S500

• Trauma WITH head injury
  • Fluid resuscitation to maintain SBP ≥90 and
  • O2 saturation >90%
• Trauma
  • 2 large bore IVs of 0.9% NaCl
  • Fluid bolus of 500 ml
  • Reassess mental status
  • Repeat fluid bolus

T710

• Tourniquets
  • 1-2″ proximal to hemorrhage
  • Tightened until controlled
  • Record application time
• Wound packing
  • Wound to groin, axilla, or neck
  • Place gauze as deeply as possible
  • apply pressure dressing
  • Apply manual direct pressure for at least 3 minutes
• Tranexamic Acid (TXA)
  • Refer to TXA protocol

SB211

• Pulse >120 or <50 or SBP <90
• RR <10 or >29
• Intubated
• Evidence of head injury
  • GCS ≤13
  • Alteration in LOC or LOC > 5 min
  • Failure to localize pain
• Suspected spinal cord injury
• Penetrating trauma to head, chest, abdomen, neck, extremities proximal to knee or elbow
• Amputation proximal to wrist or ankle
• Fractures of 2 or more proximal long bones
• Evidence of neurovascular compromise
• tension pneumothorax that is relieved
• Head, neck, or torso visible crush injury
• Abdominal tenderness, distention or seat belt sign
• Pelvic fracture
• Flail chest
• Burn injury >10% TBSA and other traumatic injuries
• Significant mechanism of injury = high index of suspicion
• Ground <30 min transport time to Level 1 trauma center

S506

• Evidence of significant blunt or penetrating trauma AND
• Age ≥16 y.o. AND
• Presence of hemodynamic instability AND
• Sustained SBP <90 or <100 if age >55 AND
• Sustained heart rate >110 AND
• Time since injury is KNOWN to be <3 hours

•  Mix 1 g TXA in 100 ml of 0.9% NaCl or LR and infuse over approximately 10 minutes IV or IO
• Use a dedicated line
• Notify receiving trauma center

M410

• Assess for spinal injuries and treat/immobilize appropriately
• If actively seizing give Versed 10mg IM
• Versed 2-4mg/min IV/IM/IO, until seizure resolves or a total of 10mg is given
• Dextrose 50% 12.5 – 25g IV/IO or Glucagon 1 mg IM if Glucose < 70
• Narcan 0.4 to 2mg IV if suspect narcotic OD
• If in the 3rd trimester of pregnancy- or up to 6 wks postpartum -actively seizing with no seizure history consider magnesium sulfate 4g IVP slowly over 15 mins
• Transport to hospital with OB services

SB213

• GCS ≤ 14
• Pulse > 90, SBP < 110
• Fall from any height with evidence of traumatic brain injury, even from standing
• Pedestrian struck by motor vehicle
• Suspected long bone fx from motor vehicle crash
• Injuries sustained in two or more body regions
• Anticoagulation and head injury

S504

• Stabilize impaled objects in place and cover other eye
• Cover penetrating eye injuries with metal eye patch—do not press on globe
• Irrigate chemicals or non-penetrating foreign matter from eye with copious amounts of water or normal saline
• Instill 2 drops of 0.5% proparacaine (Alcaine) or tetracaine into affected eye for pain (note it may sting initially, < 20 sec)
• Can repeat Alcaine in 20 min if necessary

S502

• Scene safety; remove patient from source of burn, including clothing
• Maintain airway and administer oxygen
• If respiratory distress or unconscious, intubate immediately
• Cover burns with clean, dry sheet(s) or loose, dry sterile dressing
• Remove all prostheses, rings, and constricting bands from all extremities
• Consider pain management, per pain management protocol
• If hypovolemic, initiate fluid resuscitation

T704

• Age >16, <65
• Mechanism of injury concerning for spinal injury

Immobilization is indicated only if any of the following are present:

• Altered mental status
• Suspicion of intoxication
• Distractions – either painful injuries or psychosocial distractions
• Midline spinal tenderness (careful palpation exam required)
• Focal neurological deficit (anything less than a full & symmetric motor and sensory exam in all limbs)

If patient has isolated midline cervical spine tenderness with none of the above indicators, it is appropriate to immobilize a cooperative patient using a rigid cervical collar and ambulance stretcher without a long spine board

If a patient has penetrating trauma to the head, neck, and/or torso, spinal immobilization only required if a neurologic deficit exists

M414

• Age >16; may or may not have altered level of consciousness
• Assess ABCs and suspicion for trauma
• Assess patient with Cincinnati Stroke Scale
  • Facial droop (big smile)
  • Pronator drift (extend arms, palms up, eyes closed: one arm drift = positive; both = unclear)
  • Speech (“The sky is blue in Cincinnati”)
• Assess and record the exact time the patient was last known to be normal
• Glucose level should be >70mg/dL
• Rapid transport and pre-notify destination Emergency Department
• Minimize scene time to <10 mins; do not delay unnecessarily for procedures; attempt IVs and other procedures during transport
• Refer to ED capability chart for transport destination selection
• Consider transport to a JCC Primary or Comprehensive Stroke Center if:
  • Stroke center is <15 mins farther than a non-stroke center
  • Last known normal <12 hours