BASIC TRAUMA

EMERGENCIES

GERMAINE FAY M. RAMIREZ, RN, EMT-B

Special Operations Officer III
MMDA - Public Safety Division
TOPICS:

I. Body Substance Isolation

II. Mechanism of Injury VS Nature of
Illness
III. Soft Tissues Injuries
 Wounds
 Dressing/Bandages
IV. Musculo-Skeletal Injuries
 Splinting
V. Bleeding and Shock
VI. Patient Assessment
LESSON
OBJECTIVE
Upon completion of this lesson, the
participant will be able to:
1. Know what is Body Substance
Isolation.
2. Differentiate the Mechanism of Injury
(MOI) Vs Nature of Illness (NOI)
3. Identify soft tissue injuries.
LESSON
OBJECTIVE

4. Classify the types of open wounds

5. Demonstrate the proper application of
dressing and triangular bandage.
6. List down the types of musculo-
skeletal injuries.
I. BODY SUBSTANCE
ISOLATION
BODY SUBSTANCE ISOLATION
(BSI)
Is a practice of isolating all body substances
(Blood, Urine, Feces, Tears, Etc.) of an individual,
of those who might be infected with illness , to
reduce possibility of transmitting disease.
PERSONAL PROTECTIVE
EQUIPMENT (PPE)
is protective clothing, helmets, goggles, or
other garments or equipment designed to
protect the wearer's body from injury or
infection
 TYPES OF PERSONAL
PROTECTIVE EQUIPMENT /
GARMENT
Respirators
Skin Protection
 Eye Protection
Hearing Protection
Protective clothing and ensembles
 SCENE SAFETY

 The assessment of
scene safety starts prior
to arrival.
 Ensure the scene is safe
before entering
 Wear Protective Gear
(BSI)
 SCENE SAFETY

 Ensuring the scene is

safe is rooted in
situational awareness –
being able to capture
the clues and cues that
helps a responder
comprehend what is
happening
II. MECHANISM OF INJURY
VS NATURE OF ILLNESS
 MECHANISM OF INJURY

 refers to the method by which

damage (trauma) to skin,
muscles, organs, and bones
occurs. (external force)

Evaluate:
Amount of force applied to body
Length of time force was applied
Area of the body involved
SIGNIFICANT MECHANISM
OF INJURY

Ejection from  Vehicle-pedestrian

vehicle collision
Death in  Motorcycle crash
passenger  Unresponsiveness or
compartment altered mental status
Fall greater than  Penetrating trauma
15'-20' to the head, chest, or
Vehicle rollover abdomen
High-speed
collision
C-SPINE IMMOBILIZATION

Consider early during

assessment.
To prevent movement of
the cervical spine.
Do not move without
immobilization.
Achieve normal
alignment of the cervical
spine.
 NATURE OF ILLNESS
Condition is caused by an illness.
Determine the nature of the patient’s
illness
Not caused by out side force
 THE IMPORTANCE OF
MOI/NOI

Guides preparation
for care to patient
Suggests equipment
that will be needed
Prepares for further
assessment
 THE IMPORTANCE OF
MOI/NOI

Fundamentals of
assessment are
same whether
emergency appears
to be related to
trauma or medical
cause.
III. SOFT TISSUE INJURIES

CARLO RENEE I. VENTURA, RN, EMT-B

Special Operations Officer II
MMDA - Public Safety Division
SOFT TISSUE INJURIES

Is the damage of muscle, ligaments and

tendons throughout the body.
can result in pain, swelling, bruising `
and loss of function.
SOFT TISSUE INJURIES
MANAGEMENT
RICE
is an effective procedure used in the
initial treatment of a soft tissue injury.
R - est
I - ce
C - ompression
E - levation
SOFT TISSUE INJURIES
MANAGEMENT
No HARM Protocol
This method should not be used within
the first 48–72 hours after the injury in
order to speed up the recovery process.
H - eat
A - lcohol
Re - Injury
M - assage
SOFT TISSUE INJURIES
MANAGEMENT

Monitor for the rapid change of vital

signs that might indicate internal
bleeding.
Treat for Shock
Immediately transport to hospital as
soon as possible
SOFT TISSUE WOUNDS

WOUND – is a type of injury which

happens relatively quickly in which skin
is torn, cut, or punctured or where blunt
force trauma causes a contusion.
2 Classification of Wound
1. Open Wound
2. Closed Wound
CLASSIFICATION OF
WOUND
OPEN WOUNDS – is an injury involving
an external or internal break
in body tissue, usually
involving the skin.
- Skin breaks on which
the patient is at risk for
contamination, which may
lead to infection.
OPEN WOUNDS

Occurs when
your skin
rubs or
scrapes
against a
rough or
hard surface
ABRASION
MANAGEMENT FOR
ABRASION

clean the
surface of
the wound

if with
bleeding,
apply
dressing &
bandage
OPEN WOUNDS

Penetrates
more deeply
into the
dermis than
abrasion.

LACERATION
MANAGEMENT FOR
LACERATION

clean the
surface of
the wound
apply
dressing &
bandage
if possible,
close the
open wound
OPEN WOUNDS
A flap of skin
although torn
or cut, is not
torn completely
loose from the
body
Degloving
injury
Ring injury
AVULSION
MANAGEMENT FOR
AVULSION

-clean the
surface of the
wound
return skin flap
to original
position
control bleeding
(direct pressure,
apply dressing)
OPEN WOUNDS

Loss of Body
part, usually a
finger, toe, arm,
or leg, that
occurs as the
result of an
accident or
injury.

AMPUTATION
MANAGEMENT FOR
AMPUTATION

use universal precautions &

secure the scene
 clean the wound
immobilize partial
amputation with bulky
dressing and splint.
Wrap complete amputation
in dry sterile dressing and
place in bag.
MANAGEMENT FOR
AMPUTATION

Put bag in cool container

filled with ice. Don not let
the object freeze!
Transport severed part
with patient.
OPEN WOUNDS
 Caused by an
object such as a
knife entering the
body.
 Caused by an
object puncturing
the skin, such as a
nail or needle.

PENETRATION / PUNCTURE
 MANAGEMENT FOR
PENETRATING INJURIES OF
THE NECK

 Secure the
dressing in place
with roller gauze,
adding more
dressing if needed.
 Wrap gauze
around and under
patient’s shoulder.
 MANAGEMENT FOR
PENETRATING INJURIES OF
THE NECK
FOR INJURIES TO NECK
use universal precautions and secure the
scene
apply slight to moderate pressure on the
bleeding with an occlusive dressing
tape down the edges of the dressing to
form an airtight seal
never apply pressure to both sides of the
neck at the same time
 MANAGEMENT FOR
PENETRATING INJURIES OF
THE NECK
FOR INJURIES TO NECK
place the patient on the left side
if without spinal injury, place the patient on
15 degree incline with head over, if
possible
if an object is impaled in the neck,
stabilize it in place with bulky dressing. Do
not remove it.
Treat for shock.
OPEN WOUNDS
A direct injury
resulting from
the crush
Occurs when
force or
pressure is put
on a body part

CRUSH INJURY
OPEN WOUNDS

Physical
trauma due
to a bullet
from a
firearm.

GUNSHOT WOUND
OPEN WOUNDS
Physical injury to
the body’s
abdominal cavity
consisting of a
laceration or
breaking of the
skin or mucous
membrane

ABDOMINAL WOUND
 MANAGEMENT FOR
ABDOMINAL INJURIES

 use universal precautions

and secure the scene
 do not touch the
abdominal organs or try to
replace the exposed
organs.
 MANAGEMENT FOR
ABDOMINAL INJURIES

 cover the exposed

organs with clean cloth
or sterile dressing
 cover the dressing with
occlusive dressing and
with more bulky
dressing
OPEN WOUNDS
Soft-tissue
injuries to the
face and scalp
are common.
Wounds to the
face and scalp
bleed
profusely.

FACE and SCALP INJURIES

 MANAGEMENT FOR
EPISTAXIS OR NOSE BLEED

1.Place the patient in a sitting

position
2.Have him or her lean forward
3.Apply direct pressure by
pinching the fleshy portion of
the nostrils together
4.Keep the patient calm and
still as possible (rest)
 MANAGEMENT FOR EPISTAXIS
OR NOSE BLEED

5. Do not remove object

inside the nose if there is.
6.Check for clear
fluids(cerebrospinal fluid)
which may indicate a skull
fracture.
7.Do not pack the nose.
 MANAGEMENT FOR
SKULL INJURY

1. Do not attempt to stop

the flow of blood which
could create pressure
inside the skull causing
even more damage
 MANAGEMENT FOR SKULL
INJURY

2. Place a loose dressing

around the area to
collect the drainage
3. Cover the wound to
prevent infection
4. Immediately transport to
hospital
OPEN WOUNDS

Physical injury to
the body’s
abdominal cavity
consisting of a
laceration or
breaking of the
skin or mucous
membrane
IMPALED OBJECT
 CLASSIFICATION OF
WOUND
CLOSED WOUNDS – Injury beneath the unbroken
skin
- Can be severe with damage
to internal organs
- Caused by impact with a
blunt/hard object.
- Skin breaks on which the
patient is at risk for
contamination, which may
lead to infection.
CLOSED WOUNDS
Blunt, non
penetrating
injuries that crush
and damage small
blood vessels
Characterized by
erythema and
ecchymosis
CONTUSION (Bruise)
CLOSED WOUNDS

Caused by
damage to a
blood vessel
that in turn
causes blood
to collect
under the skin
HEMATOMA
CLOSED WOUNDS

Caused by a
great or
extreme
amount of force
applied over a
long period of
time

CRUSHING INJURIES
DRESSING AND
BANDAGES
 DRESSING
- Is a sterile pad or compress applied to
wound to promote healing and protect
the wound from further harm.
PURPOSE
1) cover the wound
2) help control bleeding
3) prevent additional
contamination
 KINDS OF DRESSING

 OCCLUSIVE DRESSING
 wax or plastic material; creates an
airtight seal for an open abdominal, chest
and large neck injuries
 KINDS OF DRESSING

 GAUZE PAD DRESSING

 wax or plastic material; creates an
airtight seal for an open abdominal, chest
and large neck injuries
 KINDS OF DRESSING

 SELF ADHERING DRESSING

 Type of dressing, bandage or wrap that
coheres to itself, but does not adhere
well to other surface
 KINDS OF DRESSING
 UNIVERSAL OR MULTI – TRAUMA
DRESSING
 Ideal for stopping bleeding associated with
deep wounds and fracture.
 Great absorbency, protection and padding
to the site
 BANDAGES
- Used to hold a dressing in
place
- Control Bleeding by direct
pressure when used as a
broad or narrow folded
bandage
Kinds of Bandage:
1) Roller Bandage
2) Triangular Bandage
3) Tubular Bandage
 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

Parts of Triangular Bandage:

 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

Folding
OPEN PHASE

BROAD

SEMI - BROAD

NARROW
 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

SQUARE KNOT
 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

TRIANGLE OF FOREHEAD / SCALP

 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

ARMSLING
 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

TRIANGLE OF CHEST / BACK

 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

TRIANGLE OF SHOULDER
 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

TRIANGLE OF HIP
 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

TRIANGLE OF FOOT
 BANDAGING
( U SING T R I A NG U L A R B A N DAG E)

TRIANGLE OF HAND
IV. MUSCULO – SKELETAL
INJURIES

KIM CARLO CORTES, EMT-B

Special Operations Officer I
MMDA - Public Safety Division
MUSCULOSKELETAL
INJURIES

Closed Fracture – the

overlying skin is intact.
Proper splinting helps
prevent closed fracture
from becoming open
fracture.

FRACTURE
MUSCULOSKELETAL
INJURIES

Open fracture – skin has

been broken or torn either
from the inside by the
injured bone or from the
outside by the object that
caused the penetrating
wound with the associated
bone injury.

FRACTURE
 MUSCULOSKELETAL
INJURIES

SIGNS AND SYMTOMS

1. Deformity or angulations
2. Pain & tenderness upon
palpation or movement
3. Crepitus (lumalangitngit) –
sound or feeling of broken bone
ends rubbing together
4. Swelling (pamamaga)
 MUSCULOSKELETAL
INJURIES

SIGNS AND SYMTOMS

5. Bruising or discoloration
6. Exposed bone ends
7. Joint locked in position – reduces
motor ability or reduced ability to
articulate a joint
8. Numbness or paralysis – may
occur distal to site of injury caused
by bone pressing on a nerve
 MUSCULOSKELETAL
INJURIES MANAGEMENT

RICES
is an effective procedure used in the initial
treatment of a soft tissue injury.
R - est
I - ce
C - ompression
E – levation
S - Splinting
SPLINTING
 SPLINTING

- Used to stabilize a
broken bone while
the injured person
is taken to the
hospital for more
advanced treatment
 BASIS FOR SPLINTING

Reasons:
1. Prevent movement of any fragments, bone
ends or dislocated joints (reduce farther
injury)
2. Reduce pain & minimize the following
common complications from bone to joint
injuries:
 BASIS FOR SPLINTING

Reasons:
a. Damage to muscles, nerves & blood
vessels
b. Conversion of a closed deformed
extremity
c. Restriction of blood flow as a result of
bone ends or dislocations
d. Excessive bleeding from tissue
damage
 BASIS FOR SPLINTING

Reasons:
3. To prevent closed fracture from becoming
an open fracture
4. To minimize blood loss or shock.
SPLINTING EQUIPMENT

Rigid Splint - WOOD SPLINT

made of wood,
aluminum wire,
plastic, cardboard
or compressed
ALUMINUM PADDED WIRE
wood fibers

CARDBOARD
SPLINTING EQUIPMENT

PRESSURE
SPLINT – is an air
splint. It is soft and
pliable before
being inflated but
rigid once they are
applied and filled
with air.
 SPLINTING EQUIPMENT

TRACTION
SPLINT – use in
broken femur.
Provide counter-full,
alleviating pain,
reducing blood loss
and minimizing
further injury
 SPLINTING EQUIPMENT

IMPROVISED
SPLINT - made of
cardboard box,
cane, ironing board,
rolled-up magazine,
umbrella, broom
handle and any
other similar object
 SPLINTING EQUIPMENT

CONFORMING/FO
RMABLE SPLINT-
can be molded to
different angles
commonly used for
joint injuries(for
improvised - pillow,
blanket)
SPLINTING EQUIPMENT

SLING and SWATHE – two triangular

bandages used to hold an injured arm in
place against the body)

SLING SPLINT SLING AND SWATHE SPLINT

 GENERAL RULE FOR
SPLINTING

Always communicate your plans with your

patient if possible.
Before immobilizing an injured extremity,
expose and control bleeding.
Always cut away clothing around the
injury site before immobilizing the joint.
Remove all jewelry from the site and
below it.
 GENERAL RULE FOR
SPLINTING

Assess P.M.S. (pulse, motor function and

sensation)
Do not attempt to push protruding bone
ends back into place.
Pad a splint before applying it.
If joint is injured, immobilize it and the
bones above and below.
 DISLOCATION OF THE
SHOULDER
• Most commonly dislocated
large joint
• Usually dislocates anteriorly
• Is difficult to immobilize
• Splint the joint with a pillow
or towel between the arm
and the chest wall.
• Apply a sling and a swathe.
 CLAVICLE AND
SCAPULAR INJURIES

• Splint with a sling and swathe

 FRACTURES OF THE
HUMERUS

 Occurs either
proximally, in the mid-
shaft, or distally at the
elbow.
 Splint with sling and
swathe, supplemented
with a padded board
splint.
 ELBOW INJURIES
 Fractures and dislocations often occur
around the elbow.
 Injuries to nerves and blood vessels
common.
 Assess neurovascular function carefully
 FRACTURES OF THE
FOREARM
 Usually involves both radius and ulna
 Use a padded board, air, vacuum, or
pillow splint.
INJURIES TO THE WRIST
AND HAND
 INJURIES OF KNEE
LIGAMENTS
 Splint in position found.
 Support with pillows.
INJURIES TO THE TIBIA
AND FIBULA

Stabilize with a
padded rigid long
leg splint or an air
splint that extends
from the foot to
upper thigh.
 FOOT STABILIZATION

A pillow splint can provide excellent

stabilization of the foot.
V. BLEEDING AND SHOCK

GERMAINE FAY M. RAMIREZ, RN, EMT-B

Special Operations Officer III
MMDA - Public Safety Division
 BLEEDING
Blood escaping from the circulatory
system from damaged blood vessels.
 It can be external and internal.
 EXTERNAL BLEEDING
- when blood is leaving the body through some
type of wound.
- Any incident in which you physically saw blood
would be an external bleed.
- severity of sudden loss of blood that are serious:
ADULT - more than 1000 cc
(1 liter)
CHILDREN – 500 cc (1/2 liter)
INFANT – 100 TO 200 CC
T YPES OF EXTERNAL
BLEEDING
INTERNAL BLEEDING

It is not visible and seldom obvious and can

result to severe blood loss with rapid
progression of shock and even death.

SOURCES: injured or damaged internal

organs and fracture extremities especially
femur, hip and pelvis
INTERNAL BLEEDING

CAUSE: Blunt trauma, abnormal clotting within

the body, result of certain fractures especially
pelvic fracture.

SEVERITY: depends on the patient’s overall

condition, age, other medical condition and the
source of internal bleeding
 SIGN AND SYMPTOMS OF
INTERNAL BLEEDING
• Pain, tenderness, swelling or
discoloration of suspected site
or injury
• Bleeding from the mouth,
rectum, vagina other orifice
• Vomiting bright red blood or
like color of dark coffee
grounds
• Dark, tarry stools or stools with
bright red blood
• Tender, rigid and/or distended
abdomen
LATE SIGN AND SYMPTOMS
OF INTERNAL BLEEDING

• Anxiety, restlessness, combativeness or

altered mental status
• Weakness, faintness or dizziness
• Thirst
• Shallow, rapid breathing
• Rapid, weak pulse
LATE SIGN AND SYMPTOMS
OF INTERNAL BLEEDING

• Pale, cool, clammy skin

• Capillary refill greater that 2 seconds (in
infants and children under 6 only)
• Dropping blood pressure
• Dilated pupils that are sluggish in
responding to light
• Nausea and vomiting
 INTERNAL BLEEDING

CLOSED FRACTURE OF
FEMUR– can cause one (1)
liter blood loss

LACERATION TO THE
LIVER OR SPLEEN – can
cause severe loss of blood,
potentially fatal
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE

ENSURE YOUR OWN SAFETY

 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE

A – ALERT CALL 911

 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE

B – BLEEDING
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE

C – COMPRESS
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE
Direct Pressure on a Wound
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE
Applying a Tourniquet
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE
Wound Packing and Direct Pressure
SUMMARY PRIMARY PRINCIPLE
OF TRAUMA CARE RESPONSE
 SHOCK

failure of the circulatory system to

provide adequate blood supply
throughout the body (inadequate tissue
perfusion).
CAUSES OF SHOCK

- Inability of the heart to pump enough

blood through the organs
- Severe loss of blood; insufficient blood
in the system
- Excessive dilation of blood vessels.
Blood volume will be insufficient to fill
them and shock will develop
 SIGN OF SHOCK

Breathing: Shallow and rapid

Pulse: Rapid and Weak
Skin: Pale, cool and clammy
Face: Pale, often with blue
color(cyanosis) in the lips,
tongue,and ear lobes
Eyes: Lacklustre, pupils dilated
 SYMPTOMS OF
SHOCK
Nausea and possible vomiting
Thirst
Weakness
Vertigo – a dizzy confused state of mind
Uneasiness and fear – some patients
these symptoms can be the first sign of
shock.
 MANAGEMENT FOR
SHOCK

Maintain open airway

Prevent further loss of blood (by using
direct pressure, elevations and
pressure points)
Elevate the lower extremities 20-30 cm
only if there are no suspected spinal,
neck, chest or abdominal injuries.
 MANAGEMENT FOR
SHOCK

Keep the patient warm, but not

overheat.
Provide care for specific injuries.
Transport immediately to nearest
capable hospital.
VI. PATIENT ASSESSMENT

RICHARD VILLACERAN, RN, EMT-B

Special Operations Officer III
MMDA - Public Safety Division
PATIENT ASSESSMENT
PROCESS
 PATIENT ASSESSMENT PLAN
SCENE SIZE UP INITIAL PHYSICAL PATIENT ON GOING PATIENT’S HAND
ASSESSMENT EXAM. HISTORY ASSESSMENT OFF
What is the current General DCAP-BTLS/ SAMPLE Repeat Initial Patient age and
situation? impression DOTS Assessment sex
•MOI/NOI
•Observe for
hazards
Where is it going? Responsivenes Head Signs & Repeat physical Chief complaint
•What are the s Symptoms assessment
possibilities?
How do I control it? Airway Neck Allergies Reassess treatment Level of
•What are the and intervention responsiveness
resources needed?
Breathing Chest & Back Medications Calm and reassure Airway status
the patient
Circulation Abdomen Past History Breathing status
Patient Status Pelvis Last Oral Physical exam
Update Intake findings
Extremities SAMPLE History
Vital Signs Event Treatment
TRAUMA PATIENT
ASSESSMENT
MEDICAL PATIENT
ASSESSMENT
THANK YOU VERY MUCH…