Client Expereinceing Chest Trauma. Transported Form Disaster Scene Via Stretcher

Client Experiencing Chest Trauma: Transport from Disaster Scene via Stretcher

Chest trauma, resulting from incidents like car accidents, falls, or explosions, presents a significant challenge in emergency medicine. The initial assessment and stabilization at the disaster scene, followed by safe and effective transport to a definitive care facility, are critical for improving patient outcomes. This article delves into the multifaceted aspects of managing a client experiencing chest trauma, focusing on the transportation phase utilizing a stretcher.

Initial Assessment and On-Scene Management

Before even considering transport, a thorough initial assessment is paramount. This follows the established principles of trauma care, often using the ABCDE approach:

A – Airway and Cervical Spine Control:

• Maintaining a patent airway is the top priority. Look for signs of airway obstruction, such as gurgling, stridor, or decreased breath sounds. Consider advanced airway management techniques, such as endotracheal intubation or cricothyroidotomy, if necessary, performed by qualified personnel.
• Protecting the cervical spine is crucial, particularly in suspected mechanism of injury involving high-impact forces. Immobilization using a cervical collar and long spine board is essential until cervical spine injury is ruled out by imaging.

B – Breathing and Ventilation:

• Assess respiratory effort: Observe the rate, depth, and pattern of breathing. Look for paradoxical chest movement (flail chest), decreased breath sounds, and use of accessory muscles.
• Auscultate the lungs: Listen for diminished or absent breath sounds, indicating pneumothorax or hemothorax.
• Manage respiratory compromise: Provide supplemental oxygen via a non-rebreather mask or bag-valve mask ventilation if necessary. Consider needle thoracostomy for tension pneumothorax, a life-threatening condition.

C – Circulation:

• Control bleeding: Address any external bleeding, applying direct pressure to wounds. Consider tourniquets if bleeding is uncontrolled.
• Assess heart rate and rhythm: Use a pulse oximeter to monitor oxygen saturation and blood pressure to assess circulatory status.
• Administer fluids: Initiate intravenous (IV) access and administer isotonic crystalloid solutions to maintain blood pressure and tissue perfusion, as clinically indicated.

D – Disability (Neurological Assessment):

• Glasgow Coma Scale (GCS): Assess the client's level of consciousness using the GCS.
• Pupil size and reactivity: Check for any signs of neurological deficits.
• Monitor for signs of head injury: Be aware of potential secondary brain injuries.

E – Exposure and Environmental Control:

• Remove clothing: Expose the client's chest and abdomen to perform a thorough physical examination.
• Maintain body temperature: Prevent hypothermia by using blankets or warming devices.
• Document findings: Meticulously document all findings, interventions, and vital signs.

Transport Considerations for Chest Trauma Patients

Transporting a client with chest trauma requires careful planning and execution. Several factors influence the choice of transport method and the procedures during transportation.

Choosing the Appropriate Stretcher:

The type of stretcher used depends on the client's condition and the terrain. Options include:

• Standard stretcher: Suitable for most stable clients.
• Scoop stretcher: Useful in confined spaces or when moving a client from a difficult location.
• Backboard/Spine board: Essential for suspected spinal injuries.
• Vacuum mattress: Provides excellent immobilization and comfort.

The selection process must prioritize patient safety and comfort, balancing the need for immobilization with the risk of causing further injury during transport.

Monitoring During Transport:

Continuous monitoring is critical throughout the transport process. This includes:

• Vital signs: Regularly assess heart rate, blood pressure, respiratory rate, and oxygen saturation.
• Respiratory status: Listen for changes in breath sounds and observe for respiratory distress.
• Level of consciousness: Monitor the client's alertness and responsiveness.
• Pain management: Administer analgesics as needed to manage pain.
• Fluid resuscitation: Continue fluid administration as necessary to maintain adequate blood pressure.

Any significant changes in the client's condition should be immediately reported to the receiving hospital. A clear communication channel between the emergency medical service (EMS) crew and the hospital staff is crucial for a seamless handover.

Securing the Client on the Stretcher:

Proper securing of the client to the stretcher is crucial to prevent movement and potential further injury during transport. This involves:

• Using appropriate restraints: Use straps or other securing devices to prevent the client from sliding or falling off the stretcher.
• Padding bony prominences: Use padding to protect the client's skin from pressure sores.
• Maintaining spinal alignment: If spinal injury is suspected, maintain proper spinal alignment using a backboard or cervical collar.
• Regular checks: Regularly check the securing devices to ensure they remain properly fastened.

Communication with the Receiving Hospital:

Effective communication with the receiving hospital is crucial. This involves:

• Pre-hospital notification: Notify the hospital as early as possible about the impending arrival of the client.
• Providing pertinent information: Convey vital information, such as the client's condition, vital signs, injuries sustained, and interventions performed.
• Ensuring a smooth handover: Ensure a smooth handover of care to the hospital staff.

Specific Challenges in Transporting Chest Trauma Patients

Several challenges can arise during the transport of clients with chest trauma:

Hypoxia: Maintaining adequate oxygenation can be challenging, especially in cases of pneumothorax, hemothorax, or pulmonary contusion. Continuous monitoring and supplemental oxygen are crucial.

Hemorrhage: Significant blood loss can lead to hypovolemic shock. Rapid fluid resuscitation and blood transfusion may be necessary.

Pain Management: Chest trauma can be extremely painful. Effective pain management is crucial for reducing anxiety and improving the client's overall condition during transport.

Cardiac Arrest: Cardiac arrest can occur in severe cases of chest trauma. Immediate CPR and defibrillation are crucial.

Environmental Factors: Adverse weather conditions or difficult terrain can complicate transportation. Appropriate equipment and precautions should be taken to ensure safe transport.

Post-Transport Considerations

Upon arrival at the hospital, the client with chest trauma needs immediate attention. This includes:

• Rapid assessment: A repeat assessment of the airway, breathing, and circulation is essential.
• Imaging: Chest X-rays, CT scans, and other imaging studies are crucial for diagnosing the extent of injuries.
• Definitive care: This may include surgical intervention, such as thoracotomy or video-assisted thoracoscopic surgery (VATS), mechanical ventilation, and critical care management.

Conclusion

Transporting a client experiencing chest trauma from a disaster scene via stretcher is a complex undertaking requiring a multidisciplinary approach. Careful assessment, meticulous preparation, skillful execution, and efficient communication are all crucial for optimizing patient outcomes. Every step, from the initial assessment to the handover at the hospital, must be carried out with precision and diligence, emphasizing the principles of patient safety and effective emergency medical care. Continuous monitoring, effective communication, and addressing potential complications are key elements in ensuring the successful transport and management of such critical patients. Thorough training and adherence to established protocols are imperative for all personnel involved in this high-stakes process.