Patient Assessment Trauma

Scene Size-Up An assessment of the scene and surroundings that will provide valuable information to the EMT

1. Personal Protective Equipment/Body Substance Isolation  PPE for BSI 2. Scene Safety  Fire  HAZMAT  Car Accidents  Domestic Violence – shootings/stabbings/assaults YOUR SAFETY COMES FIRST!!!!

3. Number of Patients  Triage – French meaning “to sort”  Triage officer does not treat patients – just tags them  Cardiac arrest patients considered low triage because they are already dead 4. Need for Additional Resources  Multiple patients = more responders  ALS back-up  Police/Fire Dept.

5.Mechanism of Injury or Nature of Illness  Medical – 90% of all calls  Trauma – 10% of all calls What is causing the problem? What does that tell you?

Car Crashes Where were they sitting? Were they wearing a seat belt? 1. Head-on collision Types of injuries:  Hip  Knee & leg  Head & neck  Chest  Abdominal injuries

Head-on Collision

2. Rear-end collision Types of Injuries  Head & neck  Chest injuries 3. Side-impact collision Types of Injuries  Head & neck  Chest  Abdomen  Pelvis  Thighs

Rear-end Collision

Side-impact Collision

Penetrating trauma – passes through the skin and/or body tissues  Low velocity –Propelled by hand – ex. Knives –Injury limited to area penetrated  Medium velocity –Handguns or shotguns  High velocity –High powered assault rifle Blunt force trauma – blow that does not break the skin but causes injury  Steering wheel, baseball bat

Nature of Illness  Sources of Information are: –Patient –Family members or bystanders –Information found at the scene

Significant Mechanism of Injury  Ejection from the vehicle  Death in same passenger compartment  Fall of more than 15ft or 3 times the patient’s height  Rollover  High speed vehicle collision  Vehicle-pedestrian collision  Motorcycle  Unresponsive or altered mental status (AMS) due to the incident  Penetration of head, chest, abdomen

Significant Mechanism of Injury specifically for children  Falls more than 10ft.  Bicycle collision  Vehicle in medium speed collision

Initial Assessment (Quick Look)  The purpose of the initial assessment is to identify and treat any life threatening conditions.

Initial Assessment  Consider C-spine stabilization – have your partner stabilize the head if sufficient manpower available.  General impression of the patient: –How are they laying –Skin color –Respirations –Any blood?

Initial Assessment  Assess patient’s mental status (AVPU) –Alert –Verbal –Painful –Unresponsive Ask questions such as: * What is your name? * Where are you? * What day is it?

ABC’s TREAT AS YOU GO!!!

Initial Assessment  Assess patient’s AIRWAY status and maintain airway. –In unresponsive patients always do a jaw thrust.

Initial Assessment  Assess patient’s BREATHING – look, listen and feel. –Respirations  Quality –Bilateral chest expansion –Sucking chest wound –Flail chest – 3 or more ribs broke in 2 or more places. The pt. will have paradoxical chest movement. *** INITIATE APPROPRIATE OXYGEN THERAPY AND ASSURE ADEQUATE VENTIALATION ***

Initial Assessment  Assess patient CIRCULATION –Pulse – radial most reliable distal pulse in an adult. Brachial in a child.  Quality –Control major bleeding – pat down the body. Bright red blood (arterial) is an emergency situation and requires immediate attention. –Skin color, temperature and condition –Perfusion  Capillary Refill (INFANTS AND CHILDREN ONLY – up to age 5) <2 seconds is normal

ABC’s should take 60 – 90 seconds!!!!

Initial Assessment  Identify priority patients and make transport decision –CUPS  C ritical – CPR/arrest patient  U nstable patient  P otentially Unstable patient  S table patient

Rapid Trauma Assessment vs. Detailed Physical Exam  Rapid trauma assessment should be performed on patients with significant mechanism of injury to determine life threatening injuries.  Important in order to: –Make CUPS determination –Consider ALS intercept –Consider platinum ten minutes and golden hour

Focus History & Physical Exam  Reconsider mechanism of injury –Trauma protocols –Consider hidden injuries due to mechanism of injury.

Perform Rapid Trauma Assessment  DCAP-BTLS –D eformities –C ontusions –A brasions –P unctures/penetrations –B urns –T enderness –L acerations –S welling

Deformities

Contusions

Abrasions

Punctures/penetrations

Burns

Tenderness

Lacerations

Swelling

Focus History & Physical Exam 1. Assess the Head

2. Assess Neck a. Jugular venous distention (JVD) – Flat veins in a supine trauma patient can be an indication of blood loss. b. Tracheal deviation-moves to uninjured lung side c. Stoma/tracheostomy

** Apply Cervical Collar** 3. Assess the Chest – crepitus (bone ends rubbing together) a. listen for breath sounds – high on both sides. Under arm pits b. check for equal chest rise and expansion – paradoxical breathing

4. Assess Abdomen a. Palpate all 4 quadrants – press gently hand over hand. Do spot where the pain is last. b. Do they have a colostomy or ileostomy?

5. Assess the Pelvis –If no pain is noted, press gently in and down on the wings. DO NOT log roll someone with a suspected pelvic injury. –Assess males for priapism 6. Assess the Lower Extremities –Check pulses –Check neurological function – PMS  Pulse  Movement  Sensation

7. Assess the Upper Extremities –Check pulses –Check neurological function - PMS  Pulse  Movement  Sensation 8. Assess the Back & Buttocks –Do this when you log roll the patient to place them on the long board

Focus History & Physical Exam Obtain a Baseline Set of Vital Signs 1. Respirations a. Quality & Quantity – shallow? Labored? Deep? 29 BVM 2. Pulse a. Quality & Quantity – normal b. Bradycardia: pulse under 60 c. Tachycardia: pulse over Blood Pressure – 120/80

Obtain the SAMPLE History You should try to complete this early on in case the patient goes unconscious 1. S igns and symptoms *sign – something you can see * symptom – something a patient feels or tells you * symptom – something a patient feels or tells you 2. A llergies – to medications or latex 3. M edications (presently taking) prescription or over the counter 4. P ast Medical History 5. L ast oral intake 6. E vents leading up to the present problem

Detailed Physical Exam  Depending on the seriousness of the patient’s injuries, you may never have the opportunity to complete a detailed physical exam.  If, during your assessment, you notice a change in the patient’s condition, STOP and go back to the initial assessment.

Detailed Physical Exam  Use “DCAP-BTLS”  Assess the Head –Inspect & palpate the scalp and ears –Assess the eyes – unequal pupils = head/brain injury. –Assess the facial area including the mouth and nose  Assess the Neck –Inspect and palpate the neck –Assess for JVD –Assess for tracheal deviation

 Assess the Chest –Inspect – watch the chest rise –Palpate – check for equal expansion –Auscultate – listen to ALL 4 quadrants  Assess the Abdomen & Pelvis –Assess all 4 quadrants of the ABD –Assess the pelvis –Verbalize assessment of genitalia/perineum as needed

 Assess the Extremities –Inspect & palpate –Check neurological function (PMS) and distal circulation  Assess the Back –This may have already been done when the pt. was placed on the backboard

Ongoing Assessment (verbalized)  Repeat Initial Assessment –Stable patient every 15 minutes –Unstable patient every 5 minutes  Repeat Vital Signs  Repeats Focused Assessment 1.Reassesses mental status 2.Maintain open airway 3.Reassess breathing 4.Reassess pulse 5.Monitor skin color & temperature 6.Re-establish patient priority