Assessment of the Trauma Patient - EMS Training Incemstraininginc.com/guest/CHAPTER 10 - ASSESMENT...

EMS TRAINING INC. 2003 ©

Assessment ofAssessment ofthe Traumathe Trauma

PatientPatientChapter 10Chapter 10

TRAUMATRAUMA

The Trauma PatientThe Trauma Patient

!! Trauma means “injury”Trauma means “injury”!! Injuries can be internal or externalInjuries can be internal or external!! Patient can deny injuriesPatient can deny injuries!! The Golden HourThe Golden Hour

The Trauma PatientThe Trauma Patient!! Signs & symptoms may not be evidentSigns & symptoms may not be evident

immediatelyimmediately!! We must determine the appropriate facilityWe must determine the appropriate facility

to transport toto transport to!! We want to bring in viable patients …We want to bring in viable patients … ……

not dead packaged patientsnot dead packaged patients

What are you looking for?What are you looking for?

!! DCAP - BTLSDCAP - BTLS!!DeformitiesDeformities BurnsBurns!!ContusionsContusions TendernessTenderness!!AbrasionsAbrasions LacerationsLacerations!!Penetrations/Penetrations/ SwellingSwelling

PuncturesPunctures

The Trauma PatientThe Trauma Patient

!! We must have an organized assessmentWe must have an organized assessmentplan ….plan ….

Why? Why?

The Trauma PatientThe Trauma Patient!! We must have an organized assessmentWe must have an organized assessment

plan ….plan ….!!To find life threatening injuriesTo find life threatening injuries!!Prioritize the treatment of injuriesPrioritize the treatment of injuries!!Determine what patients are treatedDetermine what patients are treated

firstfirst

The Trauma AssessmentThe Trauma Assessment

Trauma Patient Medical patient

Initial Assessment

Scene Survey

Trauma PatientTrauma PatientAssessmentAssessment

!! Reconsider the MOIReconsider the MOI

WHY?WHY?

Reconsider the MOIReconsider the MOI

!! To help you determine how quickly youTo help you determine how quickly youmust transport the patient & whichmust transport the patient & whichassessment to use…assessment to use…

!!Significant MOISignificant MOI!!No Significant MOINo Significant MOI

Significant MOI No Significant MOI

Initial Assessment

Scene Survey

No Significant MOINo Significant MOI

!! No significant MOI & no lifeNo significant MOI & no lifethreatening injuriesthreatening injuries

No Significant MOINo Significant MOI!! Reconsider the MOIReconsider the MOI!! Determine the chief complaintDetermine the chief complaint!! Perform a “Focused Physical Exam”Perform a “Focused Physical Exam”!! Obtain baseline vital signsObtain baseline vital signs!! Take a SAMPLE historyTake a SAMPLE history!! TransportTransport!! Perform an “On-going Assessment”Perform an “On-going Assessment”

!! Why reconsider the MOI?Why reconsider the MOI?Because when you 1st arrive you Because when you 1st arrive you are looking at many things and you are looking at many things and you

could miss something significantcould miss something significant

!! Determine the chief complaintDetermine the chief complaint!!ASK them what hurtsASK them what hurts

No Significant MOINo Significant MOI!! Focused Physical examFocused Physical exam

!!make sure you INSPECT &make sure you INSPECT &PALPATEPALPATE

!!assess the areas of injuryassess the areas of injury!!you will need to expose the injuryyou will need to expose the injury

sitesite!!may lead you to assess other areasmay lead you to assess other areas

!! Baseline Vital SignsBaseline Vital Signs!! SAMPLE history SAMPLE history

!! These are done after youThese are done after youassess injuriesassess injuries

Initial Assessment

Scene Survey

Examples of SignificantExamples of SignificantMOIMOI

!! Ejected from a vehicleEjected from a vehicle!! Death in the same passengerDeath in the same passenger

compartmentcompartment!! Falls > 15 feetFalls > 15 feet!! Falls > 3 times the patients heightFalls > 3 times the patients height!! Roll overRoll over

!! High speed MVCHigh speed MVC!! Auto - pedestrian accidentAuto - pedestrian accident!! Motorcycle accidentsMotorcycle accidents!! Penetrating trauma Penetrating trauma

… shooting, stabbing… shooting, stabbing

!! Special considerations for childrenSpecial considerations for children!!Falls from 10 feet or >Falls from 10 feet or >!!Bicycle collisionsBicycle collisions!!Medium speed vehicle collisionsMedium speed vehicle collisions!!Damaged car seatsDamaged car seats

Significant MOISignificant MOI!! C-spine stabilization, call for ALS,C-spine stabilization, call for ALS,

transport as soon as possibletransport as soon as possible!! “Rapid Trauma Assessment”“Rapid Trauma Assessment”!! Baseline vital signs & SAMPLEBaseline vital signs & SAMPLE!! TransportTransport!! “Detailed Physical Exam”“Detailed Physical Exam”!! “On-going Assessment”“On-going Assessment”

Rapid TraumaRapid TraumaAssessmentAssessment

!! HeadHead!! Neck & apply cervical collarNeck & apply cervical collar!! ChestChest!! AbdomenAbdomen!! PelvisPelvis!! ExtremitiesExtremities!! Posterior bodyPosterior body!! Immobilize patient on a LBBImmobilize patient on a LBB

Rapid Trauma AssessmentRapid Trauma Assessment

!! HeadHead!!check for DCAP - BTLScheck for DCAP - BTLS!!crepitationcrepitation!!massive bleedingmassive bleeding!!check for airwaycheck for airway

obstructionsobstructions

Rapid Trauma AssessmentRapid Trauma Assessment!! NeckNeck

!!check for DCAP - BTLScheck for DCAP - BTLS!!JVDJVD!!tracheal deviationtracheal deviation

!! Apply a cervical collar nowApply a cervical collar now!!what is the function of the cervicalwhat is the function of the cervical

collar?collar?

Applying the CervicalApplying the CervicalCollarCollar

!! It must be the right size … so measureIt must be the right size … so measurecorrectlycorrectly

!!size depends on the length of the necksize depends on the length of the necknot the widthnot the width

!! Assess the neck before applying the collarAssess the neck before applying the collar!! Explain what you are doing to the patientExplain what you are doing to the patient

Applying the Cervical CollarApplying the Cervical Collar!! Keep the head in neutral positionKeep the head in neutral position!! Try to remove necklaces, earrings, hair ifTry to remove necklaces, earrings, hair if

time permitstime permits!! Cervical collars do NOT provideCervical collars do NOT provide

adequate immobilization by themselvesadequate immobilization by themselves!! You must maintain stabilization untilYou must maintain stabilization until

secured to a LBBsecured to a LBB

Stabilize and measureStabilize and measure

Choose correct collar sizeChoose correct collar size

Prepare collarPrepare collar

Slide collar under chinSlide collar under chin

Secure collar; Secure collar; maintain in-line positionmaintain in-line position

Applying the cervical collar toApplying the cervical collar toa supine patienta supine patient

Supine PatientSupine Patient

Stabilize the headStabilize the head

Measure, slide the collar in placeMeasure, slide the collar in place

Secure the collarSecure the collar

Rapid Trauma AssessmentRapid Trauma Assessment!! ChestChest

!!check for DCAP - BTLScheck for DCAP - BTLS!!paradoxical movementparadoxical movement!!crepitationcrepitation!!listen for breath soundslisten for breath sounds

Assessing the ChestAssessing the Chest

AscultatingAscultating Breath Sounds Breath Sounds

!! AbdomenAbdomen!!check for DCAP - BTLScheck for DCAP - BTLS!!distentiondistention!!rigidityrigidity!!eviscerationevisceration!!palpate a tender area lastpalpate a tender area last

Assessing the AbdomenAssessing the Abdomen

Rapid Trauma AssessmentRapid Trauma Assessment!! PelvisPelvis

!!check for DCAP - BTLScheck for DCAP - BTLS!!priapismpriapism!!instabilityinstability!!crepitationcrepitation

!! If the patient complains of pain doIf the patient complains of pain donot palpate the pelvisnot palpate the pelvis

Assessing the PelvisAssessing the Pelvis

!! ExtremitiesExtremities!!check for DCAP - BTLScheck for DCAP - BTLS!!distal distal CSM’sCSM’s!!when would you splint a injuredwhen would you splint a injured

extremity in a high priorityextremity in a high prioritypatient? patient?

Page 215

Assessing the ExtremitiesAssessing the Extremities

!! Posterior bodyPosterior body!!check for DCAP - BTLScheck for DCAP - BTLS!!check down to the buttockscheck down to the buttocks

!! Immobilize onto a LBBImmobilize onto a LBB

Assessing the Posterior Assessing the Posterior

Baseline Vital Signs &Baseline Vital Signs &SAMPLESAMPLE

!! Which vital signs should you be taking?Which vital signs should you be taking?

!! What are the SAMPLE questions?What are the SAMPLE questions?

TransportTransport

!! Make your decision to transport asMake your decision to transport assoon as you see:soon as you see:

!!significant MOIsignificant MOI!!life threatening conditionslife threatening conditions!!after you have completed yourafter you have completed your

“Rapid Trauma Exam”“Rapid Trauma Exam”

Detailed Physical ExamDetailed Physical Exam!! Repeat the “Initial Assessment”Repeat the “Initial Assessment”

!!list those steps list those steps

!! Complete all critical interventionsComplete all critical interventions!!what are critical interventionswhat are critical interventions

Detailed Physical ExamDetailed Physical Exam!! HeadHead!! NeckNeck!! ChestChest!! AbdomenAbdomen!! PelvisPelvis!! ExtremitiesExtremities!! Posterior bodyPosterior body!! Reassess vital signsReassess vital signs

Detailed Physical ExamDetailed Physical Exam

!! HeadHead!!check for DCAP - BTLScheck for DCAP - BTLS!!pupilspupils!!ears (blood & CSF)ears (blood & CSF)!!nose (blood & CSF)nose (blood & CSF)!!mouthmouth

Detailed Physical ExamDetailed Physical Exam!! NeckNeck

!!check for DCAP - BTLScheck for DCAP - BTLS!!JVDJVD!!tracheal deviationtracheal deviation!!crepitationcrepitation

!!c-collar should already be onc-collar should already be on

!! ChestChest!!check for DCAP - BTLScheck for DCAP - BTLS!!listen to breath soundslisten to breath sounds!!crepitationcrepitation!!paradoxical movementsparadoxical movements

!! AbdomenAbdomen!!check for DCAP - BTLScheck for DCAP - BTLS!!distentiondistention!!rigidityrigidity!!softnesssoftness!!rebound tendernessrebound tenderness

Detailed Physical ExamDetailed Physical Exam!! PelvisPelvis

!!check for DCAP - BTLScheck for DCAP - BTLS!!stabilitystability!!tendernesstenderness!!painpain!!priapismpriapism!!vaginal bleedingvaginal bleeding

!! ExtremitiesExtremities!!Check for DCAP - BTLSCheck for DCAP - BTLS!!distal CSM’sdistal CSM’s

!! Posterior bodyPosterior body!!check for DCAP - BTLScheck for DCAP - BTLS!!check down to the buttockscheck down to the buttocks

!! Patient should already be on LBBPatient should already be on LBB

On - Going AssessmentOn - Going Assessment

!! Repeat the “Initial Assessment”Repeat the “Initial Assessment”!! Reassess vital signsReassess vital signs!! Repeat the “Focused Assessment”Repeat the “Focused Assessment”

related to specific complaints orrelated to specific complaints orinjuriesinjuries

!! Check interventionsCheck interventions

General PrinciplesGeneral Principles

!! Tell the patient what you are doingTell the patient what you are doing!! Stress the importance of the assessment ifStress the importance of the assessment if

patient is reluctant to allow you topatient is reluctant to allow you toproperly assess themproperly assess them

!! Exposure injured areas before examiningExposure injured areas before examining!! Try to maintain eye contactTry to maintain eye contact

General PrinciplesGeneral Principles

!! Assume spinal injuries existAssume spinal injuries exist!! Apply the cervical collar during the “rapidApply the cervical collar during the “rapid

trauma exam”trauma exam”!! You should perform the “detailed physicalYou should perform the “detailed physical

exam” only after all critical interventions areexam” only after all critical interventions arecompletecomplete

General PrinciplesGeneral Principles!! The “detailed physical exam” is done mostThe “detailed physical exam” is done most

often on trauma patients with significantoften on trauma patients with significantMOIMOI

!! Practicing this often will help you performPracticing this often will help you performbetter when you have a critically injuredbetter when you have a critically injuredpatient!patient!

!! Know this assessment … someone’s life willKnow this assessment … someone’s life willdepend on your ability to do this!depend on your ability to do this!

Initial Assessment

Scene Survey

Questions aboutQuestions aboutTraumaTrauma

Assessment?Assessment?

Assessment of the Trauma Patient - EMS Training Incemstraininginc.com/guest/CHAPTER 10 - ASSESMENT...

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