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Patient Care

In Trauma Cases, Embrace the Simple

Genius is taking the complex and making it simple, according to Albert Einstein. This principle has invaluable pertinence to trauma care, says emergency physician Chris Hartman, MD, medical director for International Trauma Life Support in Indiana and assistant professor at Indiana University School of Medicine.

Hartman delivered "Trauma: Just Do It—Embracing the Complexity of Simple" to a crowded ballroom Thursday morning May 30 during the EMS Pro Expo at Foxwoods Casino and Resort in Connecticut.

Just like trauma victims, the sympathetic nervous system of EMS providers on trauma calls goes into overdrive, no matter how many you've been on, Hartman said. Your heart rate, contractility, and breathing go up. You lose focus. Your cognitive abilities decline, and you develop tunnel vision. Fine motor skills diminish.

"We're human," said Hartman. "We have to accept that fact." A true story of a 6-year old girl getting hit by a car on a quiet country road while retrieving the morning newspaper for her grandfather brought the issue to life.

These are not the times to retrieve complex tools and recall overcomplicated decision protocols, Hartman stressed. During multiple-system trauma, such as the case of young Jennifer—who died of a tension pneumothorax—increasing the number of choices can lead to improper decisions and delays in lifesaving care. Hartman stressed a return to the three reasons that cause trauma victims to die:

  • Hypovolemia
  • Hypoxia
  • Head injuries

Focus your primary survey on these lethal threats, he said. Return to the basics: You need an airway, you need dressings to stop bleeding, and you may need a needle for chest decompressions. As you learned on the first day of EMT school, verify scene safety, stem major bleeding, stabilize the spine, and assess breathing status.

Throughout the call continue to focus on why people die, Hartman said. Where do people bleed from? Is your patient ventilating and oxygenating? What about head injuries and the cervical spine?

Regarding patient assessments, the trauma scene is not the place to decide which neurological screen to use on a particular patient. Decide on one and use it every time on every patient. "For me, the Glasgow Coma Scale is useless," he said. "It doesn't help me take care of you." Counting pulse and respiration rates doesn't matter much beyond "fast" and "slow."

Educators can wax poetic about mnemonics, algorithms, and assessment tools, concluded Hartman. "I want you to remember those things for your students, but it's too much to remember with a trauma patient in front of you.

"Make life easy," he said.

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