4.2 Specific Injuries

Head and Spinal Trauma

Traumatic Brain Injury (TBI)

The brain is highly sensitive to secondary injury. After the initial impact, hypoxia and hypotension dramatically worsen outcomes. AEMT priorities:

• Maintain a patent airway and adequate oxygenation (avoid both hypoxia and routine hyperventilation).
• Support blood pressure — a single episode of hypotension significantly increases TBI mortality.
• Monitor the Glasgow Coma Scale (GCS) and pupils; a declining GCS, a blown pupil, or Cushing's triad (hypertension, bradycardia, irregular respirations) signals rising intracranial pressure (ICP).
• Elevate the head of the immobilized patient about 30 degrees if perfusion allows, and prevent hypoglycemia and hypothermia.

Spinal Trauma

Maintain in-line stabilization for a suspected spinal injury. Use selective spinal motion restriction (SMR) criteria (e.g., NEXUS-style: no midline tenderness, no focal deficit, normal mentation, no intoxication, no distracting injury) to decide on full restriction. Neurogenic shock from a spinal cord injury presents with hypotension and bradycardia with warm, dry skin below the lesion.

Chest Trauma

Chest injuries directly threaten oxygenation and circulation and are common trauma-domain test scenarios.

Tension Pneumothorax

Air accumulates in the pleural space and cannot escape, collapsing the lung and shifting the mediastinum, compressing the heart and great vessels (a form of obstructive shock).

Signs: severe respiratory distress, absent breath sounds on the affected side, hypotension, distended neck veins, and late tracheal deviation away from the injured side. It is a clinical diagnosis — treat on presentation. Definitive prehospital treatment (needle/thoracic decompression) depends on AEMT scope and local protocol; the universal AEMT actions are early recognition, high-flow oxygen, and rapid transport with notification.

Open Pneumothorax (Sucking Chest Wound)

Seal with a vented chest seal (or three-sided occlusive dressing). If tension physiology develops, burp the seal (briefly lift it) to release trapped air.

Flail Chest

Three or more adjacent ribs fractured in two or more places create a free segment that moves paradoxically (in on inspiration, out on expiration). The major killer is the underlying pulmonary contusion. Support ventilation and oxygenation; provide positive-pressure ventilation if breathing is inadequate.

Abdominal and Pelvic Trauma

The abdomen can conceal large-volume hemorrhage with few external signs. Suspect internal bleeding with significant MOI plus tenderness, distension, rigidity, bruising (e.g., flank ecchymosis), or unexplained shock.

• Evisceration: Do not push organs back in. Cover with a moist sterile dressing then an occlusive layer; keep the patient warm.
• Impaled object: Stabilize in place; do not remove (exception: when it obstructs the airway or prevents CPR).
• Pelvic fractures can bleed massively into the retroperitoneum. Avoid repeatedly rocking the pelvis to test stability. Apply a pelvic binder/sheet at the level of the greater trochanters for a suspected unstable pelvis, treat for shock, and minimize movement.

Musculoskeletal and Extremity Injuries

Splint to prevent further injury, reduce pain and bleeding, and protect nerves and vessels.

• Assess and document pulses, motor, and sensory (PMS) distal to the injury before and after splinting.
• Splint the joints above and below a fractured long bone; splint the bones above and below an injured joint.
• A traction splint is used for an isolated mid-shaft femur fracture without pelvic, knee, or lower-leg involvement.
• Cover open fractures with a sterile dressing; control associated bleeding; do not intentionally push exposed bone back in.
• An extremity that is pulseless, pale, and cold is a time-critical vascular emergency — expedite transport.

Burns

Estimate burn severity using depth, total body surface area (TBSA), location, and patient factors.

Rule of Nines (Adult)

The patient's palm (including fingers) is roughly 1% TBSA for patchy burns. In infants and young children the head is proportionally larger and legs smaller, so pediatric charts adjust these values.

AEMT Burn Priorities

• Stop the burning process and remove jewelry/constricting items.
• Suspect inhalation injury with facial burns, singed nasal hair, soot in the mouth, hoarse voice, or stridor — the airway can swell rapidly; deliver high-flow oxygen and prioritize transport.
• Cover with dry sterile dressings; avoid prolonged cooling that causes hypothermia.
• Circumferential burns of a limb or the chest can compromise circulation or ventilation.
• For significant burns, follow protocol for IV access and fluid resuscitation, and treat associated trauma.

Soft-Tissue Injuries

Classify wounds: abrasion, laceration, avulsion, puncture, amputation. Control bleeding first (direct pressure, then escalate). Wrap an amputated part in moist sterile gauze, place it in a sealed bag, and keep it cool but not frozen (not in direct ice contact). Treat closed soft-tissue injuries (contusion, hematoma) with the suspicion that significant force can cause underlying fractures or internal bleeding.