2. ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT Instructor Name: Title: Unit:

3. OVERVIEW SCENE SIZE-UP TRANSPORT DECISION AND CRITICAL INTERVENTIONS DETAILED EXAM ONGOING EXAM

4. SCENE SIZE-UP BSI DECISION SCENE SAFETY TOTAL NUMBER OF PATIENTS ESSENTIAL EQUIPMENT ARE ADDITIONAL RESOURCES NEEDED MECHANISM OF INJURY

7. What is Trauma? A serious injury or shock to the body by violence or accident!

8. Trauma Assessment is a Basic life support skill!

9. Touching the patient is a must to find possible injuries!

10. What are we looking for? Life threats that are going to kill the patient right now! Any obvious injuries that the patient has Any underlying injuries the patient may have we can’t see Changes that may occur during transport

11. How fast do patient’s die?

12. Now let’s take a look at how the assessment should go!

13. Scene size-up This is the overall picture of the scene to ensure the safest environment for yourself, your crew, other responding personnel, patient, and bystanders in that order.

14. Scene size-up BSI (body substance isolation) Scene safety Number of victims Other help or equipment needed Mechanism of injury

15. Mechanism of Injury Predictable pattern of injuries caused by forces applied to the body Helps you key in on possible injuries

16. Initial assessment General impression- your gut feeling on patient status and priority of transport LOC- AVPU on patient with simultaneous initiation of c-spine immobilization Airway- open/clear if not fix it Breathing- rate/quality interventions to airway- oxygen by NRB or BVM Circulation- compare radial vs. carotid pulses, skin color/temp/condition Control any major bleeding!

17. Decisions, decisions, decisions Load and Go or Stay and play Rapid trauma survey Focused trauma survey

18. Rapid Trauma assessment Should take less than two minutes to perform A quick scan of whole body Identifies any life threats Used to mentally note injuries to fix later

19. DCAP-BLS-TIC Deformities Contusions Abrasions Punctures/penetrations Burns Lacerations Swelling Tenderness Instability crepitation

20. HEAD Palpate the head looking for DCAP-BLS-TIC Examine the facial bones Look at ears, nose, and mouth for any fluids coming from them Check for Battle signs or raccoon eyes

21. Neck Visualize neck for DCAp-bls-tic Check neck for tracheal deviation Check neck for Jugular vein distention Palpate the back of the neck Consider applying the c-collar

22. Chest Visualize chest for DCAP-bls-tic Listen to breath sounds(this is a bls skill) Palpate the chest IF a open wound or flail chest is found have a partner place a gloved hand over area till you finish rapid trauma survey

23. Abdomen Visualize the abdomen for dcap-bls-tic Palpate abdomen for rigidity, guarding, or tenderness If patient alert and tells you where pain is feel that area last

24. Pelvis Palpate the pelvis for dcap-bls-tic It is a in and down motion Do not rock the pelvis If you find a unstable pelvis do not mess with it again

25. Lower extremities Visualize lower extremities for dcap-bls- tic Palpate down one leg at a time Check for pulse, motor, sensory function to both feet Check for capillary refill

26. Upper extremities Visualize upper extremities for dcap-bls- tic Palpate both arms Feel for pulse, motor, and sensory Check capillary refill

27. Back Log roll the patient with c-spine stabilization Visualize back for dcap-bls-tic Palpate back from neck to legs

28. Secure patient to board Secure body first Then secure head Reassess PMS after moving patient Securing head first or not securing body could be a major problem if patient becomes sick and you have to roll patient to maintain airway!

29. Attempt to obtain sample history Signs/symptoms Allergies Medicines including OTC and herbal Pertinent past medical history Last oral intake not just eating Events leading to trauma

30. Now the patient is in the ambulance enroute to the hospital!

31. Baseline Vitals Pulse Respirations Blood pressure O2 sat Skin color/condition

32. Neurological exam LOC Pupils Motor sensory

33. Detailed exam Do a slower exam of body Touch the whole body looking for injuries Fix problems as you find them Fix problems that you noted in rapid trauma assessment Looking for dcap-bls-tic again

34. Maintain body temperature during exam and transport

35. PERFORM ONGOING ASSESSMENT PERFORM REASSESSMENT OF ABC’S REASSESS VITALS EVERY THREE TO FIVE MINUTES REASSESS INTERVENTIONS AND EFFECTIVENESS

36. Give oral report Give short concise report Use the mint pneumonic –Mechanism of injury –Injuries from head to toe –Neurological exam including gcs score –Treatments performed and vital signs

37. Transfer patient out of your care!

38. PITFALLS Approaching the patient before performing a Scene Size-Up Trying to do too much on-scene –Attempting to “stabilize” the patient in the field

39. SUMMARY Scene Size-Up BTLS Primary Survey –Initial Assessment –Rapid Trauma Survey or Focused Exam Critical interventions and transport decision Detailed Exam Ongoing Exam

40. We are finished now Question? Comments Snide remarks If not thank you

41. QUESTIONS ?