Trauma

Multiple Injuries
Accidents
Alexis Luigi Lorenzo C. Cresencia, RN, MD
 TRAUMA
• UNINTENTIONAL/INTENTIONAL WOUND OR INJURY INFLICTED ON THE BODY
FROM A MECHANISM AGAINST WHICH THE BODY CANNOT PROTECT ITSELF
• LEADING CAUSE OF DEATH IN CHILDREN & ADULTS YOUNGER THAN 44 YEARS
• INCREASED INCIDENCE IN >44 YEARS
• ALCOHOL ABUSE
• DRUG ABUSE
 INJURY PREVENTION
•3 COMPONENTS
1. EDUCATION
• INFORMATION & MATERIALS TO PREVENT VIOLENCE AND MAINTAIN SAFETY AT
HOME AND IN VEHICLES
• LOCAL INJURY PREVENTION ORGANIZATIONS
• AVOID USING THE WORD “ACCIDENT”
• PEOPLE WHO ARE AT RISK FOR TRAUMA & TRAUMA RECIDIVISM SHOULD BE
IDENTIFIED
INJURY PREVENTION
2. LEGISLATION
•TO PROVIDE UNIVERSAL SAFETY MEASURES
3. AUTOMATIC PROTECTION
•AIRBAGS
•AUTOMOTIVE DESIGN
•PROVIDE SAFETY WITHOUT REQUIRING PERSONAL
INTERVENTION
 INJURY PREVENTION PROGRAM
•USE A FOCUS SIMILAR TO THE ABCDE APPROACH IN THE
PRIMARY SURVEY
•A – SSESSMENT
•B – UILDING
•C – OMMUNICATING AWARENESS
•D – EVELOPING AND IMPLEMENTING INTERVENTIONS
•E – VALUATING THE INJURY PREVENTION PROGRAM
 INTRA-ABDOMINAL INJURIES
• PENETRATING ABDOMINAL INJURIES
• GUNSHOT WOUNDS, STAB WOUNDS
• RESULTS IN A HIGH INCIDENCE OF INJURY TO HOLLOW ORGANS (SMALL BOWEL)
• LIVER
• GSW – VELOCITY AT WHICH THE MISSILE ENTERS THE BODY
• BLUNT TRAUMA
• MOTOR VEHICLE CRASHES, FALLS, BLOWS OR EXPLOSIONS
• COMMONLY ASSOCIATED WITH EXTRA-ABDOMINAL INJURIES
• INCIDENCE OF DELAYED AND TRAUMA-RELATED COMPLICATIONS IS GREATER
ASSESSMENT & DIAGNOSTIC FINDINGS
•ABDOMINAL ASSESSMENT
•BOWEL SOUNDS
• ABSENCE – EARLY SIGN OF INTRAPERITONEAL INVOLVEMENT
•PERITONEAL IRRITATION
•HYPOTENSION
•S&SX OF SHOCK
LABORATORY STUDIES
•SERIAL HEMOGLOBIN & HEMATOCRIT
•LACTATE – ACIDOSIS
•ABG
•INTERNATIONAL NORMALIZED RATIO (INR)
•WBC COUNT
 INTERNAL BLEEDING
• HEMORRHAGE + ABDOMINAL INJURY (LIVER OR SPLEEN)
• ASSESS CONTINUOUSLY FOR SIGNS AND SYMPTOMS OF EXTERNAL AND
INTERNAL BLEEDING
• FRONT OF BODY, FLANKS AND BACK
• BLUISH DISCOLORATION, ASYMMETRY, ABRASION, AND CONTUSION
• ABDOMINAL CT SCAN
• ABDOMINAL ULTRASOUND (FAST)
• PAIN – OPIOIDS
• LEFT SHOULDER – BLEEDING FROM RUPTURED SPLEEN
• RIGHT SHOULDER – LIVER LACERATION
INTRAPERITONEAL INJURY
• TENDERNESS, REBOUND TENDERNESS, GUARDING, RIGIDITY, SPASM, INC.
DISTENTION AND PAIN
• REFERRED PAIN – INTRAPERITONEAL INJURY
• PERITONEAL LAVAGE, ABDOMINAL UTZ OR CT SCAN
• DPL - USED TO EVALUATE TRAUMATIZED ABDOMEN
• INSTILLATION WARMED LR OR NSS 1L
• POSITIVE FINDINGS:
• RBC > 100,000/MM3
• WBC > 500/MM3
• PRESENCE OF BILE, FECES OR FOOD
• STAB WOUND - SONOGRAPHY
GENITOURINARY INJURY
•RECTAL AND/OR VAGINAL EXAMINATION
•INJURY TO THE PELVIS, BLADDER, URETHRA, VAGINA OR
INTESTINAL WALL
•MALE – HIGH-RIDING PROSTATE GLAND
•FEMALE – OPEN PELVIC FX
•IFC AFTER EXAMINATION
MANAGEMENT
• RESUSCITATION PROCEDURES
• BLUNT TRAUMA
• IMMOBILIZE
• C-SPINE IMMOBILIZATION
• LOGROLLING
• KNOW THE MECHANISM OF INJURY
• ABDOMINAL VISCERA PROTRUSION/EVISCERATION
• COVER WITH STERILE, MOIST SALINE DRESSINGS TO KEEP THE VISCERA FROM
DYING

• NPO AND OGT/NGT

MANAGEMENT
•TETANUS PROPHYLAXIS
•BROAD-SPECTRUM ANTIBIOTICS
•CONTINUOUS MONITORING
•GOAL: MINIMIZE LENGTH OF STAY IN THE ED
VEHICULAR ACCIDENTS
•ABC
•CHECK FOR BLEEDING
•IMMOBILIZE
•CAREFULLY EXAMINE FOR FURTHER INJURIES
•APPLY APPROPRIATE FIRST-AID MEASURES
IN CASE OF FRACTURES, WAIT FOR MEDICAL HELP OR IF THE PATIENT MUST
BE MOVED IN ORDER TO GET HELP, FOLLOW THE SUGGESTED PROCEDURES
FOR DEALING WITH FRACTURES AND FOR MOVING INJURED PERSON.
 CRUSH INJURIES
•OCCURS WHEN A PERSON IS CAUGHT IN BETWEEN OPPOSING FORCES
•RUN OVER BY A MOVING VEHICLE
•CRUSHED BETWEEN 2 CARS/ UNDER A COLLAPSED BUILDING
ASSESSMENT & DIAGNOSTIC FINDINGS
•HYPOVOLEMIC SHOCK •FRACTURES
•SPINAL CORD INJURY
•ERYTHEMA & BLISTERS •ACUTE KIDNEY INJURY
 MANAGEMENT
•ABC
•OBSERVE FOR AKI
•RHABDOMYOLYSIS
•MYALGIAS, GEN. MUSCLE WEAKNESS, DARKENED URINE
•SPLINTING/ELEVATE AFFECTED EXTREMITY
•COMPARTMENT SYNDROME (5P) – FASCIOTOMY
•MEDICATIONS AS PRESCRIBED/ORDERED
•HYPERBARIC OXYGEN CHAMBER
 MULTIPLE TRAUMA
•CAUSED BY A SINGLE CATASTROPHIC EVENT THAT CAUSES LIFE-
THREATENING INJURIES TO AT LEAST 2 DISTINCT ORGANS/ORGAN
STSTEMS
•MORTALITY R/T SEVERITY OF INJURIES, # OF SYSTEMS & ORGANS
INVOLVED, SEVERITY OF EACH INJURY ALONE AND IN COMBINATION
•HYPERMETABOLIC, HYPERCOAGULABLE AND SEVERELY STRESSED
ASSESSMENT AND DIAGNOSTIC FINDINGS
•EXTERNAL EVIDENCE – SPARSE OR ABSENT
•ASSUMED WITH SCI UNTIL PROVEN OTHERWISE
•INJURY REGARDED AS THE LEAST SIGNIFICANT IN
APPEARANCE MAY BE THE MOST LETHAL
•PELVIC FRACTURES VS. OBVIOUS ARM AMPUTATION
 MANAGEMENT
•GOALS: TO DETERMINE EXTENT OF INJURIES & ESTABLISH
PRIORITIES OF TREATMENT
•HIGHEST PRIORITY: INTERFERING WITH A VITAL
PHYSIOLOGIC FUNCTION (ABC)
•AFTER RESUSCITATION, CLOTHES ARE REMOVED/CUT OFF
•RAPID PHYSICAL ASSESSMENT
•PROPER AND COORDINATED TRANSFER TO THE ED
PRIORITY MANAGEMENT IN MULTIPLE INJURIES
 FRACTURES
•IMMEDIATE APPROPRIATE MANAGEMENT MAY DETERMINE THE
PATIENT’S EVENTUAL OUTCOME AND MAY MEAN THE DIFFERENCE
BETWEEN RECOVERY AND DISABILITY
•HANDLE BODY PART GENTLY AND AS LITTLE AS POSSIBLE
•CUT OFF CLOTHING
 PAIN  TENDERNESS
•ASSESS FOR:  SWELLING
 CREPITATION
 ECCHYMOSIS
 MANAGEMENT
•ABC
•NEUROLOGIC INJURY
•PULSELESS EXTREMITY – REPOSITIONING
•FEMUR – HARE TRACTION
•CEPHALOCAUDAL APPROACH – ESP. PERIPHERAL PULSES
•SPLINT BEFORE MOVING PATIENT
 SPLINTING
• IMMOBILIZES THE JOINT AT SITE DISTAL AND PROXIMAL TO THE FRACTURE
• RELIEVES PAIN
• IMPROVES CIRCULATION
• PREVENTS FURTHER TISSUE INJURY
• PREVENTS A CLOSED FX FROM BECOMING AN OPEN FX
• ONE HAND – DISTAL TO FX AND TRACTION APPLICATION
• OTHER HAND – BENEATH FRACTURE
• SPLINT SHOULD EXTEND BEYOND THE JOINTS ADJACENT TO THE FRACTURE
• AFTER – NEUROVASCULAR STATUS ASSESSMENT
 JOINT DISLOCATIONS
• ARTICULAR SURFACES OF THE DISTAL AND PROXIMAL BONES ARE NO LONGER
IN ANATOMIC ALIGNMENT
• “OUT OF JOINT”
• SUBLUXATION – PARTIAL DISLOCATION
• TRAUMATIC DISLOCATIONS = ORTHOPEDIC EMERGENCY
• IF NOT REDUCED IMMEDIATELY, AVASCULAR NECROSIS MAY DEVELOP
• S&SX OF TRAUMATIC DISLOCATION: ACUTE PAIN
CHANGE/AWKWARD POSITIONING
DECREASE ROM
MEDICAL MANAGEMENT
•IMMOBILIZATION
•CLOSED REDUCTION
•ANALGESIA
•MUSCLE RELAXANTS
•ANESTHESIA (IF POSSIBLE)
•SPLINTS/CAST/TRACTION
•NEUROVASCULAR STATUS Q15 MINS UNTIL STABLE
NURSING MANAGEMENT
•FOCUS: FREQUENT ASSESSMENT & EVALUATION OF THE INJURY
•COMPLETE NEUROVASCULAR ASSESSMENT WITH PROPER
DOCUMENTATION

•PATIENT AND FAMILY EDUCATION

•PROPER EXERCISES & ACTIVITIES
•COMPARTMENT SYNDROME
 SPRAIN STRAIN
Immobilize Immobilize
Cold compress Cold compress
Elevate Elevate
Warm Compress Relaxant
Cast
Surgery
 SPINAL CORD INJURY
• INJURY TO THE SPINAL CORD, VERTEBRAL COLUMN, SUPPORTING SOFT TISSUE, OR
INTERVERTEBRAL DISCS
• COMMON CAUSES:
• MOTOR VEHICLE CRASHES
• FALLS
• VIOLENCE (GSW)
• SPORTS-RELATED INJURIES
• PREDOMINANT RISK FACTORS:  Young age
 Male
 Alcohol and Drug abuse
• PARAPLEGIA & QUADRIPLEGIA
PATHOPHYSIOLOGY
•RANGES FROM TRANSIENT CONCUSSION TO CONTUSION,
LACERATION AND COMPRESSION OF THE SC TISSUE TO COMPLETE
TRANSECTION OF THE SC
•C5-C7, T12 AND L1 – MOST SUSCEPTIBLE
•2 CATEGORIES:
• PRIMARY – RESULT OF THE INITIAL INSULT/TRAUMA; USUALLY
PERMANENT
• SECONDARY – EDEMA AND HEMORRHAGE
 CLINICAL MANIFESTATIONS
• COMPLETE – LOSS OF BOTH SENSORY AND VOLUNTARY MOTOR
COMMUNICATION
• INCOMPLETE – SENSORY AND/OR MOTOR FIBERS ARE PRESERVED BELOW
THE LESION
• CLASSIFIED ACCORDING TO AREA OF DAMAGE: CENTRAL, LATERAL, ANTERIOR
OR PERIPHERAL
• ACUTE PAIN IN BACK/NECK (MAY RADIATE)
• RESPIRATORY DYSFUNCTION R/T LEVEL OF INJURY
• C4, T1-T6, T6-T12
CENTRAL CORD SYNDROME
• CHARACTERISTICS:
MOTOR DEFICITS (MORE IN UPPER EXTREMITIES)
SENSORY LOSS – VARIES (MORE PRONOUNCED
IN UPPER EXTREMITIES)
BOWEL/BLADDER DYSFUNCTION –
VARIABLE/PRESERVED COMPLETELY
• CAUSES:
INJURY/EDEMA OF THE CENTRAL CORD
HYPEREXTENSION INJURIES
ANTERIOR CORD SYNDROME
• CHARACTERISTICS:
LOSS OF PAIN, TEMPERATURE, AND MOTOR FUNCTION
INTACT LIGHT TOUCH, POSITION, AND VIBRATION
SENSATION

• CAUSES:
ACUTE DISC HERNIATION
HYPERFLEXION INJURIES (FRACTURES/DISLOCATION)
INJURY TO THE ANTERIOR SPINAL ARTERY
LATERAL CORD SYNDROME
• BROWN-SÉQUARD SYNDROME
• CHARACTERISTICS:
IPSILATERAL PARALYSIS/PARESIS
IPSILATERAL LOSS OF TOUCH, PRESSURE, AND VIBRATION
CONTRALATERAL LOSS OF PAIN AND TEMPERATURE
• CAUSES:
TRANSVERSE HEMISECTION OF THE CORD
KNIFE OR MISSILE INJURY
FRACTURE/DISLOCATION OF A UNILATERAL ARTICULAR
PROCESS
ACUTE RUPTURED DISC
ASIA CLASSIFICATION OF SCI
FUNCTIONAL ABILITIES BY LEVEL OF CORD INJURY
FUNCTIONAL ABILITIES BY LEVEL OF CORD INJURY
ASSESSMENT AND DIAGNOSTIC FINDINGS
•NEUROLOGIC EXAMINATION
•DIAGNOSTIC X-RAYS (LATERAL CERVICAL SPINE)
•CT SCAN
•MRI SCAN – SUSPECTED LIGAMENTOUS INJURY
•MYELOGRAM – IF MRI IS CONTRAINDICATED
•CONTINUOUS ECG MONITORING – BRADYCARDIA & ASYSTOLE
 EMERGENCY MANAGEMENT
• RAPID ASSESSMENT, IMMOBILIZATION, EXTRICATION, STABILIZATION AND
TRANSPORTATION TO A TRAUMA CENTER
• IMMOBILIZE ON A SPINAL BOARD WITH HEAD AND NECK MAINTAINED IN A
NEUTRAL POSITION
• HEAD BLOCKS
• KEPT ON THE TRANSFER BOARD
• MAINTAINED IN AN EXTENDED (SUPINE) POSITION
• CERVICAL COLLAR
NON-INSTITUTIONAL DELIVERY/BIRTH
•DO NOT HURRY THE BIRTH
• WASH YOUR HANDS, KEEP THE SURROUNDINGS CLEAN
•DURING THE BIRTH PROCESS, ONLY SUPPORT THE EMERGING
BABY
•WHEN THE BABY HAS BEEN DELIVERED, PLACE BETWEEN THE
MOTHER’S THIGHS WITH THE HEAD SLIGHTLY LOWERED
•COVER BOTH MOTHER AND BABY TO KEEP WARM.
NON-INSTITUTIONAL DELIVERY/BIRTH
•GENTLY MASSAGE THE MOTHER’S ABDOMEN
•IMMERSE SCISSORS IN BOILING WATER OR CLEAN THEN WITH
ALCOHOL
•CUT UMBILICAL CORD
•DO NOTHING TO BABY’S EYES, EARS, NOSE OR MOUTH
•NOTIFY THE MOTHER’S PHYSICIAN AND TRANSPORT MOTHER
AND CHILD TO THE APPROPRIATE HOSPITAL
 HYPOTHERMIA
•CORE TEMPERATURE IS < 35C (95F)
•ALCOHOL INGESTION – INCREASES SUSCEPTIBILITY
•MEDICATIONS/MEDICAL CONDITIONS – DECREASE ABILITY TO
SHIVER
•FATIGUE AND SLEEP DEPRIVATION
•WET CLOTHING AND IMMERSION IN COLD WATER HEAT LOSS
•TRAUMA VICTIMS
•FROSTBITE
 ASSESSMENT AND DIAGNOSTIC FINDINGS
•APATHY, POOR JUDGEMENT, ATAXIA, DYSARTHRIA, DROWSINESS
•PULMONARY EDEMA, COAGULOPATHY, COMA
•SHIVERING – SUPPRESSED
•WEAK PULSES
•CARDIAC DYSRHYTHMIAS
•HYPOXEMIA
•ACIDOSIS
MANAGEMENT
•REMOVAL OF WET CLOTHING, CONTINUOUS MONITORING, REWARMING, AND
SUPPORTIVE CARE
•MONITORING
• ABC
• VITAL SIGNS, CVP, UO, ABG
• BLOOD CHEMISTRY (BUN, CREA, GLUCOSE, ELECTROLYTES)
• CHEST X-RAY
• CORE BODY TEMPERATURE – ESOPHAGEAL/ BLADDER/ RECTAL THERMISTOR
• CONTINUOUS ECG MONITORING
• ARTERIAL LINE – BP MONITORING
REWARMING
•ACTIVE INTERNAL (CORE) REWARMING – MOD TO SEVERE HYPOTHERMIA (<28C TO
32.2C [82.5F TO 90F])
CARDIOPULMONARY BYPASS
WARM FLUID ADMINISTRATION
WARMED HUMIDIFIED OXYGEN BY VENTILATOR
WARMED PERITONEAL LAVAGE
MONITOR FOR VENTRICULAR FIBRILLATION
•PASSIVE (SPONTANEOUS) OR ACTIVE EXTERNAL REWARMING – MILD HYPOTHERMIA
(32.2C TO 35C [90F TO 95F))
OVER-THE-BED HEATERS
FORCED-AIR WARMING BLANKETS
SUPPORTIVE CARE
• EXTERNAL CARDIAC COMPRESSION (ONLY AS DIRECTED)
• DEFIBRILLATION OF VENTRICULAR FIBRILLATION
• MECHANICAL VENTILATION & HEATED HUMIDIFIED OXYGEN
• WARMED IV FLUIDS
• SODIUM BICARBONATE (AS ORDERED)
• ANTIARRHYTHMIC MEDICATIONS
• IFC
HEAT-INDUCED ILLNESSES
•MOST SERIOUS: HEAT STROKE
•ACUTE MEDICAL EMERGENCY CAUSED BY FAILURE OF THE HEAT-REGULATING
MECHANISMS OF THE BODY
•MOST COMMON CAUSE: NON-EXERTIONAL, PROLONGED EXPOSURE TO AN
ENVIRONMENT >39.2C (102.5F)
•EXERTIONAL HEAT STROKE – STRENUOUS PHYSICAL ACTIVITY
•HEAT EXHAUSTION - EXCESSIVE LOSS OF WATER AND ELECTROLYTES
•HEAT CRAMPS/ILLNESS – LOSS OF ELECTROLYTES DURING STRENUOUS
PHYSICAL ACTIVITY
ASSESSMENT AND DIAGNOSTIC FINDINGS
• THERMAL INJURY AT CELLULAR LEVEL – COAGULOPATHIES, DAMAGE TO THE HEART, LIVER, AND
KIDNEYS
Heat Stroke Heat Exhaustion Heat Cramps
Profound CNS dysfunction Headaches Muscle cramps
Elevated body temperature Anxiety o Shoulders
(> 40.6c [105F]) Syncope o Abdomen
o Lower Extremities
Hot, dry skin Profuse
Profound diaphoresis
Anhidrosis diaphoresis
Profound thirst
Tachypnea & tachycardia Gooseflesh
Hypotension Orthostasis
MANAGEMENT
• MAIN GOAL: REDUCE THE HIGH BODY TEMPERATURE AS QUICKLY AS POSSIBLE
• MORTALITY RELATED TO DURATION OF HYPERTHERMIA
• SIMULTANEOUS TREATMENT ON STABILIZING OXYGENATION USING CAB
• IV ACCESS
• COOL SHEETS & TOWELS OR CONTINUOUS SPONGING WITH COOL WATER
• ICE APPLIED TO THE NECK, GROIN, CHEST AND AXILLA WHILE SPRAYING TEPID WATER
• COOLING BLANKETS
• IMMERSION OF PATIENT IN A COLD WATER BATH
• ELECTRIC FAN
• STOP AT 38C
MANAGEMENT
• VITAL SIGNS
• ECG FINDINGS
• LOC
• OXYGEN SUPPORT/ET INTUBATION & MECHANICAL VENTILATION (IF SEIZURE OCCURS)
• IV INFUSION: PNSS OR PLR
• UO MONITORING
• BLOOD SPECIMENS
• ANTICONVULSANTS
• POTASSIUM SUPPLEMENTS
• SODIUM BICARBONATE
• BENZODIAZEPENES & PHENOTHIAZENES
MANAGEMENT
•HEAT EXHAUSTION •HEAT CRAMPS
LIE SUPINE IN A COOL LIE SUPINE IN A COOL
ENVIRONMENT ENVIRONMENT
IV FLUIDS ORAL SODIUM SUPPLEMENTS
ORAL FLUIDS (IF TOLERATED) ORAL ELECTROLYTE SOLUTIONS
CONVULSIONS
• IN CONVULSIVE ATTACKS, THE VICTIM’S LIPS TURN BLUE, HIS EYES ROLL UPWARD, HIS HEAD IS THROWN BACK, HIS
BODY IS JERKED BY UNCONTROLLABLE SPASMS.

• DON’T TRY TO RESTRAIN CONVULSIVE MOVEMENT

• PLACE THE VICTIM ON THE FLOOR
• RUN HEAD TO ONE SIDE TO ALLOW SALIVA TO DRAIN
• MOVE FURNITURE TO PREVENT INJURY
• PUT A ROLLED HANDKERCHIEF BETWEEN TEETH TO KEEP FROM BITING TONGUE
• IF WITH FEVER, PLACE COOL, WET CLOTHS ON FOREHEAD AND SPONGE BODY WITH ALCOHOL OR COOL WATER
• WHEN THE SPASMS SUBSIDE, MAKE THE PATIENT COMFORTABLE AS POSSIBLE
• CALL A DOCTOR
• CONVULSIONS USUALLY LAST ONLY A FEW MINUTES, BUT THE VICTIM SHOULD HAVE IMMEDIATE MEDICAL ATTENTION.
BE CERTAIN THAT HIS AIRWAY REMAINS OPEN
HYPERVENTILATION
• COMMON COMPLICATION OF EMOTIONAL UPSET AND MOST OFTEN AFFECTS ANXIOUS, HIGH STRUNG
PERSONS WHO UNKNOWINGLY BREATHE TOO RAPIDLY

• DISTURBS THE NORMAL BALANCE OF THE CARBON DIOXIDE IN THE BLOOD

• TINGLING AND SPASMS OF THE FINGERS AND TOES AND A PECULIAR NUMBNESS AROUND THE MOUTH
• THE PATIENT’S COLOR AND PULSE REMAIN NORMAL
• NOT A DANGEROUS CONDITION
• CAN USUALLY BE HELPED BY REASSURANCE
• HAVE THE PERSON BREATHE SLOWLY FOR 10 MINUTES, OCCASIONALLY LONGER INTO A PAPER (NOT
PLASTIC) BAG HELD TIGHTLY OVER HIS MOUTH AND NOSE.
• IF THIS DOES NOT WORK, TAKE PATIENT TO A HOSPITAL EMERGENCY ROOM.
DIABETES MELLITUS
•INABILITY OF THE BODY TO CONVERT SUGAR FROM FOOD INTO
ENERGY
•INSULIN – IS A HORMONE THAT HELPS THE BODY TO USE THE
SUGAR
•LEADS TO: BLINDNESS, NERVE DISEASE, HEART DISEASE, STROKE
2 TYPES OF EMERGENCY:
•INSULIN REACTION (INSULIN SHOCK)
•OCCURS WHEN TOO MUCH INSULIN IS IN THE BODY
•DIABETIC COMA
•HAPPENS WHEN THERE IS TOO MUCH SUGAR AND TOO LITTLE
INSULIN IN THE BLOOD, AND BODY CELLS DO NOT GET ENOUGH
NOURISHMENT
S&SX OF INSULIN REACTION
• FAST BREATHING
• FAST PULSE
• DIZZINESS
• WEAKNESS
• CHANGE IN LOC
• VISION DIFFICULTIES
• SWEATING
• HEADACHE
• NUMBNESS
• HUNGER
S&SX OF DIABETIC COMA
• DROWSINESS AND CONFUSION
• DEEP AND FAST BREATHING
• THIRST
• DEHYDRATION
• FEVER
• CHANGE IN LOC
• SWEET OR FRUITY SMELLING BREATH
FIRST AID
•FULLY CONSCIOUS – GIVE SUGAR, CANDY,
FRUIT JUICE, SOFT DRINK AND SUGAR
•UNCONSCIOUS – CHECK ABC’S AND CALL FOR
HELP
•CARE FOR SHOCK
 SHOCK
• BLEEDING WOUND, FRACTURE & MAJOR BURNS
• PALLOR
• COLD AND CLAMMY EXTREMITIES
• RAPID PULSE
• SHALLOW, RAPID OR IRREGULAR BREATHING
• THE INJURED PERSON IS FRIGHTENED, RESTLESS, APPREHENSIVE OR COMATOSE.
• KEEP THE PATIENT LYING DOWN WITH HEAD LOWER THAN FEET (EXCEPT THAT IN CASES OF HEAD OR CHEST INJURIES,
• WHEN THE PATIENT HAS DIFFICULTY BREATHING, THE HEAD AND SHOULDER SHOULD BE RAISED SO THAT THE HEAD
IS TEN INCHES HIGHER THAN THE FEET)
• LOOSEN PATIENT’S CLOTHING
• GET THE PATIENT TO A HOSPITAL EMERGENCY ROOM, OR CALL AN AMBULANCE
COLLECTION OF FORENSIC EVIDENCE
• METICULOUS DOCUMENTATION
• CLOTHING – DO NOT CUT THROUGH/DISRUPT ANY TEARS, HOLES, BLOOD STAINS OR DIRT
PLACE IN PAPER BAG
IF WET, AIR DRY
LABEL ONCE PLACED IN A STORAGE
• SUICIDE/HOMICIDE – AUTOPSY
TUBES AND LINES REMAIN IN PLACE (IF ANY)
HANDS COVERED WITH PAPER BAGS
• PATIENTS WHO SURVIVED TRAUMA
TISSUE SPECIMENS – HANDS AND NAILS
PHOTOGRAPHS OF WOUNDS/CLOTHING
STATEMENTS MADE BY THE PATIENT