Client Experiencing Chest Trauma. Transported From Disaster Scene Via Stretcher

Client Experiencing Chest Trauma: Transport from Disaster Scene via Stretcher

Chest trauma, resulting from blunt or penetrating injuries, presents a critical challenge in emergency medical services (EMS). The initial assessment and management at the disaster scene, followed by safe and effective transportation to a definitive care facility, are crucial steps in determining patient outcome. This article will delve into the comprehensive management of a client experiencing chest trauma transported from a disaster scene via stretcher, covering pre-hospital care, transport considerations, and hospital management.

Pre-Hospital Assessment and Management: The Scene's First Responders

The chaotic environment of a disaster scene demands a structured and systematic approach. The first responders' actions within the "golden hour" – the critical time period following injury – significantly impact survival rates. The initial assessment follows a standardized protocol, often incorporating variations of the ABCDE approach:

A – Airway and Cervical Spine Control:

• Assessment: A rapid assessment is crucial to ensure a patent airway. Look for signs of airway obstruction, such as dyspnea (difficulty breathing), cyanosis (bluish discoloration of skin), stridor (high-pitched sound during breathing), or use of accessory muscles. Assess for potential cervical spine injury, always assuming its presence until proven otherwise.
• Intervention: Maintain cervical spine immobilization using a cervical collar and backboard. If airway obstruction is present, consider advanced airway techniques such as endotracheal intubation or cricothyrotomy as necessary, performed by trained personnel. Suctioning may be required to clear airway secretions.

B – Breathing and Ventilation:

• Assessment: Assess respiratory rate, rhythm, depth, and effort. Auscultate lung sounds for the presence of diminished breath sounds, crackles, wheezes, or rhonchi. Observe for signs of respiratory distress, such as paradoxical chest movement (flail chest), increased work of breathing, or use of accessory muscles. Check oxygen saturation (SpO2) using pulse oximetry.
• Intervention: Administer high-flow oxygen via a non-rebreather mask. For patients with significant respiratory compromise, consider positive pressure ventilation with a bag-valve mask (BVM) or advanced airway management. Addressing pneumothorax (collapsed lung) or tension pneumothorax (life-threatening air accumulation in the pleural space) is paramount. Needle decompression may be performed by trained personnel in the pre-hospital setting for tension pneumothorax.

C – Circulation and Control of Bleeding:

• Assessment: Assess heart rate, rhythm, and blood pressure. Check for signs of shock, such as pallor, cool clammy skin, tachycardia (rapid heart rate), and hypotension (low blood pressure). Identify sources of external bleeding and control them using direct pressure, elevation, and tourniquets if necessary. Assess for internal bleeding, indicated by signs such as distended abdomen, guarding, or bruising.
• Intervention: Control external bleeding promptly. Administer intravenous (IV) fluids to maintain adequate blood pressure and perfusion. Blood transfusion may be required in cases of significant blood loss. Monitoring vital signs frequently is essential.

D – Disability (Neurological Assessment):

• Assessment: Briefly assess the client’s level of consciousness using the Glasgow Coma Scale (GCS). Check pupils for size, reactivity, and equality. Assess for any neurological deficits such as weakness, paralysis, or altered mental status.
• Intervention: Treatment is directed at the underlying cause of neurological deficits. This could involve managing airway, breathing, or circulation issues, or addressing specific neurological injuries.

E – Exposure and Environmental Control:

• Assessment: Completely expose the client to perform a thorough physical examination, but maintain warmth and prevent hypothermia. Document all injuries and findings.
• Intervention: Remove clothing to facilitate a complete assessment and treatment. Maintain the client's body temperature using blankets or warming devices.

Transport Considerations: Safe and Effective Transfer

Once the initial assessment and stabilization are complete, the client needs to be transported safely to a hospital. The choice of transport method depends on several factors, including the severity of the injury, the availability of resources, and the distance to the hospital. Given the scenario, stretcher transport is used.

Stretcher Selection and Preparation:

The stretcher chosen should provide adequate immobilization and support for the client's injuries. A scoop stretcher or a spine board may be used, ensuring appropriate spinal immobilization. The stretcher should be adequately padded to prevent further injury during transport. Securing the client to the stretcher is critical to prevent movement and potential exacerbation of injuries.

Monitoring During Transport:

Continuous monitoring of vital signs is essential during transport. This includes heart rate, blood pressure, respiratory rate, SpO2, and GCS. The EMS team should remain vigilant for any changes in the client's condition and adjust treatment as necessary.

Communication with Receiving Hospital:

Effective communication with the receiving hospital is crucial. The EMS team should provide a concise report including the client's vital signs, the mechanism of injury, the interventions performed, and the client's current condition. This ensures a smooth handoff to the hospital team and allows for prompt treatment upon arrival.

Challenges in Disaster Scene Transportation:

Disaster scenes present unique challenges. Limited access, debris, and potential for further injury complicate transport. Careful planning and coordination are crucial to ensure safe and efficient transport. The use of specialized equipment, such as all-terrain vehicles or helicopters, might be necessary. Maintaining communication with the command center is essential for coordinating resources and navigating the scene effectively. Safety of both the patient and the EMS personnel is paramount.

Hospital Management: Definitive Care

Upon arrival at the hospital, the client undergoes a more comprehensive assessment and management. The initial focus remains on stabilizing the airway, breathing, and circulation.

Advanced Imaging and Diagnostic Tests:

Chest X-rays, computed tomography (CT) scans, and other imaging studies are used to evaluate the extent of chest injuries. These tests can identify pneumothorax, hemothorax (blood in the pleural space), rib fractures, flail chest, and other injuries. Further diagnostic tests, such as blood tests, may be required to assess for internal bleeding or other complications.

Surgical Interventions:

Surgical intervention might be necessary to address certain chest injuries. For example, a chest tube may be placed to drain air or blood from the pleural space in cases of pneumothorax or hemothorax. Open reduction and internal fixation (ORIF) may be needed for rib fractures causing respiratory compromise. In cases of severe lung injuries, surgery might be required for repair or lung resection. Cardiothoracic surgery may be necessary for injuries involving the heart or major blood vessels.

Medical Management:

Medical management focuses on addressing the underlying injuries and complications. Pain management is crucial, and analgesics may be administered to relieve pain and improve respiratory function. Respiratory support, such as mechanical ventilation, may be required for clients with severe respiratory compromise. Fluid resuscitation and blood transfusion are used to manage hypovolemic shock. Antibiotics may be given to prevent or treat infection. Close monitoring of vital signs and other parameters, such as oxygen saturation, is crucial throughout the hospital stay.

Post-Operative Care and Rehabilitation:

Post-operative care focuses on pain management, respiratory support, and preventing complications such as infection or pneumonia. Physical therapy and rehabilitation play a vital role in helping the client regain strength and function. Respiratory therapy is frequently needed to facilitate effective breathing and coughing, and to clear secretions.

Long-Term Outcomes and Complications:

Long-term outcomes depend on the severity of the initial injuries, the effectiveness of treatment, and the client’s overall health. Possible long-term complications include chronic pain, respiratory impairment, post-traumatic stress disorder (PTSD), and cardiac issues. Follow-up appointments and ongoing rehabilitation are crucial for optimal recovery and to address potential long-term complications.

Conclusion: A Multidisciplinary Approach

Managing a client experiencing chest trauma transported from a disaster scene via stretcher requires a coordinated, multidisciplinary effort. From the initial assessment and stabilization by first responders to definitive care in the hospital, each step is crucial. A thorough understanding of pre-hospital management, transport considerations, and hospital-based interventions is essential for optimizing patient outcomes and improving survival rates. This intricate process highlights the importance of teamwork, efficient communication, and the seamless integration of resources across different levels of care. Continuous advancements in emergency medicine and trauma care aim to refine these protocols further, enhancing the chances of successful recovery for clients facing such critical injuries. The focus remains on minimizing morbidity and mortality, providing comprehensive support, and facilitating a return to optimal quality of life for those who experience this type of devastating trauma.