2d • EMT Talk
Trauma & Environmental Emergencies
Open Sucking Chest Wound
What it is:
Open defect in the chest wall allowing air to move in and out of the thoracic cavity
Pathophysiology
During Inspiration:
- Intrathoracic pressure becomes negative
- Air is pulled into the chest
- Air may enter through the wound instead of the trachea
During Exhalation:
- Intrathoracic pressure becomes positive
- Air is pushed out of the chest (including through the wound)
Why it’s dangerous:
- Air bypasses normal airway → impaired ventilation
- Can progress to tension pneumothorax
EMS Management
- Apply occlusive dressing immediately (BLS first)
- Prefer vented dressing
- Monitor for signs of tension pneumothorax
NREMT Pearl: Air moves through wound: negative pressure in, positive pressure out
Basilar Skull Fracture
What it is:
A basilar skull fracture is a break in the bones at the base of the skull, often caused by significant head trauma, and is commonly associated with signs such as Battle’s sign, raccoon eyes, and cerebrospinal fluid (CSF) leakage.
Classic Signs (MEMORIZE)
Battle’s Sign
- Bruising behind the ear (mastoid)
- Indicates basilar skull fracture
Raccoon Eyes
- Periorbital ecchymosis
CSF Leakage
- Clear fluid from nose or ears
- Possible halo sign
NREMT Decision Point
If these signs are present → assume basilar skull fracture
EMS Considerations
- Avoid nasopharyngeal airway (NPA)
- Spinal precautions
- Gentle airway management
NREMT Pearl: Battle’s sign = basilar skull fracture until proven otherwise
Babinski Reflex
What it is:
Neurologic reflex tested by stroking the sole of the foot
Normal vs Abnormal
Normal (adults)
- Toes curl downward
Positive Babinski (ABNORMAL)
- Big toe extends upward
- Other toes fan out
What it indicates:
Upper motor neuron / central nervous system damage
Clinical Significance
- Seen in: Brain injury Stroke Spinal cord injury
NREMT Pearl: Upgoing big toe = CNS problem
Heat Exhaustion vs Heat Stroke
Heat Exhaustion
What it is:
Fluid and electrolyte depletion
Presentation
- Cool, clammy skin
- Heavy sweating
- Weakness
- Nausea/vomiting
- Normal or slightly elevated temperature
EMS Management
- Cooling
- Oral/IV fluids
- Rest
Heat Stroke (LIFE-THREATENING)
What it is:
Failure of thermoregulation → core temperature >104°F (40°C)
Presentation (MEMORIZE)
- Hot skin (may be dry or sweaty)
- Altered mental status
- Seizures possible
- Tachycardia
EMS Management
- Rapid cooling immediately
- Airway support
- IV fluids
NREMT Pearl: AMS + hot patient = heat stroke
Summary
- Open chest wound → negative pressure pulls air in, positive pushes out
- Battle’s sign / raccoon eyes / CSF leak → basilar skull fracture
- Babinski positive → CNS damage
- Heat exhaustion → cool, sweaty
- Heat stroke → hot, altered, life-threatening
7:35
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Trauma & Environmental Emergencies
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