Assessment of the Trauma Patient

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Assessment of the Trauma Patient
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• Focused History and Physical Exam for the Trama
  Patient

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• No significant mechanism of injury
• Focus assessment on just the areas of injury or
  compliant.
• Includes
• Physical Exam
• VS
• SAMPLE

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• D C A P B T L S
• e o b u u e a w
• f n r n r n c e
• o t a c n d e l
• m u s t s e r l
• i s I u r a i
• t I o r n t n
• i o n e e I g
• e n s s s o
• s s s n
• s

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• Apply a cervical collar
• during the rapid trauma assessment

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• Trauma patient with a significant mechanism of
  injury
• Remember with children same type of injury may
  take less force.
• Continue spinal immobilization
• Reconsider transport decision
• Reassess MS

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• Perform a Rapid Trauma Assessment
• Inspect
• Palpate
• Auscultate
• Smell
• From head-to-toe

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• Jugular vein distension
• Paradoxical motion
• Flail chest
• Crepitation
• Subcutaneous Emphysema
• Pulsating mass
• Pelvis- Priapism

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• PMS PMS
• PMS PMS
• PMS
• PMS PMS PMS
• PMS
• PMS PMS PMS
• PMS PMS

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• Reconsider mechanism of injury
• Determine chief complaint
• Perform a focused physical exam

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• Expose

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• Mechanism of Injury
• Index of suspicion
• Law of inertia A object in motion stays in
  motion until acted upon by another force
• Three collisions First vehicle strikes
  something
• Second Victim strikes something
  on impact

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• Third collision organs strike

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• Examples
• Head-on collision
• Up and over injury
• up and over the steering wheel
• Down and under injury
• down and under the steering wheel

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• Rear-end collision
• Head and neck injury
• Side impact collision
• Skeletal and internal injuries
• Rollover
• Possibility of ejection
• Rotational Impact
• Observe damage to the windshield, steering
  wheel, dash and pedals

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• Motorcycles and ATVs
• Helmet?
• Suspect any and all types of injuries

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• Falls
• Height of fall
• three times patient height is severe
• Surface they landed on

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• Penetrating Trauma
• Shooting stabbing
• Velocity Speed of the object
• Low velocity
• Stabbing
• Injury usually isolated to area penetrated
• multiple wounds
• damage to internal organs

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• Medium-velocity
• Handguns and shotguns
• Arrows
• High velocity
• High powered rifles
• Assault rifles

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• Bullets cause damage in two ways
• Damage directly from the bullet itself
• Cavitation
• pressure wave

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• Blunt Force Trauma
• maintain a high index of suspicion

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Assessment of the Medical Patient

• Responsive
• Four parts
• History of present illness
• Focused physical exam
• OPQRST
• SAMPLE
• Baseline VS
• Prior history
• DCAPBTLS

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• Unresponsive
• Patient history from family, bystanders etc.
• Rapid assessment
• Abd distension, firmness, rigidity
• Pelvis Incontinence of urine, feces
• ID bracelets
• Baseline VS
• Consider need for ALS
• History of present illness and SAMPLE

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• History of present illness and SAMPLE
• Patients name
• What happened
• what did family/bystander see
• Did patient complain of anything prior
• Know illness
• Medications