Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

Chapter 8 – Rapid Trauma Exam © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives Describe when it is appropriate for the EMS provider to perform the rapid trauma exam (RTE). Describe when it is appropriate for the EMS provider to perform the rapid trauma exam (RTE). Explain the objectives of the rapid trauma exam (RTE). Explain the objectives of the rapid trauma exam (RTE). Describe how DCAP-BTLS is used during the RTE. Describe how DCAP-BTLS is used during the RTE. Explain the steps of the RTE. Explain the steps of the RTE. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives (continued) Explain why it is necessary to remove various clothing during the RTE and what considerations should be taken in removing any clothing. Explain why it is necessary to remove various clothing during the RTE and what considerations should be taken in removing any clothing. List several examples of significant MOI. List several examples of significant MOI. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Introduction RTE is quickly accomplished on the scene RTE is quickly accomplished on the scene In rare occasions the RTE may be completed in the ambulance: In rare occasions the RTE may be completed in the ambulance: Environmental issues (i.e.: snow, rain) Environmental issues (i.e.: snow, rain) IA problems that are unresolved IA problems that are unresolved © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Exam Quickly examine: Quickly examine: Head Head Neck Neck Chest Chest Abdomen Abdomen Pelvis Pelvis Extremities Extremities Back/buttocks Back/buttocks Continue manual spinal immobilization throughout Continue manual spinal immobilization throughout Assess for DCAP-BTLS Assess for DCAP-BTLS © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

The “DCAP-BTLS” Acronym D – deformity D – deformity C – contusions C – contusions A – abrasions A – abrasions P – penetration/punctures P – penetration/punctures B – burns B – burns T – tenderness T – tenderness L – lacerations L – lacerations S – swelling S – swelling Crepitation and auscultation as appropriate Crepitation and auscultation as appropriate © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Steps in the RTE BSI precautions BSI precautions Remove clothing as appropriate (environment, privacy) Remove clothing as appropriate (environment, privacy) Reconsider MOI Reconsider MOI Head/neck Head/neck Chest – auscultate Chest – auscultate Abdomen – 4 quadrants Abdomen – 4 quadrants Pelvis Pelvis Extremities – distal PMS Extremities – distal PMS Posterior – have the board ready Posterior – have the board ready © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

MOI Examples Feet-first impact Feet-first impact Head-first impact Head-first impact Fall on outstreched arm Fall on outstreched arm Fall on or twisting of the knee Fall on or twisting of the knee Up and over the dashboard Up and over the dashboard Down and under the dashboard Down and under the dashboard Lateral impact Lateral impact Coup-contra coup head injury Coup-contra coup head injury © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

MOI Examples Penetration by high velocity projectile Penetration by high velocity projectile Injury suggestive of underlying injuries Injury suggestive of underlying injuries Physical abuse Physical abuse Waddell’s triad Waddell’s triad Blow to the side of the head Blow to the side of the head Ejection from vehicle Ejection from vehicle Partial ejection Partial ejection © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion If significant MOI the RTE is done If significant MOI the RTE is done Sequential evaluation of the: head/neck, chest, abdomen, pelvis, extremities, and posterior Sequential evaluation of the: head/neck, chest, abdomen, pelvis, extremities, and posterior Time is important! Time is important! Be quick and accurate Be quick and accurate Practice, practice, practice! Practice, practice, practice! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.