TRAUMA ASSESSMENT

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TRAUMA ASSESSMENT

• Emergency Medical Technician - Basic

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Scene Size-Up

• Safety
• Yourself
• Your partner
• Other responders
• Bystanders
• Patient

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Scene Size-Up

• Scene
• Location?
• Appearance?
• Where is patient?
• What is condition of vehicle?
• Were seatbelts used?
• Mechanism of Injury? Amount of force?

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Scene Size-Up

• Situation
• Additional support?
• Critical vs. Non-critical patient?

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Initial Assessment

• Find life threats
• If life-threat is present, CORRECT IT!
• If you cant correct it
• Oxygenate
• Ventilate
• TRANSPORT

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Initial Assessment

• With critical trauma you may never get past the
  initial assessment
• Most obvious or dramatic injury usually isnt
  whats killing the patient
• Listen to patients chief complaint

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Initial Assessment

• Airway with C-Spine Control
• Manual stabilization of C-Spine
• Noisy breathing Obstructed breathing
• But all obstructed breathing is NOT noisy
• Assume airway problems with
• Decreased LOC
• Head, face, neck, thorax trauma

OPEN - CLEAR - MAINTAIN
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Initial Assessment

• Breathing
• Is patient breathing
• Is patient moving air adequately?
• Is O2 getting to blood

LOOK - LISTEN - FEEL
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Initial Assessment

• Breathing
• Give O2 immediately if
• Change in LOC
• Possible shock
• Possible severe hemorrhage

• Chest pain
• Chest Trauma
• Dyspnea
• Respiratory Distress

If you think about giving O2, GIVE IT!
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Initial Assessment

• Breathing
• Assist ventilations if
• Rate is lt12
• Rate is gt24
• Decreased tidal volume
• Increased respiratory effort

If you cant tell if ventilations are adequate,
THEY ARENT!
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Initial Assessment

• Breathing
• If breathing is compromised
• Expose
• Palpate
• Auscultate

Try to find, correct cause
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Initial Assessment

• Circulation
• Is heart beating?
• Is patient perfusing?
• Serious external hemorrhage ?

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Initial Assessment

• Circulation
• Pulses present?
• Radial gt BP gt 80 systolic
• Femoral gt BP gt 70 systolic
• Carotid gt BP gt 60 systolic
• Skin color, temperature
• Cool
• Pale
• Moist

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Initial Assessment

• Circulation
• If circulation is compromised
• Expose
• Palpate
• Auscultate

Try to find, correct cause
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Initial Assessment

• Circulation
• If carotid pulse absent
• Extricate
• CPR
• MAST
• Transport

Fewer than 1 of blunt trauma victims in cardiac
arrest survive
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Initial Assessment

• Disability
• Level of consciousness Best indicator of brain
  perfusion
• Pupils--Eyes are windows of CNS
• Decreased LOC
• Head injury
• Hypoxia
• Hypoglycemia
• Shock

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Initial Assessment

• Level of Consciousness (LOC)
• A - Alert
• V - Verbal
• P - Painful
• U - Unresponsive

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Initial Assessment

• Decreased LOC Unequal Pupils Epidural or
  Subdural Hematoma Until Proven Otherwise

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Initial Assessment

• Expose, Examine
• You cant treat what you dont find
• Remove clothing from critical patients ASAP
• But do NOT delay resuscitation to remove clothing
• Cover patient with blanket after exam is complete

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Initial Assessment

• Vitals signs are not necessary to determine
  whether patient is critical
• Regardless of your findings

If the patient looks sick, he is sick
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Initial Resuscitation

• Treat as you go!
• Aggressively correct hypoxia, hypovolemia

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Initial Resuscitation

• Immobilize C-spine
• Maintain airway
• Oxygenate
• Rapid extrication to long board
• Assist ventilations

• Expose
• MAST (PASG)
• Transport
• Reassess - Report

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Initial Resuscitation
Critical Trauma Goals

• Minimum Time On Scene
• Maximum Treatment in Route

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History, Physical Exam

• You will get to this with MOST trauma patients
• Perform only after
• Initial assessment is completed, and
• All life-threats are corrected
• Do NOT hold critical trauma in field for
  secondary history, physical exam

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History, Physical Exam

• Significant mechanism of injury, multiple
  injuries, possible unknown injuries?
• Rapid head-to-toe assessment
• Baseline vital signs
• SAMPLE history

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History, Physical Exam

• NO significant mechanism of injury, isolated
  trauma only
• Focused assessment of injury site
• Baseline vital signs
• SAMPLE History

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Head to Toe Exam

• Organized, systematic
• Superior to Inferior
• Proximal to Distal
• Look - Listen - Feel - Smell

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Head to Toe Exam

• Extremity assessment must include
• Pulse
• Skin color, temperature
• Capillary refill
• Motor, sensory function

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Focused Exam

• Isolated Injury
• No significant mechanism of Injury
• Head-to-toe not necessary since other injuries
  unlikely

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Focused Exam

• Assess isolated injury only
• Be prepared to perform head-to-toe exam if other
  injuries identified
• Be prepared to manage as critical trauma patient
  if condition deteriorates

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Baseline Vital Signs

• Quality
• Weak (Thready)
• Full
• Bounding

• Pulse
• Rate
• Rapid
• Slow
• Rhythm
• Regular
• Irregular

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Baseline Vital Signs

• Quality
• Shallow
• Full
• Deep
• Labored

• Respirations
• Rate
• Inadequate
• lt10 or gt24
• Rhythm
• Regular
• Irregular

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Baseline Vital Signs

• Blood Pressure
• Hypotensive?
• Hypertensive?
• Narrow pulse pressure?
• Wide pulse pressure?

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Baseline Vital Signs

• Pupils
• Dilated?
• Unequal?
• Reaction to light
• Normal?
• Sluggish?
• Unequal?
• Unresponsive?

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Baseline Vital Signs

• Skin
• Color
• Temperature
• Moisture
• Turgor
• Capillary refill

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SAMPLE History

• Signs, Symptoms
• Signs
• Objective findings
• What you perceive
• Symptoms
• Subjective
• What patient experiences

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SAMPLE History

• Allergies
• ANY Allergies?
• Dont focus only on allergies to medication
• All allergies could be significant
• What are they?
• Are you being treated for this condition?

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SAMPLE History

• Medications
• Do you take any medications?
• What are they?
• Are you taking them as prescribed?
• Are you taking any over-the-counter meds?
• May we see the medications?

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SAMPLE History

• Past, Pertinent Medical History
• Have you had any recent illnesses?
• Have you been receiving medical care for any
  conditions?

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SAMPLE History

• Last oral intake
• Last food or drink
• Events leading up to incident