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TRAUMA CARE is pregnancy possible?2–4,26–31 Obtain a complete set of vital signs, including heart rate, EKG, blood pressure, skin temperature and respiratory rate, as early as possible. Rapidly assess and monitor breath sounds and respiratory effort. Reassess vitals every 10 minutes, or more frequently as needed.2–4,26–31 Treatment Treatment will be influenced by a number of factors, including the severity of the patient's condition, mechanism of injury, level of services available in the field and local protocols. Recall that the management of immediately life-threatening traumatic injuries (e.g., uncontrolled bleeding) should take priority over management of non-life-threatening conditions (e.g., extremity fractures). The presence or suspicion of injuries must also be consid- ered when determining destination. If multisystem trauma is involved, the patient may initially be transported to a trauma center for resuscitation, then transferred later if needed. Spinal immobilization may be indicated. Providers should consult their local protocols regarding indications and technique.2–4,26–33 Treatment should always start with securing the patient's ABCs and managing any life threats. Manage the airway, using manual support as needed. This can range from the simple jaw thrust to endotracheal intubation. Airway management and administration of supplemental oxygen are mainstays of resuscitation efforts. Consider adminis- tering oxygen whenever hypoxia and/or acidosis is anticipated or suspected.2–4 After securing the patient's ABCs and managing any life-threatening injuries, subsequent treatment can begin. This may include wound care, establishing IV access and fluid resuscitation. When an intravenous line is started, blood work may be obtained according to local protocols.2–4 Take care to proactively maintain the patient's body temperature. This is espe- cially important in scenarios where IV fluid administration is involved. To avoid hypothermia, consider basic measures 50 FEBRUARY 2012 | EMSWORLD.com such as warming the patient compart- ment, ensuring the patient is covered and administrating warm IV fluids.2–4,27,31 Administering intravenous fluids is often indicated in trauma patients. One goal of fluid resuscitation is to allow for the perfusion of vital organs without overhydrating the patient, which may worsen bleeding. Normal saline and lactated Ringer's are appropriate crys- talloid solutions for initial resuscitation in the prehospital setting. IV flow rates and volumes will vary depending on factors including patient age, symptoms and/or injuries, as well as local protocols. When infusing intravenous fluids, monitor the patient's temperature. Cooler fluids may have a significant impact on core body temperature.2–4,27,32 Depending on the patient's condi- tion, it may not be possible to obtain traditional peripheral intravenous access. Intraosseous access and infusion is an option that can be used in the prehos- pital setting. Consult local protocols regarding the use of this procedure.2–4 Additional prehospital treatment will be influenced by a variety of factors, including the patient's chief complaint and overall condition, and provider judg- ment. Pain management may be indi- cated. While medications and specific routes of administration may vary, fentanyl, morphine and Dilaudid are effective in managing pain. If the patient has an altered mental status, focus treat- ment on the underlying cause, such as hypoxia, hypoglycemia or narcotic inges- tion. Potential cardiac findings, such as an irregular heartbeat, palpitations or chest pain, may warrant continuous cardiac monitoring.5–7 Factors such as the patient's age, injuries, vital signs and overall condition will need to be considered.2–4 The specific management of injuries will vary and depend on factors such as the nature of the injury, provider judgment and local protocols. Manage external hemorrhage through the application of direct pressure, use of pressure points and a tourniquet if indicated. Manage suspected fractures using appropriate techniques, including immobilization when indicated.2–4,34 The following are some key reminders to keep in mind when managing a trauma patient and trying to avoid the trauma triad of death. HEAD INJURIES A priority is to ensure that the patient has an open airway and supplemental oxygen is administered. These steps, which can often be completed simulta- neously, are critical when treating for, or attempting to avoid, hypoxia or anoxia. An open airway and oxygen administra- tion also can help avoid the cascade of events involved in the trauma triad of death. NECK TRAUMA Manage this in accordance with local protocols. Remain aware of poten- tial airway compromise. The presence of internal or external neck injury or hemor- rhage must always trigger consideration of airway implications, to avoid hypoxia and ensure the patient has an open airway. Manage external hemorrhage with direct pressure. Consider IV fluid administration. CHEST INJURY This requires the provider to consider numerous factors involved in the trauma triad of death, including hypoxia, hemor- rhage and perfusion. The presence of a tension pneumothorax may require needle decompression. Treating an open chest injury may include use of an occlusive dressing. A flail section or asymmetrical chest may require applying a bulky dressing. Penetrating chest trauma consider- ations should include internal bleeding/ injury and management of hypoxia. Airway management, including assisting and/or supporting the patient's ventila- tions, and administration of oxygen are key interventions. Intravenous fluids, fluid selection, volume and rate of administra- tion should be in accordance with local protocols. Take care during fluid admin- istration to avoid overload. ABDOMINAL TRAUMA Scenarios can encompass open and closed wounds, internal and external