Paramedic Trauma Study Guide
Download Study Guide PDFThis study guide covers Trauma for paramedics, aligned with NREMT paramedic certification standards (National EMS Scope of Practice Model 2019 with updates), AHA BLS/ACLS/PALS 2025 Guidelines (current as of 2026), and PHTLS 10th Edition principles. Trauma is a core domain on the NREMT Paramedic exam, covering advanced patient assessment, hemorrhage control, airway management, shock management, and transport decisions for multi-system trauma. Paramedic Scope in Trauma: Advanced airway management (RSI/DSI, surgical airway), IV/IO access, fluid resuscitation (permissive hypotension), vasopressors, blood product administration (if protocol allows), needle decompression, chest tube insertion (in some protocols), analgesia/sedation, and rapid transport to appropriate trauma centers. Key Principle: Rapid recognition and aggressive management of life threats according to the C-ABCDE sequence (Catastrophic hemorrhage, Airway, Breathing, Circulation, Disability, Exposure). Minimize on-scene time for critical trauma patients (“golden hour”).
Disclaimer: This is a study aid, not official. For PDF, copy into a word processor and export. Always follow current local protocols, NREMT skill sheets, and the latest AHA/PHTLS guidelines.
Section 1: Advanced Trauma Assessment (Paramedic Focus)
Primary Assessment (C-ABCDE with ALS Interventions):
- C – Catastrophic Hemorrhage: Control massive external bleeding (direct pressure, tourniquet, hemostatic dressing, junctional tourniquet). TXA 1g IV/IO over 10 mins within 3 hours of injury.
- A – Airway: Establish and maintain patent airway. Consider RSI/DSI for GCS <8 or impending airway compromise. Use advanced adjuncts (ETT, supraglottic airway). Confirm placement with continuous waveform capnography.
- B – Breathing: Assess for tension pneumothorax (needle decompression), open pneumothorax (vented occlusive dressing), flail chest (stabilize). Manage ventilations to target EtCO&sub2; 35-45 mmHg (avoid hyperventilation unless signs of herniation – then EtCO&sub2; 30-35 mmHg briefly).
- C – Circulation: Obtain 2 large-bore IVs/IOs. Fluid resuscitation with warmed crystalloids; permissive hypotension (SBP 80-90 mmHg or palpable radial pulse) for penetrating torso trauma without head injury. Vasopressors (norepinephrine) for refractory shock. Consider blood products if protocol allows.
- D – Disability: GCS score and trend. Pupil exam (size, reactivity, equality). Rapid neuro assessment. Check blood glucose.
- E – Exposure/Environment: Full exposure to identify all injuries. Cover with warm blankets to prevent hypothermia; consider fluid warmers.
Secondary Assessment:
- Rapid Head-to-Toe Exam: DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling).
- AMPLE History: Allergies, Medications, Past medical history, Last oral intake, Events leading to injury.
- Pain Management: Fentanyl 1-2 mcg/kg IV/IN/IM (titrate), ketamine for analgesia/sedation.
Section 2: Hemorrhage Control & Shock Management
Advanced Hemorrhage Control:
- TXA (Tranexamic Acid): 1 gram IV/IO over 10 minutes, followed by 1 gram over 8 hours. Administer within 3 hours of injury for significant hemorrhage/shock.
- Massive Transfusion Protocol (MTP): Activation if available for severe hemorrhagic shock (e.g., >3 units PRBC in 1 hour).
- Permissive Hypotension: Target SBP 80-90 mmHg for penetrating torso trauma without head injury to prevent clot dislodgement.
Types of Shock in Trauma:
- Hypovolemic Shock: Most common. Due to blood loss. Treat with fluids, blood products, hemorrhage control.
- Obstructive Shock: Tension pneumothorax, cardiac tamponade. Treat underlying cause.
- Neurogenic Shock: Spinal cord injury. Hypotension (often with bradycardia) due to loss of sympathetic tone. Treat with fluids (cautious) and vasopressors.
Section 3: Thoracic & Abdominal Trauma
| Injury | Signs/Symptoms | Paramedic Management | Key Notes |
|---|---|---|---|
| Tension Pneumothorax | Absent breath sounds (affected side), tracheal deviation (late), JVD, hypotension, severe dyspnea | Needle decompression (2nd ICS mid-clavicular or 4th/5th ICS anterior axillary line) | Immediate life-threat; do NOT wait for tracheal deviation. |
| Open Pneumothorax (Sucking Chest) | Sucking sound through wound, air movement | Vented occlusive dressing (3 sides taped) | Monitor for tension pneumothorax. |
| Cardiac Tamponade | Beck’s Triad (JVD, muffled heart sounds, hypotension), narrow pulse pressure | Rapid transport; fluids (cautious) to maintain preload; pericardiocentesis if protocol/training allows | Often penetrating trauma to chest. |
| Abdominal Trauma | Distension, rigidity, guarding, pain, signs of shock | Rapid transport to trauma center; IV/IO access; fluids (permissive hypotension); prepare for evisceration management | High index of suspicion for internal bleeding. |
Section 4: Head & Spinal Trauma
Head Trauma:
- Signs of Increased Intracranial Pressure (ICP): Cushing’s Triad (HTN with wide pulse pressure, bradycardia, irregular respirations), altered LOC, unequal/dilated pupils, posturing.
- Management: Maintain airway (RSI/DSI if needed), ventilate to maintain EtCO&sub2; 35-45 mmHg (brief hyperventilation to 30-35 mmHg for signs of herniation), elevate head of bed 30°, avoid hypotension (target SBP >110 mmHg), consider mannitol 0.25-1 g/kg IV or hypertonic saline if protocol allows.
Spinal Trauma:
- Spinal Motion Restriction (SMR): Apply if high-energy MOI, midline spinal tenderness, neurological deficit, altered LOC, distracting injury, intoxication.
- Neurogenic Shock: Hypotension with bradycardia, warm/dry skin below injury. Manage with cautious fluids and vasopressors (norepinephrine).
Section 5: Burns
Burn Assessment:
- Rule of Nines (Adult): Head 9%, each arm 9%, chest 9%, abdomen 9%, each leg 18%, back 18%, perineum 1%.
- Palmar Method: Patient’s palm = ~1% TBSA.
- Depth: Superficial (1st degree), Partial thickness (2nd degree), Full thickness (3rd degree). Paramedics classify and initiate treatment; do not try to determine exact depth in field.
Burn Management:
- Stop burning process (remove clothing/jewelry).
- ABCDEFG: Airway (intubate early if facial burns, stridor, hoarseness), Breathing (high-flow O&sub2;), Circulation (2 large-bore IVs/IOs).
- Fluid Resuscitation (Parkland Formula): 4 mL × kg × %TBSA (half in 8 hrs, rest in 16 hrs). Administer warmed fluids.
- Cover burns with dry sterile dressings (prevent hypothermia/infection).
- Pain management (fentanyl, ketamine).
- Carbon Monoxide poisoning: 100% O&sub2; via non-rebreather.
- Special Considerations: Chemical burns (irrigate), electrical burns (cardiac monitoring).
Section 6: NREMT Paramedic Skill Emphasis & High-Yield Scenarios
- RSI/DSI: For definitive airway control in patients with GCS <8 or impending airway failure. Use paralytics (succinylcholine, rocuronium) and sedatives (ketamine, etomidate).
- Needle Decompression: Life-saving intervention for tension pneumothorax.
- Massive Hemorrhage Control: Apply tourniquets, hemostatic dressings, TXA.
- Fluid Resuscitation: Balanced approach (permissive hypotension, warm fluids).
- Scenarios: Multi-system trauma with head injury → RSI, EtCO&sub2; target, SBP >110 mmHg. Burn patient with airway compromise → early intubation, fluid calculation, cover burns.
Example Math (Fluid for Burn Patient):
Question: A 70 kg adult has full and partial thickness burns covering 30% TBSA. Using the Parkland formula (4 mL/kg/%TBSA), how much fluid should be administered in the first 8 hours? Solution: 4 mL × 70 kg × 30% = 8400 mL total. First 8 hours = 8400 mL / 2 = 4200 mL. Reasoning: Calculate total fluid, then divide by 2 for the first 8 hours. Review NREMT Paramedic skill sheets (e.g., Ventilatory Management - Adult, Spinal Immobilization, Advanced Medication Administration), PHTLS algorithms, and practice complex trauma scenarios. Good luck on your paramedic certification—be systematic, anticipate complications, and provide advanced, life-saving care! 🚑