
(10 kg)
47
Quick Trach Equipment
 Contained in one kit
 Size 4.0 or 2.0 pre-assembled
cricothyrotomy unit
 Attached 10 ml syringe
 Connecting tubing
 Padded neck strap
 Add to kit



PPE’s
Cleansing material
BVM
48
Quick Trach Landmark
Identification
 With patient supine, hyperextend neck if no
neck injury suspected
 Locate cricothyroid membrane

Located between thyroid cartilage (Adam’s
apple) and cricoid cartilage
 Start
at sternal notch and run finger upward
 First rigid landmark is cricoid cartilage
 Cricothyroid membrane just above cartilage
49
Landmark Identification
Alternative Method
 Palpate prominence of Adam’s apple


Slowly palpate finger downward
Finger drops off into cricothyroid membrane
50
Quick Trach Confirmation
 Audible escape of trapped air
 Ability to aspirate air via syringe during insertion
 Ability to ventilate Quick Trach 1 breath every
6 – 8 seconds
 Observation of bilateral rise and fall of chest
51
Why do Quick Trachs Fail???
 Improper identification of landmarks
 Blockage lower down/ more distal in airway
system
 Improper insertion of device
 Not removing red stopper
 Potential for barotrauma (i.e.: subcutaneous
emphysema or pneumothorax)
if exhalation is inadequate and
airway pressure is elevated
52
What Is Your Impression???
 Review the following slides
 Based on MOI and presenting signs and
symptoms, determine your general
impression
 Discuss intervention priorities
53
What Would You Do???
 Patient was unrestrained driver involved in
head-on with tree
 Patient is in shock
 All peripheral veins are collapsed
 What would be your alternative to inserting
a peripheral IV???

Evaluate extremities for IO access
 What would block use of this site?
 Fracture of extremity or infection at intended
site
54
What Would You Do???
 Patient becomes unconscious and
unresponsive while eating
 You are unable to ventilate even after
repositioning & performing the Heimlich
 What could be your next interaction?


Visualize the airway with blade and handle
Have Magill forceps available
 For unrelieved obstruction, what device
would be appropriate to use?

Prepare for insertion QuickTrach or needle
cricothyrotomy
55
What Do You Think???
 How do you find the cricothyroid
membrane???

Start at notch and run finger up to first
bony ring
 Go

to soft spot above the cricoid cartilage
OR…
Palpate down to the Adam’s apple
prominence
 Slide
finger over prominence into soft space
56
What Would You Do???
 Your patient is in full arrest and in VF
 CPR is ongoing following defibrillation
 What is your next action – IV access or
insertion of advanced airway???

Gain IV access
 You
need a route for drug administration
 You should already have airway secured via BVM

What are the sites for IO insertion if necessary?
 First
site of choice is proximal tibia
 Back-up site is humeral head
57
What Do You Think???
 How do you find the proximal tibial
landmark???

Palpate the distal edge of the patella (knee
cap)
 Leg
must be straight
 Flexed knee alters the landmark

2 fingers below patella palpate the tibial
tuberosity prominence
 Not

always palpable in the young
Move 1 finger width medially
58
What Do You
Think???
 How do you find the humeral head
landmark???

Patient’s elbow MUST be tucked back and
adducted; hand resting over navel
 Landmark
not prominent when arm moved
forward


Palpate humeral head slightly forward from
midline
Aim drill tip to space between sternum and
spine
59
Here’s the story…
 Your patient has shallow, slow
respirations
 They do not respond to a sternal rub
 There is no change after Narcan
administration
 Blood glucose level is 72
60
What Do You Think???
 What measures can be utilized to protect
their airway???

Positioning
 Easiest

technique; least often used
Suction ready
 If
used, limited to 10 seconds and suction applied
during withdrawal

Placement of advanced airway
 ETT
attempted first
 King airway placed if unable to place ETT
61
What Do You Think???
 How do you size the King airway???

By patient height
 How far down do you initially insert the King
airway???

Until the colored hub is even with the teeth or lip line
 When are the cuffs inflated on the King???



When the device is inserted up to the hub
Inflate with volume printed on side of tube and on
packaging
Reposition tube by pulling it out until bagging is easy and
you observe rise and fall of chest
62
Triage Practice
Category I or Category II
 Review the following slides
 Determine if the patient is a Category I,
II, or non-category trauma patient
 Be prepared to explain your rationale
63
Triage Practice #1
 You are with the patient who passed out
at a local event found lying in the grass
 Minor laceration right palm with broken
bottle lying near patient
 Definite evidence of excessive ETOH
consumption

GCS – (3, 2, 5) Total 10
 Is this a Category I trauma patient due to
GCS <13?

No; no evidence of blunt head injury
64
Triage Practice #2
 Upon arrival, your patient is standing at the
roadside
 Patient was restrained driver in rollover; self
extricated
 What category trauma is this?

Not Category I or II – restrained in a rollover
 Can this patient sign a refusal for transportation?



Yes, if they are alert and oriented x3 and understand
the risks and benefits
But, due to MOI encourage transport
65
Requires a full, documented assessment
Triage Practice #3
 Your patient was struck by a forklift and hit on
the right chest wall
 They are more comfortable with shallow
respirations and not moving around
 Your palpation indicates crepitations over
multiple areas of the rib cage; SpO2 94%
 Lung sounds are diminished but present
 You suspect a flail chest
 What category trauma is this???

Category I – flail chest
66
Triage Practice #4
 Your patient required extrication of 25 minutes



Respiratory rate of 32 and shallow
Unstable pelvis
Penetration of thigh
 What meets criteria for a Category I patient?

Respiratory rate >29 and unstable pelvis
 What meets criteria for a Category II patient?

Extrication >20 minutes
67
Triage Practice #5
 Patient slipped in garage and hit head
 GCS – 15; alert and oriented
 Med history: Allopurinol,
hydrochlorothiazide, Xarelto, Lipitor
 Does this patient meet criteria for
Category I, II, or non-category???


Category II co-morbidity – on anticoagulant
(Xarelto)
Increased risk for internal bleeding
68
Case Review
 Review following cases
 Decide general impression
 Discuss interventions
69
Case Review #1
 EMS at scene of a low speed MVC vs pole
 67 y/o unconscious driver; GCS 11 (3, 3, 5)
 Multiple facial lacerations
 Obvious deformity to wrist
 What is the rhythm strip & implications???
Sinus brady with ST elevation; obtain 12 lead EKG
70
Case Review #1
 What are your suspicions???




Driver passed out due to low heart rate
Driver passed out due to AMI
Driver had AMI that caused MVC
Driver had MVC and then AMI
 You are now caring for a trauma and
acute medical patient
 What Category trauma are they???

Category I – GCS <13 with evidence blunt
head injury
71
Case Review #1 – 12 Lead EKG
Is there ST elevation?
ST elevation II, III, aVF – Inf wall MI
72
Case Review #1
 What are the implications to your care based
on working diagnosis?


Patient needs routine trauma care
Patient also requires care for AMI
 Can

you give ASA if not alert?
Hold ASA; document why in narrative
 Does


he need NTG?
No complaints of chest pain so usually held
 FYI - Some cardiologists do tend to use it for
decreasing pre-load even in absence of chest pain
Remember to screen for additional contraindications
73
 B/P, Viagra use (already know inferior wall MI)
Case Review #2
 EMS called for an adult patient that fell from
a 2nd floor balcony
 Eyelids flutter to touch
 Moaning and groaning
 Flexes right arm, extends left arm
 What is the GCS???



Eye opening – 2
Verbal response – 2
Motor response – 3 (give best score possible)
74
Case Review #2
 Injuries found after assessment






Scalp laceration
Forehead hematoma
Flail chest right
Deformed right humerus
Right tib/fib deformity
Left femur deformity
75
Case Review #2
 VS: B/P 82/56; P – 124; R – 24 shallow; SpO2 91%
 What interventions does the patient require?



Manual c-spine control
Supplemental oxygen
IV access
 Limited
access to peripheral site
 If IO, site choice limited to left humerus

Fluid challenge – 200 ml increments
 B/P
goal 90 systolic as guideline
76
Case Review #2
 What Category trauma is this patient and why?

Category I
 GCS
<13 with blunt head injury
 Flail chest
 2 or more long bone fractures
 Anatomical injury and unstable vital signs are
used to indicate a Category I trauma patient
 MOI used to indicate a Category II trauma
patient
77
Case Review #2
 As a Category I trauma patient, where
does this patient get transported to?

Highest level Trauma Center within 25
minutes transport time
78
Case Review #2
 What is this rhythm?
Sinus tachycardia
 Does this patient require Adenosine?

No!!!; consider the cause and treat the cause
79
Case Review #2 - Discussion
 When would you administer Adenosine?


Adult stable narrow complex SVT
Adult stable wide complex monomorphic VT
 Assumed
to be SVT with aberrancy until proven
otherwise


Peds probable SVT with adequate and poor
perfusion
Peds possible VT with adequate perfusion
80
Permissive Hypotension
 Not a new concept; evidenced-based
research has been underway
 Challenges the “way we’ve always done it”
just because “that’s the way we’ve always
done it”
 Currently researching what parameters
SHOULD be used to evaluate circulatory
status of patient to determine condition status


Currently use systolic blood pressure
Region X SOP uses systolic >90 as guideline
81
Permissive Hypotension cont’d
 What do we know?


Achieving a “normal” B/P increases the
hemorrhaging volume and increases mortality
rates
Infusing large amounts of crystalloid fluids
Dilutes circulating blood volume left
 Dilutes/makes less effective remaining components
(i.e.: clotting mechanisms)


When B/P is “normal”, compensatory
mechanisms of body not triggered to “turn on”
82
Permissive Hypotension cont’d
 Why are we talking about this topic???

Informational
 Want

to share current research underway
Educational
 Could
explain a Medical Control order to restrict
fluid resuscitation
 Using critical thinking skills, could encourage
dialogue with Medical Control regarding degree of
fluid resuscitation in field for certain traumatically
injured patients
83
Case Review #3
 You are called for an adult who
was “clotheslined” while riding
their motorcycle


You find rider separated from motorcycle
Unresponsive struggling to breathe
 You provide routine trauma care


Manual c-spine control
Initial/primary assessment
 Determined
to be rapid transport
84
Case Review #3
 What are the progression of steps for
securing the airway???

Attempt repositioning
 Restrictions
in place for this patient due to
high suspicion for c-spine injury

Attempt BVM
 Rate

1 breath every 5 – 6 seconds
Progress to ETT
 Requires

in-line technique for placement
Best performed with minimal 2 people
85
Case Review #3
 If unable to pass ETT, then what???

Progress to King airway
 Blind
insertion technique
 Sizing according to patient height
 If unable to ventilate with BVM, then what???

Consider QuickTrach device

How is this device sized?
 4.0
for adults > 77#
 2.0 for peds 22 – 77#
86
Reminder –
Ventilatory Rates via BVM
 Infant and child
1 breath every 3 – 5 seconds
 For documentation that would be assisted
rate of 12 – 20 breaths per minute

60 seconds (1 minute)  5 = 12
 60 seconds (1 minute)  3 = 20

 Adult
1 breath every 5 – 6 seconds
 For documentation that would be assisted
rate of 10 – 12 breaths per minute

87
Reminder –
Ventilatory Rates via Advanced
Airway
 Infant, child and adult

Via ETT, King, combitube or any other
advanced airway system
1
breath every 6 -8 seconds
 For documentation that would be assisted
rate of 8 – 10 breaths per minute
 60 seconds (1 minute)  8 = 8
 60 seconds (1 minute)  6 = 10
88
Future Developments in
Region X
 Use of tourniquets
 Use of QuikClot
 Information and educational material for
these devices as methods for control of
bleeding are being developed by the
Region
89
Tourniquets
In general:
 Tourniquets used when other initial steps
fail to control bleeding
 Tourniquet chosen needs to be minimally
4 wide or commercial device
 Needs to be placed just proximal to the
wound but as distal as possible
 Once placed, a tourniquet should not be
removed
90
QuickClot
 Hemostatic dressing used to promote clotting
 Used after failure of conventional methods*
Direct pressure
Pressure points
 Works with physical action

Material placed over wound absorbs water
molecules from blood to allow concentration of
clotting factors
 *Note: Elevation not found to be effective OR harmful; if used
would be in conjunction with direct pressure; never alone
91
Use of QuickClot
 Pilot study will be completed in Region X
utilizing volunteer departments



Participating departments will complete
training
Participating departments will report results
via an evaluation form
Results of pilot study to be discussed at
Region X Trauma/EMS meetings for
adoption decision
92
Preceptor Role – Peer Review
 Often perform as a peer in this role

You are of the same rank as the person you
are overseeing
 Peer review based on current acceptable
practices
 Feedback is timely, routine and a continual
expectation
 Peer review fosters continuous learning
 Feedback is given as a dialogue

Focuses on the level of the provider along the
93
novice-to-expert continuum
Bibliography
 Bledsoe, B., Porter, R., Cherry, R. Paramedic Care





Principles & Practices, 4th edition. Brady. 2013.
Mistovich, J., Karren, K. Prehospital Emergency
Care 9th Edition. Brady. 2010.
Region X SOP’s; IDPH Approved January 6, 2012.
IDPH Administrative Code Subpart H Trauma
Centers
https://balancedscorecard.org/Portals/0/PDF/datac
oll.pdf
http://blog.esurance.com/seat-belt-history/
94
Bibliography cont’d
 http://www.jems.com/article/intraosseous/pain





management-use-io
http://www.narescue.com/media/NAR/guides/ISGKingLTD.pdf
www.vidacare.com
www.youtube.com/watch?v=sHib5EHbUEc
www.youtube.com/watch?v=GYM3cUBBzls
www.youtube.com/watch?v=ca710sG4-ck
www.youtube.com/watch?v=aGfDpXrxOk
95
Bibliography cont’d
 www.savevid.com/video/rusch-quicktrach.html
 http://www.youtube.com/watch?v=xWERlDWNNm4
 http://www.youtube.com//watch?v=uyh-TDb2xkc
 http://youtube.com/watch?v=BELokurs5fU
 http://www.jems.com/article/patient-care/permissive-
hypotension-trauma-resuscitat
 www.NARescue.com
 www.z-medica.com/
96