ASSESSMENT of the TRAUMA PATIENT
When Worst Gets You First !
The EMT Needs to Separate Patients That Need Rapid Assessment & Critical Intervention vs. Patients That Can Be Managed Using Components of the Focused Assessment.
ASSESSMENT of the TRAUMA PATIENT
TOPIC OVERVIEW
- Differences Between Significant & Non-Significant Mechanism of Injury
- Differentiate Who Needs Rapid Trauma Assessment & Who Needs Focused History and Physical Exam
- Perform Rapid Trauma Assessment
- Gather a Focused History for a Trauma Patient
- Perform a Detailed Exam for a Trauma Patient
MECHANISM OF INJURY
- Ejection From Vehicle
- Death Same Compartment
- Roll Over Accident
- High Speed Accident
- Vehicle vs. Pedestrian
- Motorcycle
MECHANISM OF INJURY
- Falls > 15 Feet
- or 3 x Pt’s Height
- Penetration Injuries
- Head
- Chest
- Abdomen
- Trauma Resulting In
- Unconsciousness
- Altered Mental Status
MECHANISM OF INJURY
- Hidden Injuries
- Seat Belts
- Save Lives
- Can Cause Injury
- Strong Bones of Shoulder & Pelvis Are Utilized
- Improperly Worn Can Cause Numerous Injuries
MECHANISM OF INJURY
- Hidden Injuries
- Air Bags
- Supplemental
- Use Seat Belt
- Steering Wheel
- "Lift & Look"
- Deformity of Wheel
MECHANISM OF INJURY
- Falls > 10 Feet
- MVA – Medium Speed
- Bicycles
RAPID TRAUMA ASSESSMENT
- RTA è
Significant MOI è
Find Life-Threatening Injuries
- Continue Spinal Immobilization
- Get ALS Assistance, if Possible
- Reconsider Transport Decision
- S & G or Stay & Play
- Assess Mental Status Constantly
RAPID TRAUMA ASSESSMENT
- Inspect & Palpate
- Look & Feel
- DCAP – BTLS
- Deformity - Burns
- Contusion - Tenderness
- Abrasion - Lacerations
- Penetration - Swelling
RAPID TRAUMA ASSESSMENT
- Head
- DCAP – BTLS
- Crepitation
- Fluids
- Neck
- DCAP – BTLS
- JVD
- Tracheal Deviation
- Crepitation
RAPID TRAUMA ASSESSMENT
- Chest
- DCAP – BTLS
- Paradoxical Movement
- Crepitation
- Breath Sounds
- 4 Locations
- Auscultation
- Present
- Absent
- Equal
RAPID TRAUMA ASSESSMENT
- Abdomen
- DCAP – BTLS
- Firm
- Soft
- Distended
- 4 Quadrants
RAPID TRAUMA ASSESSMENT
- Pelvis
- DCAP – BTLS
- Gently Compress
- Tenderness
- Motion
- Do Not Rock
RAPID TRAUMA ASSESSMENT
- Extremities
- All 4
- DCAP – BTLS
- Distal Pulses
- Motor Function
- Sensation
- aka: PMS
RAPID TRAUMA ASSESSMENT
- Back
- Spinal Precautions
- Log Roll
- DCAP - BTLS
RAPID TRAUMA ASSESSMENT
- Obtain Baseline Vital Signs
- Assess SAMPLE History
- Get ALS
- Get Moving if Assessment Findings & MOI Dictate
- If No Significant Mechanism of Injury or Rapid Assessment Finds Only Minor Injuries Use Focused Assessment
FOCUSED ASSESSMENT
If No Significant MOI
- Reconsider mechanism of injury.
- Determine chief complaint.
- Perform focused physical exam based on:
- Chief complaint
- Mechanism of injury
FOCUSED ASSESSMENT
- No Significant MOI (cont.)
- Use DCAP-BTLS on focused area of assessment.
- Assess baseline vital signs.
- Obtain SAMPLE history.
RULES OF ASSESSMENT
- Explain to the patient what you are doing.
- Expose areas before assessing.
- Assume spinal injury.
CERVICAL COLLARS
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
DETAILED PHYSICAL EXAM
- You may never have time to perform a detailed exam on a patient with critical injuries.
DETAILED PHYSICAL EXAM
Assess areas examined in rapid trauma assessment plus:
- Face
- Ears
- Eyes
- Nose
- Mouth
DETAILED PHYSICAL EXAM
- Examine slower than during rapid trauma assessment.
- Often done during transport.
- Reassess vital signs.
DETAILED PHYSICAL EXAM
The abdomen, pelvis, and extremities may have already been assessed during rapid trauma assessment.
If not yet done, assess these areas thoroughly
DETAILED PHYSICAL EXAM
- Perform the steps of the Rapid Trauma Assessment —BUT MORE SLOWLY.
- Perhaps it Should Be Called - DETAILED
- Don’t Forget to Reassess Vital Signs