Assessment 848th Forward Surgical Team

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Assessment848th Forward Surgical Team
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Assessment

• P problem
• I intervention
• E evaluation

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Airway

• Open Airway
• Jaw Thrust/Chin Tilt
• Jaw thrust is preferred
• Check for
• Foreign Body (eg. Teeth)
• Saliva or Blood
• Tongue

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Breathing

• Observe
• Rise and fall
• Paradoxical movement
• Rate and Rhythm
• Rapid or slow
• Depth
• Shallow
• Effort
• Use of accessory muscles
• Auscultate
• Anterior
• Bilateral axillary
• Posterior if position time permit

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Circulation

• Check Pulses
• Radial pulse 80/palp BP
• Femoral pulse 70/palp BP
• Carotid pulse 60/palp BP
• Skin Color
• Pink
• Pale
• Purple or dusky
• Skin Temperature
• Warm
• Cool
• Capillary Refill
• Brisk (1-3 secs)
• Sluggish (gt3secs)

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Disability(Neuro Exam)

• Response to (AVPU)
• A alert
• V verbal
• P pain
• U unresponsive

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Neuro Continued
Total 15
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Revised Trauma Score (RTS)
Total 12
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RTS Categories for Survival

• Score vs. Survival
• 12 99.5
• 11 96.9
• 10 87.9
• 09 76.6
• 08 66.7
• 07 66.3

• 06 63
• 05 45.5
• 03-04 33.3
• 02 28.6
• 01 25
• 00 3.7

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Expose

• Remove All Clothing
• Secondary Assessment
• Observe Deformities, Contusions, Abrasions,
  Punctures, Burns, Tenderness, Lacerations,
  Swelling (DCAP/BTLS)
• Head, face, and neck (DCAP/BTLS)
• Chest (DCAP/BTLS)
• Abdomen (DCAP/BTLS)
• Pelvis (DCAP/BTLS)
• Extremities (DCAP/BTLS)
• Back (DCAP/BTLS)

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Temperature

• Obtain Temp
• Oral
• Axillary
• Rectal (preferred route of Capt. Malson)
• Normal 98F
• Hyperthermic gt101F
• Treatment
• Cool IV fluids, apply water, wet dressings, do
  not cover
• Hypothermic lt94F
• Treatment
• Warm IV fluids, keep dry, apply warm blankets

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Get What You Missed!!

• Revisit Assessments
• P problem
• I intervention
• E evaluation

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History

• A allergies
• M medications
• P past medical history
• L last meal
• E events
• Commonly missed, but extremely important step
  in total assessment

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Normal Vital Signs
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Cervical Spine (C-spine)Immobilization

• Alert and Oriented (AO)
• No C-spine if AO X3 with Neg. assessment
• Unconscious with suspected injury always
  immobilize
• Motor Vehicle Crashes (MVCs)
• Same as above
• High suspicion from impact signs
• Head Injuries
• GCS lt8
• Penetrating Wounds
• Do not automatically warrant unless blunt trauma
  accompanies
• Falls
• Fall from gt3Xs the height of the patient

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Immobilization Devices

• Rigid C-collar
• Various sizes
• Measure from the manubrium of the sternum to the
  tip of chin (hang loose)
• NOTE always maintain neutral head position
  when measuring and placing collar
• Soft Collar
• Not commonly used, provide minimal support
• Head Blocks
• Back Board
• Log roll technique with continuous C-spine
  support
• Straps or Tape
• Always strap from head to toe to avoid further
  injury

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Questions

• 1LT(Capt. Wannabe) Randy L. Cassidy