# Trauma: bleeding, limb injury & TBI

Control hemorrhage, protect perfusion and ventilation, and recognize destination needs.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/trauma/
Official source: [SO-T-005 — General Injury and Trauma - Adult / Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- A fluid threshold for general medical hypotension is not the same as the TBI threshold.
- Trauma-center designation and high hemorrhage risk are ketorolac exclusions in PR-075.

## Source documents

- [SO-T-005 — General Injury and Trauma - Adult / Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf)
- [B-010 — Tourniquets: Indications and Procedure](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12429.pdf)
- [PR-075 — Ketorolac for Patient Analgesia](https://www.ochealthinfo.com/sites/healthcare/files/2025-05/PR-75%20ketorolac%205-2025.pdf)

## Bleeding control & transport

- Start direct pressure. If bleeding continues, consider an approved hemostatic dressing; use a tourniquet for uncontrolled extremity hemorrhage under B-010.
- Do not delay transport to establish IV access. For hypotension, the adult order starts with 250 mL saline and permits continued infusion to support perfusion.
- Base contact is required for trauma-triage criteria, hypotension, or saline needed for stabilization.

## Limb injuries & impaled objects

- Splint/immobilize fractures and document distal pulses and sensation. Cold packs over a splint may improve comfort.
- Stabilize impaled objects when possible. Do not remove face/neck objects unless ventilation is compromised; avoid delays to extrication/transport.
- For qualifying pain with systolic BP above 90, source options include morphine 5 mg (or 4 mg carpuject) IV/IM, fentanyl 50 mcg IV/IM, or fentanyl 100 mcg IN, each with one repeat after 3 minutes as specified.

## Suspected traumatic brain injury

- Monitor SpO₂ continuously and escalate oxygen/airway/ventilation support to maintain saturation above 90%. Use continuous ETCO₂ and target 35–45 mmHg when possible, especially during assisted ventilation.
- Check systolic BP every 5 minutes. Below 100, give 250 mL saline and continue infusion toward BP above 100; for age 65 and older, use the source’s below-110 trigger and above-110 target.
- At GCS 8 or below, establish an airway by the most appropriate available means. Transport to a trauma center.

## Handoff

- Report mechanism, hemorrhage control, tourniquet time, neurologic findings, oxygenation/ETCO₂, BP trends, and treatment response.
- Use the complete SO-T-005 for eye injury, airbag exposure, pregnancy-positioning, and other branches beyond this focused guide.