1. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 10 Assessment of the Trauma Patient

2. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Overall Assessment Scheme Scene Size-Up Initial Assessment TraumaMedical Physical Exam Vital Signs & SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam OngoingAssessment HOSP

3. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Assessing the Trauma Patient Is there a significant mechanism of injury? No Perform a focused assessment. Yes Perform a rapid assessment.

4. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Mechanism of Injury

5. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Significant Mechanism of Injury

6. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Significant Mechanism of Injury Ejection from vehicle Death in same passenger compartment Fall of greater than 15 feet or 3 times the patient’s height

7. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Rollover of vehicle High-speed vehicle collision Vehicle-pedestrian collision Significant Mechanism of Injury

8. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Motorcycle crash Unresponsive or altered mental status Penetrating injury of head, chest, or abdomen Significant Mechanism of Injury

9. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Falls greater than 10 ft. Bicycle collision Vehicle in medium- speed collision Infants and Children Significant Mechanism of Injury

10. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Mechanism of Injury: Interior of Vehicle Deformities to a vehicle’s interior may show where person struck the surface and reveal a mechanism of injury.

11. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bent Steering Wheel

12. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Broken Mirror

13. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Distorted Pedals

14. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Spider-Webbed Windshield

15. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Deformed Dashboard

16. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ If Significant Mechanism of Injury Reconsider mechanism of injury. Assess mental status. Continue spine stabilization. Perform a rapid trauma assessment.

17. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Rapid Trauma Assessment

18. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Inspect and Palpate for DCAP-BTLS ======== DCAPDCAP Deformities Contusions Abrasions Punctures/ Penetrations ======== BTLSBTLS Burns Tenderness Lacerations Swelling

19. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Deformities

20. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Contusions

21. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Abrasions

22. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Punctures/Penetrations

23. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Burns

24. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Tenderness

25. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Lacerations

26. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Swelling

27. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Rapid Trauma Assessment Head Neck Chest Abdomen Pelvis Extremities Posterior

28. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Head: DCAP-BTLS + Crepitation

29. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation

30. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chest: DCAP-BTLS + Crepitation and Breath Sounds Breath Sounds (Presence and Equality)

31. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Mid-clavicular Mid-axillary Listen to both sides of the chest. Is air entry present? Absent? Equal on both sides? Compare left side to right side.

32. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Abdomen: DCAP-BTLS + Firmness and Distention

33. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Pelvis: DCAP-BTLS ( Pelvis: DCAP-BTLS ( Compress gently.)

34. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor Function

35. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Posterior: DCAP-BTLS

36. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Assess baseline vital signs. Obtain SAMPLE history. Consider requesting ALS. Reconsider transport decision. Significant Mechanism of Injury

37. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Transport

38. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ If No Significant Mechanism of Injury Reconsider mechanism of injury. Determine chief complaint. Perform focused physical exam based on: Chief complaint Mechanism of injury

39. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ No Significant Mechanism of Injury Use DCAP-BTLS on focused area of assessment. Assess baseline vital signs. Obtain SAMPLE history.

40. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Vital Signs Respirations Pulse Skin color, temperature, condition Pupils Blood Pressure

41. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ SAMPLE History S=Signs and symptoms A=Allergies M=Medications P=Pertinent past history L=Last oral intake E=Events leading to injury or illness

42. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Rules of Assessment Explain to the patient what you are doing. Expose areas before assessing. Assume spinal injury.

43. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cervical Collar Sizing and Application

44. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cervical Collars STIFNECK TM Rigid Extrication Collar Philadelphia Cervical Collar TM

45. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ STIFNECK TM Collar – Seated Patient Stabilize head and neck manually.

46. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Sizing a Cervical Collar Measure the patient’s neck. Measure the collar. 1 2

47. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Slide collar up toward patient’s chin. STIFNECK TM Collar – Seated Patient

48. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Position front of collar under chin. STIFNECK TM Collar – Seated Patient

49. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Wrap collar around back of neck. STIFNECK TM Collar – Seated Patient

50. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Secure the collar. STIFNECK TM Collar – Seated Patient

51. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Rearrange fingers to maintain support. STIFNECK TM Collar – Seated Patient

52. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Kneel at patient’s head. STIFNECK TM Collar – Supine Patient

53. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Stabilize the head and neck. STIFNECK TM Collar – Supine Patient

54. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Maintain stabilization. STIFNECK TM Collar – Supine Patient

55. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Slide back of collar under patient’s neck. STIFNECK TM Collar – Supine Patient

56. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ STIFNECK TM Collar – Supine Patient Secure collar.

57. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ STIFNECK TM Collar – Supine Patient Maintain manual stabilization.

58. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Detailed Physical Exam

59. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Who Needs a Detailed Physical Exam? Determined by patient’s condition: After critical interventions for a patient with significant MOI Occasionally for a patient with no significant MOI Rarely for a medical patient

60. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ You may never have time to perform a detailed exam on a patient with critical injuries. Who Needs a Detailed Physical Exam?

61. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Steps in the Detailed Physical Exam

62. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ The Detailed Physical Exam Assess areas examined in rapid trauma assessment plus: Face Ears Eyes Nose Mouth

63. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Examine slower than during rapid trauma assessment. Often do during transport. Reassess vital signs. The Detailed Physical Exam

64. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ ======== DCAPDCAP Deformities Contusions Abrasions Punctures/ Penetrations ======== BTLSBTLS Burns Tenderness Lacerations Swelling DCAP-BTLS

65. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Head Head DCAP-BTLS

66. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Ears Ears DCAP-BTLS + Drainage

67. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Eyes DCAP-BTLS + Discoloration Unequal pupils Foreign bodies Blood in anterior chamber

68. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Nose and Mouth DCAP-BTLS + Teeth Obstructions Swollen or lacerated tongue

69. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ DCAP-BTLS + Odors Discoloration Drainage Bleeding Nose and Mouth

70. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Neck: Assessment Limited by Cervical Collar

71. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chest: Reassess Breath Sounds Presence and Equality

72. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ The abdomen, pelvis, and extremities may have already been assessed during rapid trauma assessment. If not yet done, assess these areas thoroughly The Detailed Physical Exam

73. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Extremities: Reassess Distal Pulse, Sensation, Motor Function

74. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Perform the steps of the Rapid Trauma Assessment —BUT MORE SLOWLY.

75. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Reassess Vital Signs Respirations Pulse Skin color, temperature, condition Pupils Blood pressure

76. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 1. When should you perform a detailed physical exam? 2. Explain the letters DCAP-BTLS. 3. What do you assess in the detailed physical exam that you don’t assess in the rapid trauma assessment? Review Questions

77. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 4. List some significant mechanisms of injury. 5. List the steps of the focused history and physical exam for the trauma patient with a significant mechanism of injury. Review Questions

78. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 6. List the steps of the rapid trauma assessment. 7. List the signs and symptoms that correspond to DCAP-BTLS. 8. Tell what each of the letters in SAMPLE stands for. Review Questions

79. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 9. Describe how to apply a STIFNECK TM collar to a seated patient. To a supine patient. 10. List the steps in the focused history and physical exam for the trauma patient with no significant mechanism of injury. Review Questions

80. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ S TREET S CENES What is the priority of this patient? What should be done next? When should vital signs be taken?

81. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ S TREET S CENES What should you do next? What should be done for the detailed assessment if there is time before reaching the trauma center?