![]() ![]() Whether you take the blood pressure or not, your patient will still be in big trouble. ![]() If you need a blood pressure to tell you if your patient is sick or not, your patient is in big trouble. Say that with me, “We don’t take blood pressures on trauma patients while we’re still on scene.” The other four vitals will tell us all that we need to know. We don’t take blood pressures on trauma patients while we’re still on scene. Trauma scene vitals are pulse, respiration, skin signs and level of consciousness. Control major bleeding and take a quick set of vitals. ![]() While we’re immobilizing the spine we need to do a rapid trauma survey looking for critical bleeding and other injuries that may need immediate intervention. If it’s comfortable and loose, it isn’t immobilization. If you need to log roll the patient, you’re going to need those straps tight. There’s no point in putting someone in full c-spine and then cinching the straps and tape to the snugness of a loose t-shirt. And know that once you’ve decided to c-spine the patient you’ve made the choice to sacrifice comfort for safe, clinically appropriate, immobilization. In critical trauma, the name of the c-spine game is fast. For patients with significant multi-system trauma, scene delays from slow c-spine procedures could be a real detriment to their care. For patients with spinal injuries, c-spine can possibly prevent debilitating neurological compromise. C-spine can be a blessing and it can be a curse. Delegate manual immobilization and then push the pace of the c-spine operation. If you’re running the show, you have no business grabbing the patients head. When an oral option is available, use it first. ET tubes, suction catheters and NG tubes can increase ICP and aggravate nasal cavity injuries when inserted into the nose. While it’s sometimes unavoidable, we try to keep advanced airway interventions out of the nose when possible. Head injury patients are prone to vomiting so you should have suction standing by and a plan for rolling the patient if the need arises. Maintaining the patient in the slightly hypocapnic range (ETCO2 around 35) is a good goal. Keep ventilations steady at 12 to 20 breaths per minute. Our tendency is to over-ventilate head injuries. All of these should be protected from the possibility of a clenched jaw with some sort of bite block type protection. If the Glasgow is less than eight, consider an advanced airway like a king tube, combi-tube or ET tube. In these cases, oral and nasal airway adjuncts are helpful in ensuring proper ventilation while keeping the head midline and neutral. Seizures and posturing can produce trismus and spinal precautions prohibit proper tilting of the head. Our brain injured patients can present some unique airway challenges. The brain is sensitive to hypoxia and a poorly managed airway can turn a significant but recoverable head injury into a devastating head injury. Head trauma management begins with the airway. ![]()
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