1. Trauma Patient Assessment

2. Trauma Assessment

3. Size-Up
Safety
BSI
MOI
Number of Patients
Additional Resources

4. Safety
Traffic
Smoke
Electricity
Haz-Mat

5. Safety
Hostile Persons
Weapons
Drugs
Silence

6. BSI
Gloves
Goggles
Mask
Gown

7. BSI Gloves for minimal fluids
Add eye protection if there’s any chance of splatter
Add gown and mask for gross contamination

8. Mechanism of Injury Ejection
Death of another passenger in the same vehicle
Falls >15’ or 3X patients height (child = >10’)
Roll-over
High speed collision (child = moderate speed)

9. Mechanism of Injury (cont.)
Pedestrian Involvement
Motorcycle (child = bicycle)
Altered mental status
Penetrating wounds to head, chest, abdomen)

10. Number of Patients
Call for additional resources ASAP

11. Additional resources
Extrication
Traffic control
Utilities

12. Initial Assessment General Impression Mental Status Airway Breathing
Circulation
Determine priority

13. General Impression Age, Weight, Gender
Position (relative to posture and surroundings)
Activity
Obvious Injuries/Bleeding

14. Assess Mental Status Take C-Spine control
A – Alert and immediately responsive
V – Responsive to verbal stimuli
P – Responsive to painful stimuli
U – Unresponsive

15. Assess Airway Open if necessary using jaw-thrust maneuver
Consider oro- or naso-pharyngeal airway
Note unusual sounds and correct cause
Snoring – oro-/naso-pharyngeal airway
Gurgling – suction
Stridor – consider intubation
Silence

16. Correcting silence Attempt ventilation Reposition Heimlich
Visualize and remove
Intubate
Trans-laryngeal jet insuflation

17. Assess Breathing Look, Listen, Feel Rate, Rhythm, Depth (tidal volume)
Use of accessory muscles/retractions
Treat
Absent – ventilate x2, check pulse
< 12/min – assist ventilation
Decreased tidal volume – assist ventilation
Labored – oxygen 10 liters NRB
Normal or rapid – consider oxygen

18. Assess Circulation - Pulses
Compare radial and corotid
Rate
Normal
Fast
Slow
Rhythm
Regular
Irregular
Quality
Weak
Thready
Bounding

19. Assess Circulation - Skin
Color
Temperature
Moisture

20. Assess Circulation - Bleeding
Direct pressure
Pressure dressing

21. Determine priority Poor general impression Mental status changes
Difficulty breathing
Shock
Chest pain
Severe bleeding
Severe pain

22. Rapid Trauma Assessment
Head to toe
Rapid sweep to identify major injuries which could prove life threatening
DCAP-BTLS

23. Rapid Trauma Assessment (cont.) DCAP/BTLS
D - deformities
C - contusions/ crepitation
A - abrasions
P - penetrations/ paradoxical movement
B - burns
T - tenderness
L - lacerations
S - swelling

24. Package and begin transport
Immediate – immobilize, load, go
Delayed – immobilize, treat as necessary, transport

25. Focused History and Physical
Baseline vital signs
SAMPLE History
Focus on and treat injuries found during initial assessment and rapid trauma assessment as appropriate considering priority

26. Focused History and Physical SAMPLE History
S – signs/symptoms
A – allergies
M – medications
P – past medical history
L – last oral intake
E – events leading up to the incident

27. Detailed Physical Exam
As appropriate, considering priority
Repeat initial assessment
Complete critical interventions
Careful head to toe survey (DCAP/BTLS)

28. Detailed Physical Exam Head to Toe
Head – DCAP/BTLS and creptiation
Ears – DCAP/BTLS and blood/fluid
Face – DCAP/BTLS and blood/fluid
Eyes – DCAP/BTLS and discoloration, pupils, foreign bodies, blood
Nose – DCAP/BTLS and blood/fluid
Mouth – DCAP/BTLS and teeth, foreign bodies, swelling, lacerations, odor

29. Head to Toe

30. Detailed Physical Exam Head to Toe
Neck – DCAP/BTLS and JVD, crepitation
Chest – DCAP/BTLS and palpate for paradoxical motion, symmetry, crepitation, and auscultate breath sounds
Abdomen – DCAP/BTLS and tenderness, rigidity, distention
Pelvis – DCAP/BTLS and pain, tenderness, motion, crepitation

31. Head to Toe

32. Detailed Physical Exam Head to Toe
Upper extremities – DCAP/BTLS and PMS
Lower extremities – DCAP/BTLS and PMS
Posterior – DCAP/BTLS

33. On-Going Assessment Reassess vital signs Reassess injuries
Reassess interventions