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Introduction To TCCC

This document provides an overview of tactical combat casualty care (TCCC) including its history, principles, and phases of care. TCCC was established in 2001 as a Special Operations research project to develop prehospital trauma guidelines for tactical environments. The goals of TCCC are to treat the casualty, prevent additional casualties, and complete the mission, with an emphasis on treating life-threatening hemorrhage as the primary threat.

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Steve Fetalino Demaala

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100% found this document useful (1 vote)

197 views

Introduction To TCCC

Uploaded by

Steve Fetalino Demaala

Available Formats

Download as PDF, TXT or read online on Scribd

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INTRODUCTION TO TCCC

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OVERVIEW

• History of TCCC
• Principles of TCCC
• Phases of TCCC

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LEARNING OBJECTIVES
Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

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HISTORY OF TCCC

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HISTORY OF TCCC

• Committee on Tactical Combat Casualty Care

(CoTCCC)
– Established 2001
– Originally a Special Operations research project

• TCCC Guidelines
– Published every 4 years in Prehospital Trauma Life
Support manual
– National Association of Emergency Medical
Tehcnicians posts updates on their website as they
are approved

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HISTORY OF TCCC

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PRINCIPLES OF TCCC

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PRINCIPLES OF TCCC
• Fundamentally different than civilian medicine
– Unique wounds
– Tactical conditions

• “Good medicine may be bad tactics”

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PRINCIPLES OF TCCC
• Three primary goals:

1) Treat the casualty

2) Prevent additional casualties
3) Complete the mission

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PHASES OF TCCC

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PHASES OF TCCC
• TCCC is divided into three distinct care phases:

1) Care Under Fire

2) Tactical Field Care
3) Tactical Evacuation Care

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CARE UNDER FIRE
• Care rendered at the scene while Corpsman and
casualty are still under effective fire
– Point of injury
– On the “X”

• Risk of additional casualties is extremely high

• The best medicine is fire superiority. The need for

medical care must be weighed against the need to
move to cover and to suppress hostile fire rapidly

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CARE UNDER FIRE
• Self Aid/Buddy Aid
– Is the casualty conscious?
– Can the casualty return fire?
– Can the casualty treat themselves?
– Can the casualty move to you?

• Tourniquets for life-threatening extremity

hemorrhage are the ONLY intervention used during
this phase

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TACTICAL FIELD CARE
• Corpsman and casualties are no longer under
effective enemy fire

• Time to reassess interventions and fully assess the

casualty

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TACTICAL FIELD CARE
PRIORITIES OF TACTICAL FIELD CARE
• Disarm all casualties with altered mental status
• Obtain airway
• Asses and treat external hemorrhaging
• Manage shock/fluid resuscitation
• Hypothermia prevention
• Pain relief/antibiotics

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TACTICAL FIELD CARE
• M – Manage and treat external hemorrhage

• A – Airway assessment

• R – Respiratory trauma assessment

• C – Circulation assessment

• H – Head trauma assessment & Hypothermia

prevention/management

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TACTICAL EVACUATION CARE
• Casualties are being transported to a higher
echelon of care

• Encompasses both medical

evacuation (MEDEVAC) and
casualty evacuation (CASEVAC)

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TACTICAL EVACUATION CARE
• MEDEVAC
– Dedicated medical platforms
– Crewed by medical personnel

• CASEVAC
– Armed assets with no Red Cross markings
– Point of injury to first MTF

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INTRODUCTION TO TCCC

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MANAGE
SHOCK
CASUALTIES

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OVERVIEW

• Cardiovascular System Terminology

• Anatomy Cardiovascular System
• Types of Shock
- Signs & Symptoms
- Treatment

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LEARNING OBJECTIVES
Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

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TERMINOLOGY

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TERMINOLOGY
• Overview
• Shock is regarded as a state of generalized cellular
hypoperfusion in which delivery of oxygen to the cells is
inadequate to meet metabolic needs.

• There is no laboratory test to diagnose shock.

• The initial step is to recognize its presence.

• By far, the most common cause of shock in the trauma

casualty is hemorrhage.

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TERMINOLOGY

• Systolic Blood Pressure

– force of the blood against vessels produced
by ventricular contraction
– Normal Systolic BP = 120 –140 mmHg

• Diastolic Blood Pressure

– pressure in vessels while the heart is at rest
– Normal Diastolic BP = 60 – 80 mmHg

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MEDICAL TERMINOLOGY

• Preload
– amount of blood returning into the heart from the
systemic circulatory system (venous return)
• Afterload
– resistance to blood flow the heart must overcome to
pump blood
• Stroke Volume
– amount of blood pumped by the heart with each
contraction
• Capillary Refill Test
– Indicative of tissue perfusion
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TERMINOLOGY
• Nervous System (2 components)
– Sympathetic
• Fight or flight response
• Goal is to maintain sufficient amount of
oxygenated blood to critical areas

– Parasympathetic
• Rest and digest
• Maintains normal body functions

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TERMINOLOGY
• Metabolism
– Aerobic Metabolism
• Body’s principle energy process
• Uses oxygen as power source

– Anaerobic Metabolism
• Back-up power system
• Uses stored body fat

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CARDIOVASCULAR ANATOMY

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CARDIOVASCULAR ANATOMY
• Shock occurs from failure of any one or more
of the cardiovascular components:

– Pump: Heart

– Fluid: RBC, WBC, Platelets

– Container: Arteries, Veins,
and Capillaries

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TYPES OF SHOCK
3 Types of Shock
1- Hypovelemic
2- Distributive
3- Cardiogenic

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HYPOVOLEMIC SHOCK

• Definition: Loss of body fluids from dehydration,

burns, or hemorrhage. The container has
retained its normal size but the fluid volume is
decreased.

• Hemorrhagic shock is the most common form of

hypovolemic shock in a tactical situation.

• On the battlefield, assume all shock, until proven

otherwise, is hemorrhagic shock.

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HYPOVOLEMIC SHOCK
• Signs and Symptoms
– Signs and symptoms of hemorrhagic shock
are linked to the amount of blood lost and the
body’s reaction to it.
– DO NOT rely on B/P as the primary
indicator
– To accurately assess for shock, pay close
attention to:
• Mental status of casualty
• Quality of distal pulses
• Heart rate
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HYPOVOLEMIC SHOCK

Hemorrhagic shock can be

divided into four classes:

Class I Shock
Minimal affects, no significant
clinical findings
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HYPOVOLEMIC SHOCK

• Class II Shock
– Casualty getting worse
– Breathing faster, heart beating faster
– Compensatory mechanisms are able to
maintain B/P and perfusion

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HYPOVOLEMIC SHOCK

• Class III Shock

– Unfavorable signs begin to appear
– The body can not maintain adequate perfusion
– Casualty is in significant trouble

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HYPOVOLEMIC SHOCK

• Class IV Shock
– Severe stage of shock
– Even though blood volume may be restored
and vital signs stabilized, death is imminent, if
you don’t act quickly.
– Survival depends on immediate hemorrhage
control and aggressive resuscitation. May not
be able to do in tactical situation.

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HYPOVOLEMIC SHOCK
• Treatment
– STOP THE BLEEDING !!!!
- LIFE THREATENING extremity hemorrhage, use
tourniquet and/or hemostatic agents
- LIFE THREATENING non-extremity hemorrhage,
use direct pressure
– Consider IV and fluid resuscitation
• Remember- only ¼-⅓ of an isotonic crystalloid
remains in the intravascular space 30-60 minutes
after infusion.

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DISTRIBUTIVE SHOCK

• Definition: Shock that occurs when blood

vessels enlarge without an increase in
fluid volume.

• Causes: Spinal cord trauma, fainting,

severe infections, and allergic reactions.

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DISTRIBUTIVE SHOCK

3 different types:
- Septic
- Neurogenic
- Psychogenic

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SEPTIC SHOCK
• Cause
– Severe, life threatening bacterial infection
– Toxins cause blood vessels to dilate and
plasma is lost through vessel walls, causing a
loss in volume
– Usually seen 5 – 7 days after initial trauma, so
your focus is on prevention rather than
treatment

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SEPTIC SHOCK
• Signs and Symptoms
– Hypotension
– Fever
– Cold, clammy skin
– Pale, mottled skin color
– Altered LOC
– Slowed CAP refill

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SEPTIC SHOCK
• Treatment
– Usually performed at higher level of care
– Priority should be on TACEVAC
– IV fluid therapy
– IV antibiotic therapy (directed by MO)

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DISTRIBUTIVE SHOCK

3 different types:
- Septic
- Neurogenic
- Psychogenic

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NEUROGENIC SHOCK

• Definition: Failure of the nervous system to

control blood vessel diameter. Results in
significant dilation of peripheral arteries.

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NEUROGENIC SHOCK
• Causes
– Brain or spinal cord injuries

• Signs & Symptoms

Bradycardia and
– Slow Heart Rate hypotension not usually
– Dry and warm skin seen together so use this
– Hypotension as a red flag!

– Injuries consistent with spinal injury

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NEUROGENIC SHOCK
• Treatment
– Maintain ABC’s
– Spinal Immobilization
– O2 therapy (if available)
– Fluid resuscitation
– Trendelenburg position
– Keep patient warm
– TACEVAC

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DISTRIBUTIVE SHOCK

3 different types:
- Septic
- Neurogenic
- Psychogenic

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PSYCHOGENIC SHOCK
• Stimulation of the 10th Cranial nerve (Vagus Nerve)
• AKA – vasovagal syncope or fainting
• Condition is considered temporary and self-
correcting

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PSYCHOGENIC SHOCK
• Causes
– Fear
– Bad or upsetting news
– Sight of blood or trauma

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PSYCHOGENIC SHOCK
• Signs and Symptoms
– Fainting
– Cool, clammy skin
– Weakness
– Altered LOC
– Hypotension (briefly)

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PSYCHOGENIC SHOCK
• Treatment
– Usually self limiting condition
– Place patient in a horizontal position

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CARDIOGENIC SHOCK
• Shock caused by failure of heart to pump
blood throughout the body. There is
enough fluid (blood) filling the pump but
there is something wrong with the pump.

• Causes may be:

• Intrinsic (internal causes)
• Extrinsic (external causes)

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CARDIOGENIC SHOCK
• Intrinsic Causes
– Myocardial Infarction
– Blunt injury to the heart

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CARDIOGENIC SHOCK
• Signs and Symptoms

– Abnormal pulse rate/rhythm

– Chest pain

– Shortness of Breath

– Nausea and Vomiting

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CARDIOGENIC SHOCK
• Treatment

– Maintain ABC’s

– Obtain IV access

– Oxygen therapy (if available)

– CASEVAC

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CARDIOGENIC SHOCK
• Extrinsic Causes
– Tension Pneumothorax
– Cardiac Tamponade

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CARDIOGENIC SHOCK
• Tension Pneumothorax signs and symptoms

– Obvious chest trauma

– SOB

– Tachycardia

– Cyanosis

– Absent lung sounds on affected side

– JVD/Tracheal deviation (late sign)

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CARDIOGENIC SHOCK
• Cardiac Tamponade signs and symptoms
– Chest trauma
– SOB/Dyspnea
– Tachycardia
– Cyanosis
– Distant heart tones
– Narrowing pulse pressure

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CARDIOGENIC SHOCK
• Treatment
– Maintain ABC’s
– O2, if available
– CASEVAC
– Needle Thoracentesis (for tension
pneumothorax)

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VOLUME RESUSCITATION
Beneficial when three conditions exist:
1. The casualty is bleeding at a rate of 25-
100ml/ min.
2. The fluid administration rate is equal to the
bleeding rate.
3. The scene time and transport time exceed
30 minutes
– NEVER delay transport to start an IV

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VOLUME RESUSCITATION

You will receive training on the type of

vascular access to start and the type of
fluids to give in the lesson on
Tactical Fluid Resuscitation

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MANAGE
SHOCK
CASUALTIES

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MANAGE HEMORRHAGE

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OVERVIEW

• Types of Hemorrhage
-Signs and Symptoms of External and Internal Hemorrhage
• Estimating Blood Loss
• Methods of Hemorrhage Control
• Tourniquet Application

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LEARNING OBJECTIVES

Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

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BACKGROUND

• Historically, 20% of injured combatants die

on the battlefield

• In Vietnam, over 60% died from bleeding

out within 3 to 5 minutes.

Notice how strong flow is.

This is a small, surgically induced bleed.
Imagine how fast a big hole would bleed!

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BACKGROUND

• Many of these deaths could have been

prevented with timely intervention.

• To decrease these statistics, you must be

able to rapidly identify and manage
hemorrhage.

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TYPES OF HEMORRHAGE

• Loss of blood from damaged vessels is a

large source of external hemorrhage in
combat
– Arterial - Bright red blood, spurting
– Venous - Dark red, steady even flow
– Capillary - Brick red, oozing

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EXTERNAL HEMORRHAGE

• Easy to recognize: blood everywhere

• Causes
– Penetrating wounds
• Gunshot, stab and shrapnel wounds
– De-gloving wounds
• Vehicle accidents
– Amputating wounds
• Blasts from artillery, mortars
or landmines

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EXTERNAL HEMORRHAGE

• You must determine which bleeding is

LIFE-THREATENING and which is non-life
threatening.

– This depends on the amount of blood loss

and the class of shock of the patient.

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SIGNS & SYMPTOMS

• External Hemorrhage
– Massive blood loss
– Obvious signs and symptoms of shock

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INTERNAL HEMORRHAGE

• Harder to recognize, can’t visually see it

• Frequent cause of death
• Indications: bleeding from mouth, rectum,
or blood in the urine
• Requires surgical intervention
• Treat and TACEVAC

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INTERNAL HEMORRHAGE

• Causes
– Blunt trauma
– Concussion injuries from blasts
– Vehicle accidents
– Falling from heights
– Closed fractures

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SIGNS & SYMPTOMS

• Internal Hemorrhage
– Hematemsis – Rapidly forming
– Hemoptysis hematoma and
– Hematochezia edema
– Melena – Signs of shock
– Hematuria
– Ecchymosis
– Rigid abdomen

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ESTIMATING BLOOD LOSS (EBL)

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ESTIMATE BLOOD LOSS (EBL)

• Why is determining EBL important?

– Average adult blood volume = approx. 5 liters

– Loss of 25% to 40% = Life Threatening

Condition

– Helps to predict who will go into or be in

shock

– Identifies who to treat first

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ESTIMATE BLOOD LOSS (EBL)

• How to determine EBL:

– Look for blood surrounding patient
– Inspect clothing for blood saturation
– Inspect bandage saturation
– Determine level of shock

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ESTIMATE BLOOD LOSS (EBL)

Small Battle Medium Large Battle Abdominal

Dressing Battle Dressing Battle Dressing
Dressing

Amount of
estimated 300 ml 750 ml 1000 ml 2500 ml
blood

EBL About About

About 6% About 20%
15% 50%
*Amounts are based on the average adult blood volume of about 5 liters.

Massive hemorrhage may be fatal within 60 -120 seconds.

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METHODS OF HEMORRHAGE
CONTROL

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DIRECT PRESSURE

• Initial control measure (unless in Care

Under Fire Phase)
• Will control most types of hemorrhage
• Requires two hands and lots of pressure
to be done right
• You can convert it to a pressure
dressing

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BANDAGES AND DRESSINGS

• Any material applied

to hold a dressing in
place, wrap or bind a
body part

• Provides additional
pressure to dressing

• Protects the dressing

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BANDAGES AND DRESSINGS

• Ensure dressing is tight enough

• Provide pressure over the entire wound

• Dressing must cover the entire wound,

bandage must cover the entire dressing

• Leave fingers and toes exposed

• Assess circulation using PMS

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PRESSURE DRESSING

• If hemorrhage continues
– DO NOT remove the first dressing
– Apply a second dressing over the first
• If hemorrhage still cannot be controlled:
- Use a tourniquet!
• Once hemorrhage is controlled, cover the
entire dressing with a bandage

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KERLIX

• Advantages
– Absorbency
– Stretchable
– Sterile
– Packs well
• Disadvantages
– Loses bulk
– Catches debris
– Snags easily
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ACE WRAP

• Advantages
– Quickly applied
– Pressure to entire
area
– Excellent support
• Disadvantages
– Decrease peripheral
circulation

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CRAVATS

• Advantages
– Versatile
– Small packaging
– Can be used as a
tourniquet
• Disadvantages
– Very little
absorbency

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COMBINATION: DRESSING/BANDAGE

• Cinch Tight
– Found in the IFAK

– Medium to large
battle dressing
combined with a 4
inch ace wrap

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“H” BANDAGE

• Found in the IFAK

• It is a medium to
large battle
dressing combined
with a 4 inch wide
Ace Wrap.
• Has a distinctive
“H” on dressing to
help apply pressure

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FIELD EXPEDIENT DRESSINGS

• Patient clothing
• Patient equipment
• Anything else available to you
• The only limitation is YOUR imagination!

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HEMOSTATIC AGENTS

• A hemostatic agent causes the wound

to develop a clot that stops the flow of
blood and will remain within the wound
until removed by medical personnel.

• The only hemostatic agent approved

by the CoTCCC is QuikClot Combat
Gauze.

• QuikClot Combat Gauze is the first-

line treatment of life threatening
hemorrhage in a tactical setting that is
not amenable to tourniquet placement.

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HEMOSTATIC AGENTS

COMBAT GAUZE
• Combines surgical gauze with an
inorganic material that stops arterial and
venous bleeding in seconds.
• Does not create heat
• Is non-allergenic
• Fits any size or shape wound
• Rolls are 4 yards long by 3” wide

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COMBAT GAUZE

• Application Procedures
– Expose injury
– Remove excess blood; preserve any clots
– Locate source of most active bleeding
– Remove Combat Gauze from package
– Pack tightly into wound
– May be re-packed or adjusted to ensure
proper placement

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COMBAT GAUZE

• Application Procedures (cont.)

– Apply enough direct pressure to stop bleeding
– Hold pressure for a minimum of 3 minutes
_ Once applied Combat Gauze will be removed
by authorized medical personnel only
_ Can be reinforced with an additional roll if
bleeding continues
– Leave in place and secure with pressure
dressing
– Document, place empty package near wound,
and transport the patient

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TOURNIQUETS

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TOURNIQUET APPLICATION

• In Care Under Fire, A TOURNIQUET IS THE

FIRST OPTION for controlling life-threatening
extremity hemorrhage. Place the tourniquet
tightly over the uniform, proximal to the
wound.
– It can be properly placed during Tactical Field
Care.

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CAT TOURNIQUET

• Tourniquet of choice is the Combat Application

Tourniquet (CAT)
• Issued upon deployment
• Lightweight and easy to use, even on yourself
• Beware of
counterfeit!

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SOF-T TOURNIQUET

• 1-1/2 inch constriction band

• Aluminum windlass rod
• Applied the same way, regardless of location

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FIELD EXPENDIENT TOURNIQUET

GOOD BAD

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TOURNIQUET POINTERS

– Do NOT place over a joint

– Do NOT place over two bones (tib/fib,
radius/ulna)
– Do NOT cover with dressing, blanket,
clothing, etc., leave exposed

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APPLICATION TIGHTNESS

• The bigger the extremity, the tighter it needs to be.

• May need multiple tourniquets
• Don’t stop tightening when the casualty complains
it hurts but when hemorrhage is controlled.
• Consider use of pain medications
• Mark the casualty
• Do NOT cover the tourniquet after application.
Leave it exposed to ease monitoring.

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TOURNIQUET TO A DRESSING

Tourniquet use is the first line of hemorrhage control

while in the Care Under Fire Phase.

Only when in the Tactical Field Care Phase should

you even consider converting a tourniquet to a
pressure dressing.

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TOURNIQUET TO A DRESSING

Do NOT convert a tourniquet to a pressure dressing

under the following conditions:
• The casualty is in Class III or IV shock

• There has been a complete amputation below the tourniquet.

• There is no one to monitor the casualty for re-bleeding.

• Tourniquet has been in place for more than 6 hours.

• Short transport time to surgical intervention.

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DEMONSTRATION

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PRACTICAL APPLICATION

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CTPS LAB

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MAINTAIN AIRWAY

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OVERVIEW

• Terminology
• Anatomy
• Signs & Symptoms
• Treatments

FMST 404
LEARNING OBJECTIVES
Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

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TERMINOLOGY

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TERMINOLOGY
• PHARYNX – Muscle lined with mucous running
from the back of the soft palate to the upper end
of the esophagus; Divided into three sections:
– Nasopharynx
– Oropharynx
– Hypopharynx

• NASAL SEPTUM – Separates left and right

airways of nose

• NARES – External openings of nasal cavity

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TERMINOLOGY
• LARYNX (voicebox) – Cartilaginous box located
above the trachea, containing vocal cords and
muscles that make them work

• EPIGLOTTIS – Leaf-shaped structure that acts

like a gate, directing air into the trachea and
solids/liquids into the esophagus.

• TRACHEA (windpipe) – Main trunk of the

system of tubes air passes to and from the
lungs.
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ANATOMY

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ANATOMY
• Upper Airway
– Consists of nasal cavity and oral cavity

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ANATOMY

• Lower Airway
– Trachea
– Branches
– Lungs

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SIGNS & SYMPTOMS

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SIGNS & SYMPTOMS

• Decreased Neurological Function

• Mechanical Obstruction

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SIGNS & SYMPTOMS

• Decreased LOC
– Affects ventilatory drive
• Flaccidity of the
tongue
– Occludes hypopharynx
– Most common obstruction

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SIGNS & SYMPTOMS

• Mechanical
obstructions
– Foreign bodies
• Teeth
• Gum
• Chewing tobacco
• Blood
• Vomit
– Outside materials

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SIGNS & SYMPTOMS

• Assessment of the Airway

– Look for obvious injuries; talk to casualty
• Talking suggests open airway
– Be aware of LOC when PT is in supine
– PT may need to remain in position found to
avoid aspiration

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SIGNS & SYMPTOMS

Conduct a physical examination:

• Look

• Listen

• Feel, Feel

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SIGNS & SYMPTOMS
Look:
• Look at the face, lips, nose and neck of the casualty
- Cyanosis/edema
- Obvious injuries
- Blood/debris
• Open and look into the mouth for foreign objects or deformities
- Teeth
- Tobacco/food
- Debris
• Look for bilateral, normal chest rise and fall
- Unilateral chest rise/fall
- Paradoxical movement
• Look for use of accessory muscles and increased work of
breathing
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SIGNS & SYMPTOMS

Listen:
• Listen for presence/absence of breath sounds
- Basic quality
- Tachypnea/bradypnea
- Rhythm/depth

•Listen for any sounds signaling upper airway

compromise
- Tongue
- Blood/vomit
- Foreign bodies

• FMST 404
SIGNS & SYMPTOMS

Feel, Feel:

• Place hand on casualty’s chest and lower ear to

mouth

• Feel for warm breath against your face/ear

• Feel for chest rise and fall with hand

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SIGNS & SYMPTOMS

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TREATMENTS

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TREATMENTS

Manual Clearing of Airway

• Visual inspection

• Finger sweep (if visible)

• Position patient on side to allow gravity

assisted clearing of airway

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TREATMENTS

Manual Maneuvers
• The tongue is connected to the mandible
moves forward with it

• 2 Methods:
• Trauma Jaw Thrust

• Trauma Chin Lift

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TREATMENTS

Nasopharyngeal Airway (NPA)

• Soft, rubberlike device inserted through one of
the nares

• Used on conscious/unconscious casualties

unable to maintain their own airway

• Must be long enough to bypass

tongue in order to be effective

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TREATMENTS

King Laryngeal Tracheal Tube (King LT)

• Single lumen, blindly inserted airway created as
an alternate to tracheal intubation or mask
ventilation, resulting in minimal airway trauma

• Used only on unconscious patients, as the gag

reflex may cause vomiting

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MAINTAIN AIRWAY

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EMERGENCY CRICOTHYROIDOTOMY

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OVERVIEW

• Anatomical Landmarks
• Indications
• Proper Equipment
• Procedural Steps
• Complications

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LEARNING OBJECTIVES

Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

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ANATOMICAL LANDMARKS

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ANATOMICAL LANDMARKS

• TRACHEA
– Windpipe

• THYROID
CARTILAGE
– Adam’s Apple
– Located in upper
part of throat
– More prominent in
men

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ANATOMICAL LANDMARKS

• CRICOID CARTILAGE
– ¾ inch inferior to thyroid
cartilage
– Framework of the larynx
• CRICOTHYROID
MEMBRANE
– Soft tissue between
thyroid cartilage and
cricoid cartilage
– Only covered by skin

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ANATOMICAL LANDMARKS

• CAROTID ARTERIES
– Two principal arteries of the neck

• JUGULAR VEINS
– Two principal veins of the neck

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ANATOMICAL LANDMARKS

• ESOPHAGUS
– Tube extending downward
from pharynx to stomach
– Lies posterior to the trachea

• THYROID GLAND
– Located in front of the lower
part of the neck on each
side of the trachea

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ANATOMICAL LANDMARKS

Jugular Vein

Thyroid Cartilage
Cricothyroid Membrane
Cricoid Cartilage

Carotid Artery
Thyroid Gland

Trachea

FMST 405
FMST 405
INDICATIONS

FMST 405
INDICATIONS

• Definition of Emergency Cricothyroidotomy

– An emergency surgical procedure where an
incision is made through the skin and
cricothyroid membrane.
– Allows for the placement of an airway into the
trachea when other methods of airway
management are not possible

FMST 405
INDICATIONS

• Obstucted airway:
– Facial and oropharyngeal edema from
severe trauma
– Foreign objects

• Congenital deformities that inhibit

intubation

FMST 405
INDICATIONS

• HEAD AND NECK TRAUMA

– Facial and oropharyngeal edema
– Facial fractures
– Nasal fractures
– Cribriform fractures
• C-SPINE FX
• LAST RESORT
• CONTRAINDICATIONS
– Massive trauma to larynx

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FMST 405
PROPER EQUIPMENT

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PROPER EQUIPMENT

• Scalpel with no. 10 blade

• Antiseptic (alcohol or Providone Iodine)
• 6-7 mm endotracheal tube /10cc syringe
• Tape
• Instrument to expose/define opening
• Gauze (petroleum and sterile)
• BVM and oxygen source
* Most items are contained in the Cric Kit
in the Corpsman Assault Pack*
FMST 405
PROPER EQUIPMENT

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PROCEDURAL STEPS FOR
EMERGENCY CRICOTHYROIDOTOMY

FMST 405
PROCEDURAL STEPS

(1) Assess the patient

(2) Gather equipment
(3) Prepare and Position Patient
• Supine position
• Cleanse site with alcohol or betadine swabs
• Stand to one side of the patient

(4) Locate cricothyroid membrane

FMST 405
PROCEDURAL STEPS

(5) Make Incision

– Vertical incision through the skin about 1 inch
long over the cricothyroid membrane
– Visualize the cricothyroid membrane
– Horizontal incision through the membrane
• DO NOT make incision more than 1/2 inch deep or
you may perforate the esophagus.

FMST 405
PROCEDURAL STEPS

(6) Open the Incision

– Use tracheal hook or hemostats

(7) Insert Tube

– Lubricate and insert tube
– No more than 3-4 inches
– Inflate balloon with 10cc of air

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PROCEDURAL STEPS

(8) Check for proper placement

– Connect to Oxygen Supply (if available)
– Connect BVM
– Check for breath sounds
– Constantly recheck for breath sounds
• If breath sounds are absent on the LEFT side only, tube
should be pulled back
(9) Secure Dressing
– Secure with ribbon and/or tape
– Apply petroleum gauze followed by sterile gauze
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PROCEDURAL STEPS
(10) Monitor patient
– Continuously reassess
– 1 breath every 5 seconds

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FMST 405
ASSOCIATED COMPLICATIONS

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COMPLICATIONS

• Hemorrhage (MOST COMMON)

– Causes
• Minor lacerations of superficial capillaries
• Major lacerations of major vessels
– Treatment
• Minor Bleeding – direct pressure and
dressing
• Major Bleeding – same as minor, if unable
to control bleeding the vessel may need to
be tied off.
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COMPLICATIONS

• ESOPHAGEAL PERFORATION – creating

a hole between esophagus and trachea
– Causes
• Incision too deep
• Forcing tube through trachea

– Treatment
• Requires surgical intervention
• TACEVAC to higher level of care

FMST 405
COMPLICATIONS
ESOPHAGEAL PERFORATION

E
T

Tube entered through • “T” indicates trachea

wound into esophagus • “E” indicates esophagus
FMST 405
COMPLICATIONS

• SUBCUTANEOUS EMPHYSEMA –
presence of free air or gas in the subcutaneous
tissue, crackling sensation when palpated
– Causes
• Incision too wide
• Air leaking out of insertion site

– Treatment
• None necessary
• Resolves spontaneously
• Use petroleum gauze to help reduce incidence

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FMST 405
DEMONSTRATION

FMST 405
FMST 405
PRACTICAL APPLICATION

FMST 405
FMST 405
EMERGENCY CRICOTHYROIDOTOMY

FMST 405
MANAGE RESPIRATORY TRAUMA

FMST 406
OVERVIEW

• Terminology
• Anatomy
• Respiratory Trauma
• Needle Thoracentesis

FMST 406
LEARNING OBJECTIVES
Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

FMST 406
FMST 406
TERMINOLOGY

FMST 406
TERMINOLOGY

• DYSPNEA - Difficult or labored breathing

• WHEEZE - High pitched whistling sound that is caused
by movement of air through a narrowed airway
• STRIDOR - A harsh shrill respiratory sound produced
from the obstruction of the laryngeal area
• HYPERVENTILATION - Increase in the rate and depth
of respiration causing a increase in O2 and a decrease
in CO2
• HYPOVENTILATION - Loss of ventilation drive (TBI).
Upper or lower airway obstruction, and decreased
expansion of the lungs.
FMST 406
TERMINOLOGY

• TACHYPNEA - Abnormally excessive, rapid rate of

respirations (>20 BPM)

• BRADYPNEA – Abnormally slow rate of respiration (<8

BPM)

• HYPOXIA - Insufficient concentration of O2 in the tissue in

spite of an adequate blood supply

• HYPOXEMIA – Decreased level of O2 in the bloodstream

• APNEA - Total cessation of breathing, also known as a

respiratory arrest

FMST 406
TERMINOLOGY

• SUBCUTANEOUS EMPHYSEMA - Presence of air or a

gas in the subcutaneous tissues around the face, neck,
and/or the chest

– Skin may appear swollen and makes a CRACKLING

sound when palpated
– Sounds and feels like RICE CRISPIES

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FMST 406
ANATOMY

FMST 406
ANATOMY
• Thorax (Chest Cavity)
– Protected by a bony cage formed by the:
• Sternum
• Costal cartilages
• Ribs
• Vertebrae

FMST 406
ANATOMY

• THORAX (Chest Cavity)

– Diaphragm
• Primary muscle of respiration

• Inferior border of the chest cavity

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ANATOMY

• PLEURA
– Thin membranes separated by a small
amount of fluid
• Fluid between the two pleural membranes
create surface tension and causes the two
pleura to stick together
• Prevents lungs from collapsing

FMST 406
ANATOMY
• PLEURA
– PARIETAL
PLEURA – Lines
inner portion of the
thoracic cavity

– VISCERAL
PLEURA – Lines the
outer surface of the
lung

FMST 406
ANATOMY
• LUNGS – occupy the left and right halves of the
thoracic cavity
– Left lung: 2 lobes
– Right lung: 3 lobes, larger than the left
– ALVEOLI: Smallest component of the lungs,
saclike structures where CO2 and O2
exchange takes place

FMST 406
ANATOMY

• MEDIASTINUM
– Area in the middle of the thoracic cavity that
encases:
• Heart
• Great vessels (aorta, superior / inferior
vena cava)
• Trachea (windpipe)
• Bronchi
• Esophagus

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FMST 406
RESPIRATORY TRAUMA

FMST 406
RESPIRATORY TRAUMA

- Causes

- Signs & Symptoms

- Treatment

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RESPIRATORY TRAUMA

• Chest injuries are the second leading

cause of trauma deaths each year
• Many of these injuries can be managed
without surgery
• Usually classified into 2 categories
– Blunt and Penetrating

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RESPIRATORY TRAUMA

• Penetrating Injuries
-Gun shot and stab
wounds

-Organs in path of
object are injured

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RESPIRATORY TRAUMA

• Blunt Injuries
-Caused by severe burst, shearing, or rapid
deceleration
-May result in:
–Pulmonary contusion
–Pneumothorax
–Flail chest
–Pericardial tamponade
–Aortic Rupture

FMST 406
RESPIRATORY TRAUMA

FMST 406
RESPIRATORY TRAUMA
Assessment of Respiratory Trauma

• Look for the obvious, but also communicate with the casualty if
possible.

• Likely to be experiencing chest pain, frequently the pain is

worse with respiratory efforts or movement.

• Shortness of breath.

• Apprehensive or lightheaded if shock is developing.

FMST 406
RESPIRATORY TRAUMA

Conduct a physical examination:

• Observation

• Auscultation

• Palpation

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RESPIRATORY TRAUMA
Observation:
• Casualty is observed for pallor of the skin and sweating

• The presence of cyanosis

• Observe frequency of respirations (rate, rhythm, and

depth)

• Look for gasping, contractions of the accessory muscles of

respiration in the neck, or nasal flaring

•Look for signs of trachea deviation and distended jugular veins

FMST 406
RESPIRATORY TRAUMA

Observation Cont.
• Chest is examined for contusions, abrasions, and
lacerations

• Identify whether chest wall expands symmetrically

with breathing.

• Identify whether any portion of the chest wall

moves paradoxically with respiration

FMST 406
RESPIRATORY TRAUMA

Auscultation:
• The entire chest is evaluated to identify decreased
breath sounds on one side compared to the other
which may indicate pneumothorax or hemothorax on
the examined side.

•Pulmonary contusions may result in abnormal

breath sounds (crackles).

FMST 406
RESPIRATORY TRAUMA

Palpation:

By gently pressing the chest wall with hands and

fingers to assess for the presence of tenderness,
crepitus (either bony or subcutaneous
emphysems), and bony instability of the chest
wall is performed.

FMST 406
RESPIRATORY TRAUMA

MANAGEMENT OF SPECIFIC INJURIES

-Rib Fracture
-Flail Chest

FMST 406
RIB FRACTURE

• Occurs when force applied is greater than

the strength of the rib

REMEMBER!!
ANY rib fx can cause injuries to nearby
structures

FMST 406
RIB FRACTURES

• SIGNS AND SYMPTOMS

– Pain at the site with inhalation/exhalation
– Shortness of breath (SOB)
– Deformity
– Crepitus
– Bruising

FMST 406
RIB FRACTURES

• TREATMENT
– Anticipate potential complications
• Tension Pneumothorax
– Simple Rib FX’s
• Usually require no tx other then analgesics
– Multiple FX’s
• Can be immobilized to the affected side
using patient’s arm and a sling

FMST 406
RIB FRACTURES

• TREATMENT
– Encourage coughing and deep breathing
– Avoid bandaging or taping that encircles the
chest
– Monitor and TACEVAC as necessary

FMST 406
FLAIL CHEST

• A segment of 2 or more adjacent ribs

fractured in at least 2 places

• The segment moves IN with inhalation and

OUT with exhalation, called Paradoxical
Movement

• Caused by blunt trauma to the chest wall

FMST 406
FLAIL CHEST

• SIGNS & SYMPTOMS

– Localized chest pain, aggravated by breathing
and coughing
– Rapid, shallow respirations
– Tenderness or crepitus upon palpation
– Subcutaneous emphysema

FMST 406
FLAIL CHEST

• TREATMENT
– Immobilize flail segments upon inhalation
using strips of tape
– Positive pressure ventilation if you suspect
respiratory failure
– Analgesics
– O2 if available
– Monitor and TACEVAC as necessary

FMST 406
Flail Chest

FMST 406
PNEUMOTHORAX

FMST 406
DEFINITION OF PNEUMOTHORAX

• A simple pneumothorax is caused by the

presence of air in the pleural space.

• The air separates the pleura causing the

lungs to either partially or totally collapse

FMST 406
PNEUMOTHORAX

• CAUSES
– Penetrating trauma of the chest
• Also possible with abdominal injuries that
cross the diaphragm
– Blunt trauma
– Spontaneous

FMST 406
PNEUMOTHORAX

• SIGNS / SYMPTOMS
– Pleuritic chest pain
– Tachypnea / Dyspnea
– Decreased or absent breath sounds on
affected side
– Decreased chest wall motion

FMST 406
PNEUMOTHORAX

• TREATMENT
– Place pt in Fowler’s or Semi-Fowler’s position
– Administer O2 if available
– Use BVM if hypoxia is present
– If caused by wound, apply occlusive dressing
– Monitor for s/sx’s of tension pneumothorax
– TACEVAC ASAP

FMST 406
TENSION PNEUMOTHORAX

• Air enters the pleural space and cannot

escape
• Pressure builds in pleural space, the lung
collapses and the mediastinum is forced to
the opposite side
– Breathing becomes more difficult
– Cardiac blood flow is severely decreased

FMST 406
TENSION PNEUMOTHORAX

• EARLY SIGNS AND SYMPTOMS

– Unilateral decreased or absent breath

sounds

– Dyspnea

– Tachypnea

FMST 406
Tension Pneumothorax
• PROGRESSIVE SIGNS AND
SYMPTOMS
– Increased dyspnea

– Increased tachypnea

– Difficulty ventilating

FMST 406
TENSION PNEUMOTHORAX

• LATE SIGNS AND SYMPTOMS

– Jugular Vein Distention (JVD)
– Tracheal Deviation (towards unaffected side)
– Signs of acute hypoxia
– Narrowing pulse pressures
– Signs of uncompensated shock

FMST 406
TENSION PNEUMOTHORAX

• In some cases the only signs of a

developing tension pneumothorax are:
– Compromised oxygenation
– Tachycardia
– Tachypnea
– Unilateral decreased or absent breath sounds

FMST 406
TENSION PNEUMOTHORAX

• TREATMENT
– Treat all chest injuries
– Perform needle thoracentesis
– Administer oxygen (if available)
– Pain management
– Monitor and TACEVAC

FMST 406
SHOTGUN BLAST TO LOWER RIGHT
CHEST / UPPER RIGHT ABDOMEN

Initial Needle
Thorancentesis

FMST 406
OPEN PNEUMOTHORAX
(SUCKING CHEST WOUND)

FMST 406
OPEN PNEUMOTHORAX

• DEFINITION
– A collection of air or gas in the pleural space
that causes the lung to collapse
– More than the normal amount of air will enter
the lung adding stress and tension to affected
side

• CAUSES
– Gunshot, stab wounds, impaled objects,
occasional blunt trauma

FMST 406
OPEN PNEUMOTHORAX

Head

Left side of
Posterior
Thorax

FMST 406
OPEN PNEUMOTHORAX

• SIGNS AND SYMPTOMS

– Pain at the injury site
– Chest wall trauma
– Shortness of breath
– Tachypnea
– Decreased chest wall motion
– May hear a sucking or bubbling sound as air
moves through the wound

FMST 406
OPEN PNEUMOTHORAX

• TREATMENT
– Occlusive Dressing
• Apply chest seal
• Improvised chest seal
– Tape on all sides

• Assess anterior and posterior torso for

entrance/exit wounds

FMST 406
CHEST SEALS
Bolin Chest Seal Asherman Chest Seal

H&H Wound Seal

FMST 406
OPEN PNEUMOTHORAX

• TREATMENT (cont.)
– Place patient on AFFECTED Side
– Monitor for signs/symptoms of tension
pneumothorax
– Administer O2, if available
– Pain management
– Monitor and TACEVAC ASAP

FMST 406
HEMOTHORAX

• Blood accumulated into the chest cavity

from lacerated vessels compressing the
lung
• Prevents adequate ventilation
• Causes
– Penetrating or blunt trauma

FMST 406
HEMOTHORAX

• SIGNS / SYMPTOMS
– SOB
– Chest pain
– Tachypnea
– S/S of shock: pallor, confusion, hypotension
– Decreased or absent breath sounds
– Hemoptysis (coughing up blood)
– Decreased chest wall motion

FMST 406
HEMOTHORAX

• TREATMENT
– Place patient in Fowler’s position
– Treat chest injuries
– Treat for shock
– Administer O2, if available
– Monitor and TACEVAC

FMST 406
HEMOPNEUMOTHORAX

• A collection of blood and air in the pleural

space
• May result in a collapsed lung and pressure
on the heart and uninjured lung
• Caused by penetrating trauma to the chest
wall or the lungs

FMST 406
HEMO-PNEUMOTHORAX

FMST 406
HEMOPNUEMOTHORAX

• SIGNS / SYMPTOMS
– Tachypnea
– Decreased breath sounds
– Signs of shock

FMST 406
HEMOPNUEMOTHORAX

• TREATMENT
– Place patient In Fowler’s Position
– Perform needle thoracentesis to relieve
pressure
• If blood is withdrawn, immediately remove
needle and catheter
– Administer O2, if available
– Treat for shock
– Monitor and TACEVAC

FMST 406
FMST 406
NEEDLE THORACENTESIS

FMST 406
PURPOSE

• Definition:
– Procedure where a needle and catheter is
inserted through the chest wall into the pleural
space

• Purpose:
– Relieves accumulated pressure in the pleural
space
– Reduces pressure on the heart, lungs, and
chest cavity

FMST 406
ANATOMICAL LANDMARKS

• Mid-Clavicular Lines (A) A A

• 2nd Intercostal Space (B)

FMST 406
ANATOMICAL LANDMARKS

Tension Pneumothorax of Left lung

FMST 406
FMST 406
INDICATIONS

• Any casualty with thoracic injury is at risk of a

tension pneumothorax
• Casualties with penetrating wounds to the chest
and those with signs of rib fracture are at risk
• There are NO significant contraindications

FMST 406
FMST 406
PROPER EQUIPMENT

• 14-gauge, 3.25 inch needle catheter

• Antiseptic solution

• Gloves

FMST 406
FMST 406
PROCEDURAL STEPS

• Assess Casualty and Make Decision

– Based on MOI
– Noted increase in difficult breathing

• Inspect
• Auscultate
• Palpate

FMST 406
PROCEDURAL STEPS

• Assemble and Check Equipment

– 14-gauge, 3.25 inch needle/catheter
– Antiseptic Solution
– Gloves

FMST 406
PROCEDURAL STEPS

• Prepare Patient
– Upright position
– Explain procedure
– Expose chest

FMST 406
PROCEDURAL STEPS

• Identify Landmarks

– Midclavicular Line
– 2nd Intercostal Space

FMST 406
PROCEDURAL STEPS

• Perform the Procedure

– Cleanse area
– Insert needle/catheter (over the rib, NOT below)
– Puncture parietal pleura
– Remove needle
– Secure catheter

FMST 406
FMST 406
PROCEDURAL STEPS

• Reassess Patient
– IAP the chest
– Visually inspect neck
– Monitor patient’s response
– Continue monitoring and reassessing

FMST 406
FMST 406
COMPLICATIONS

• Hemothorax
– Blood within the pleural space
– Caused by needle puncturing any vessel within
the chest
• Cardiac Tamponade
– Pressure on the heart that occurs when blood or
fluid builds up in the space between the heart
muscle and the pericardium.
– Ensure needle is at or lateral to the nipple line

FMST 406
COMPLICATIONS

• Subcutaneous Emphysema
– Released air becomes trapped under skin
– Feels like “rice crispies”

• Misdiagnosis
– Performing a needle thoracentesis on a
casualty with non-penetrating torso trauma
could result in a pneumothorax if not already
present.

FMST 406
FMST 406
DEMONSTRATION

FMST 406
FMST 406
PRACTICAL APPLICATION

FMST 406
FMST 406
MANAGE RESPIRATORY TRAUMA

FMST 406
MANAGE ABDOMINAL INJURIES

FMST 407
OVERVIEW

• Major Abdominal Organs

• Significance of Abdominal Organs
• Blunt and Penetrating Trauma
• Signs and Symptoms
• Treatment

FMST 407
LEARNING OBJECTIVES

Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

FMST 407
FMST 407
MAJOR ABDOMINAL ORGANS

OVERVIEW
• Unrecognized abdominal injury is one of the major causes of
death in the trauma casualty.

• Early deaths typically result from massive blood loss caused by

either penetrating or blunt injuries.

• The abdomen contains the major organs of digestion and

excretion.

• The simplest and most common method of describing the

portions of the abdomen is by quadrants. In this system, the
abdomen is divided into four equal parts by two imaginary lines that
intersect at right angles at the umbilicus.

FMST 407
MAJOR ABDOMINAL ORGANS

Separated into 4 equal quadrants

• RUQ • LUQ
– Colon – Colon
– Right Kidney – Left Kidney
– Pancreas – small – Pancreas
portion – Spleen
– Liver – Stomach
– Gallbladder

FMST 407
MAJOR ABDOMINAL ORGANS

Separated into 4 equal quadrants

• RLQ • LLQ
– Ascending Colon – Descending Colon
– Small Intestine – Small Intestine
– Major artery and – Major artery and
vein for right leg vein for left leg
– Appendix

FMST 407
ORGANS OF THE ABDOMEN

FMST 407
FMST 407
SIGNIFICANCE OF ABDOMINAL ORGANS

FMST 407
ABDOMINAL ORGANS

• HOLLOW ORGANS – Gastrointestinal and

urinary tract through which material pass
• Stomach
• Intestines
• Bladder

– Rupture causes septicemia and toxicity

– Bleeding is generally minimal

FMST 407
ABDOMINAL ORGANS

• SOLID ORGANS – Solid masses of tissue

• Liver
• Pancreas
• Spleen
• Kidneys

– Highly vascular, injury results in severe

bleeding

FMST 407
FMST 407
MECHANISM FOR ABDOMINAL INJURIES

• Assessing the patient for abdominal injuries begins with

knowledge of the MOI. Numerous mechanisms lead to
the compression and shear forces that may damage
abdominal organs. Abdominal Injuries can be caused
by:

– Blunt Trauma

– Penetrating Trauma

FMST 407
MECHANISM FOR ABDOMINAL INJURIES

Blunt Trauma

– Great threat to life because injuries are more

difficult to diagnose

– The injuries to abdominal organs result from

either compression or shear forces.

FMST 407
MECHANISM FOR ABDOMINAL INJURIES

Penetrating Trauma
– A foreign object enters the abdomen and opens the
peritoneal cavity to the outside

– Penetrating trauma is more readily visible than blunt

trauma

– Multiple organ damage can occur in penetrating

trauma

– A mental visualization of the potential trajectory

FMST 407
FMST 407
SIGNS AND SYMPTOMS

FMST 407
SIGNS AND SYMPTOMS

• Note any
protective gear
worn by the
casualty

• History of the
injury

• Focus on the weapon, number of times shot or

stabbed, and amount of blood at the scene

FMST 407
SIGNS AND SYMPTOMS

• Unless there are associated injuries,

casualties with abdominal trauma generally
present with a patent airway.

• When abnormalities are found it should

be exposed and examined in greater
detail.

• This involves inspection and palpation of

the abdomen looking and feeling for soft
tissue injuries and distention.

FMST 407
SIGNS AND SYMPTOMS

• Soft tissue injuries include contusions, abrasions, stab

or gunshot wounds, obvious bleeding, and unusual
findings such as evisceration or impaled objects.

• Palpate to identify areas of tenderness.

• Begun in an area where the casualty does not

complain of pain. Then, each abdominal quadrant.

• While palpating a tender area, the provider may note

that the casualty “tenses up” the abdominal muscles in
that area. This reaction, called voluntary guarding,
serves to protect the patient from pain.

FMST 407
SIGNS AND SYMPTOMS

• Deep palpation of
obvious injuries
should be avoided

• Be careful around
impaled objects

FMST 407
SIGNS AND SYMPTOMS

• Auscultation of bowel sounds is generally not a

helpful field assessment tool.

• Time should not be wasted to determine their

presence or absence as this diagnostic sign will
not alter the field management of the casualty.

FMST 407
SIGNS AND SYMPTOMS

• The assessment of abdominal injuries can be

difficult. Some signs that raise the index of
suspicion are:
• Mechanism of injury

• Soft tissue injuries to the abdomen,

flank, or back

• Shock without an obvious cause

• Level of shock greater than explained by

other injuries

FMST 407
SIGNS AND SYMPTOMS

Some signs that raise the index of

suspicion continued:
• Abdominal tenderness

• Involuntary guarding

• Percussion tenderness

• Diminished or absent bowel sounds

FMST 407
FMST 407
TREATMENT

FMST 407
BLUNT ABDOMINAL INJURIES

• TREATMENT
– Maintain ABC’s
– Establish baseline vital signs
– Place in supine position with knees slightly flexed
– History
– Keep calm
– Treat for shock
– DO NOT strongly palpate the abdomen
– Monitor and TACEVAC

FMST 407
PENETRATING ABDOMINAL INJURIES

– DO NOT remove
impaled objects
• Leave in place
• Secure with
bulky dressings

FMST 407
PENETRATING ABDOMINAL INJURIES

• TREATMENT
– Maintain ABC’s
– Inspect for exit wounds
– If intestines ARE NOT
exposed
• Apply dry, sterile
dressing

EVISCERATED BOWEL

FMST 407
PENETRATING ABDOMINAL INJURIES

• If intestines ARE exposed:

– Apply moist sterile dressing soaked in normal
saline
– Gently secure eviscerated bowel
– Treat for shock
– DO NOT probe for objects
– Monitor and TACEVAC

FMST 407
FMST 407
DEMONSTRATION

FMST 407
FMST 407
MANAGE
ABDOMINAL INJURIES

FMST 407
MANAGE MUSCULOSKELETAL
INJURIES

FMST 408
OVERVIEW

• Anatomy

• Types of Musculoskeletal Injuries

• Types of Splints

FMST 408
LEARNING OBJECTIVES

Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

FMST 408
FMST 408
ANATOMY OF THE
MUSCULOSKELETAL SYSTEM

FMST 408
SKELETAL SYSTEM

• Boney framework consisting of 206 bones

• Classifications
– Long, Short, Irregular and Flat

• Divisions
– Axial Skeleton
– Appendicular Skeleton

FMST 408
SKELETAL SYSTEM

FMST 408
MUSCULAR SYSTEM

• Consists of tissues, muscles, cartilage, tendons

and ligaments
– Functions: Movement, Posture, Heat, Bodily Functions
– Muscle Types:
• Skeletal (Voluntary)
• Smooth (Involuntary)
• Cardiac (Myocardium)

FMST 408
MUSCULAR SYSTEM

FMST 408
FMST 408
TYPES OF MUSCULOSKELETAL INJURIES

FMST 408
SOFT TISSUE INJURIES

• Involve the skin and underlying musculature

• Injury to the tissues is commonly referred to as

either a closed or open wound

FMST 408
OPEN WOUNDS

• Injury in which the skin is interrupted, or broken,

exposing tissues underneath

FMST 408
CLOSED WOUNDS

• SKIN IS NOT BROKEN

FMST 408
ABRASIONS

• Superficial scratches of the skin surface

• Oozing blood from injured capillaries

• Painful due to nerve ending damage

FMST 408
ABRASIONS

• Also known as “Road

Rash”

• “Rug Burns”

• “Mat Burns”

FMST 408
ABRASIONS

• Treatment

– Cleanse the wound

– Cover injury with a small

bandage

– Prevent infection - use

anti-bacterial ointment

FMST 408
LACERATIONS

• Produced by objects with sharp edges

• A blow from a blunt object

• Can be smooth or jagged

FMST 408
LACERATIONS

• Treatment
– Hemorrhage control

– Immobilization - if major
tendons and muscles are
severed

– Treat for shock

– TACEVAC as needed

FMST 408
AVULSIONS

• AVULSION
– Flap of skin that is torn
loose or completely pulled off.

FMST 408
AVULSIONS

• Treatment
– Control bleeding, apply dressing to avulsed area

– Replace flap

– If completely torn off:

– Wrap in saline soaked gauze or pack in ice

– Transport with the patient

– Immobilize extremity as indicated

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TRAUMATIC AMPUTATIONS

• Non-surgical removal of limb or appendage

• There may be less bleeding when

blood vessels spasm and retract

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TRAUMATIC AMPUTATIONS

• TREATMENT
– Hemorrhage control
• Tourniquet to control life-threatening hemorrhage

– Treat for shock

– Preserve amputation in sterile dressing

• Pack in ice and send with patient

– TACEVAC ASAP

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STRAINS, SPRAINS AND DISLOCATIONS

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STRAINS, SPRAINS & DISLOCATIONS

• STRAIN
– Injury to MUSCLE or tendon resulting from over
exertion or over stretching

• SPRAIN
– Partial or complete tearing or stretching of a
supporting LIGAMENT within a joint

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STRAINS, SPRAINS & DISLOCATIONS

• DISLOCATION
– Displacement of bone ends at the joints resulting in an
abnormal stretching of the ligaments around the joints

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STRAINS, SPRAINS & DISLOCATIONS

• SIGNS AND SYMPTOMS

– Point tenderness or burning sensation

– Marked deformity of joint

– Pain and edema

– Complete loss or decreased range of motion (ROM)

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TREATMENT

• STRAINS
– Supportive bandaging

– Immobilize
• Ensure muscle is in relaxed position
– RICE
» Rest
» Ice
» Compression
» Elevation

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TREATMENT

• SPRAINS

– Treat like a fracture

– Supportive Bandage / Immobilize

– RICE

– Relieve pain

– TACEVAC

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TREATMENT

• DISLOCATION

– Attempt to reduce only if no pulse is present

– Splint in position it was found

– Pain management

– TACEVAC

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COMPLICATIONS

• Hemorrhage
– Separated bone ends may tear muscle tissue
and lacerate blood vessels

• Nerve Damage
– Bone ends may cut or pinch nerves

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FMST 408
TYPES OF FRACTURES

FMST 408
TYPES OF FRACTURES

• Break in the continuity of a bone

• Two Types:
– Open
– Closed

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OPEN FRACTURES

• Breaks through overlying tissues

• Bone may protrude through the

skin

• Penetrating object breaks

through skin to the bone

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CLOSED FRACTURES

• Bone does not break through the

skin

• Tissue beneath the skin might be

damaged

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SIGNS & SYMPTOMS

• Inability to move extremity

• Discoloration

• Deformity

• Edema

• Pain with or without movement

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SIGNS & SYMPTOMS

• Exposed bone fragments

(open fractures)

• Crepitus/Grating

• Injury indicating fracture

(e.g. gunshot wounds)

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GENERAL PRINCIPLES FOR TREATMENT OF
FRACTURES

FMST 408
TREATMENT

• Control hemorrhage

• Treat for shock

• Check distal pulses

• Immobilize with splint

• Recheck PMS

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TREATMENT

• Relieve pain

• Reduce only if no distal pulse

• Document treatment

• Monitor and TACEVAC

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FMST 408
TYPES OF SPLINTS

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SPLINTING

• PURPOSE OF SPLINTING

– To immobilize that portion of the body which is injured

– Prevent further damage

– Decrease pain

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RIGID SPLINTS

• Cannot change shape

• Body part positioned to fit splint

• Examples:
– Wood
– Plastic
– Metal

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FORMABLE SPLINTS

• Wrap around extremity

• Can be molded

• Examples:
– Pillows
– Ponchos
– Blankets

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IMPROVISED SPLINTS
• Made from any available material that can
be used to stabilize a fracture

• Only limited by your creativity!

• Examples
– Sticks
– Branches
– Tent poles

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ANATOMICAL SPLINTS

• Readily available

• Use the casualty’s body

as splint

• Examples
– Strap legs together
– Secure arm to body
– Tape fingers together

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MANUFACTURED SPLINTS

• Designed for specific injuries & applications

• Examples in AMAL 635:
– Thomas Half-Ring Telescopic Splint
– Pneumatic “air” Splint

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BANDAGES IN SPLINTING

• Used to bind or wrap a body part

• Hold splints in place

• Protect body part from further injury

• Examples:
– Sling
– Swathe

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GENERAL RULES FOR SPLINTING

• Control hemorrhage (Dressing/Bandage)

• Expose fracture site

• Establish distal pulse

• Exposed bone
– Cover ends with sterile dressing

• Splint in position found

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GENERAL RULES FOR SPLINTING
• Attempt to straighten closed fx ONLY if there is
no pulse
• DO NOT retract exposed bone (Open Fractures)
• Immobilize above and below fracture
• Reassess pulse after splinting
• When in doubt SPLINT!!
• TACEVAC as needed

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FMST 408
TECHNIQUES FOR SPLINTING

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JAW FRACTURES

• Apply Modified Barton splint

• Designed to pull lower jaw forward
• Support on head, not neck
• Do not lay patient on their back

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CLAVICLE FRACTURES

• Immobilize with Figure 8 bandage

• Use sling and swathe

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HUMERUS FRACTURES

• Upper arm near shoulder

– Place pad in arm pit
– Bandage to body

• Middle of upper arm

– Use splint on outside of arm
– Secure to body
– Support with sling

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FOREARM FRACTURES

• If only one bone is broken

– You may use other bone as splint

• Apply two splints above and below forearm

• Cover from wrist to elbow

• Support with sling

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WRIST/HAND FRACTURES

• Splint in position of function

• Leave fingers exposed

• Support with sling

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RIB FRACTURES

• Assess ABCs

• Single fx
– Immobilize using arm
– Sling and secure with bandage

• Mulitiple fx
– Immobilize flail segment with
tape

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PELVIC FRACTURES

• Position of comfort (knees bent or straight)

• Pillow or padding between legs

• Wrap sheet around pelvis

• Tie knees and ankles together

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FEMUR FRACTURES

• Use anatomical splint

• Splint in 4 places
– Above/below fx
– Above/below knees
– Around feet

• Consider traction splint for

mid-shaft fx

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PATELLAR FRACTURES

• Position of comfort

• Place splint underneath leg

•
• Padding under knee

• Immobilize in four places

– Around thigh
– Above/below knee
– Around ankle

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LOWER LEG FRACTURES
• If only one bone is broken
– You may use the other to splint

• Utilize stirrup with SAM splint

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ANKLE/FOOT FRACTURES

• Wearing boots
– Use Figure 8 with cravat

• No boots
– Wrap ankle with bandage or
ace wrap
– Use Figure 8 to secure ankles

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SPINAL FRACTURES

• Indications
– MV accident, Fall (2-3x height), blunt trauma

• Immobilize from head to toe

– Spine board if available

• Use C-collar for neck

• Maintain & monitor ABCs

FMST 408
FMST 408
FMST 408
MANAGE HEAD, NECK AND FACE
INJURIES

FMST 409
OVERVIEW
• Anatomy of the Head
• Types of Head Injuries
• Treatment of Head Injuries
• Anatomy of the Neck
• Types of Neck Injuries
• Treatment of Neck Injuries
• Anatomy of the Face
• Types of Facial Injuries
• Treatment of Facial Injuries

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LEARNING OBJECTIVES

Please Read Your

Terminal Learning Objectives

And

Enabling Learning Objectives

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FMST 409
Number of Injuries by Body Region
(March 04- Dec 07) Other and
Unspecified, 375, 3%

Lower Extremities,
2849, 20% 3,817
Patients
Head and Neck, This does
6036, 43%
include TBI.

Upper Extremities,
2731, 19%

Spine and Back, 439,

Torso, 1643, 12% 3%

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ANATOMY

Cranial Vault – part of the skull that contains

the brain
• Occipital Frontal Bone
Parietal Bone

• Temporal
• Parietal Ethmoid Bone
• Frontal
• Sphenoid Occipital Bone
• Ethmoid Temporal Bone

Sphenoid Bone

FMST 409
ANATOMY