Trauma Scoring

1
Trauma Scoring

• Emergency Medical Technician - Basic

2
Trauma Score Uses

• Triage
• Level I Trauma Center?
• Air Transport?
• Assessment
• Tracking condition changes

3
Trauma Score Uses

• Severity reporting to on-line medical control,
  receiving facility
• Research
• Outcomes assessment
• Quality assurance

4
Scoring Factors

• Circulation/Perfusion
• Presence
• Adequacy
• Disability

• Physiological Status
• Airway
• Breathing
• Presence
• Adequacy

5
Scoring Factors

• Mechanism of Injury
• Kinematics
• Type, direction, amount of force

6
Scoring Factors

• Anatomical Site of Injury
• Not accurate by self for pre-hospital use
• Visible soft tissue/ orthopedic injury may
  distract from head, chest, abdominal trauma
• Penetrating trauma depth/direction deceiving
• Blunt trauma assessment difficult, especially
  abdomen

7
Scoring Factors

• Anatomical Site of Injury
• Penetrating trauma
  Chest, abdomen, head, neck, groin
• gt 2 long bone fractures
• Burns gt15 BSA, face, airway
• Flail chest
• Scalping injury
• Paralysis
• Amputation proximal to wrist/ankle

8
Scoring Factors

• Co-morbid Factors
• Burns associated with other major trauma
• Age lt 5 or gt 55
• Known cardiac, respiratory disease
• Prolonged extrication/transport time

9
Scoring Factors

• Logistics
• Extrication gt20 minutes
• Inaccessible scene
• Long transport time

10
Scoring Factors

• Kinematics--Motor Vehicle Collisions
• Speed gt20 MPH
• Rearward displacement of front axle
• Deformity of auto gt20 inches
• Passenger compartment intrusion
• gt15 inches - patient side
• gt20 inches - opposite side

11
Scoring Factors

• Kinematics--Motor Vehicle Collisions
• Rollover
• Ejection from vehicle
• Death/Serious injury of same car occupant

12
Scoring Factors

• Kinematics--Pedestrian vs Vehicle
• Struck at gt20 mph
• Thrown gt 15 feet
• Child lt 12 years old
• Kinematics--Falls
• gt15 feet or gt3x victims height

13
Scoring Factors

• If any of scoring factors present
• Patient will require Level I or II Trauma Center
• If transport time gt20 minutes consider calling
  helicopter

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Revised Trauma Score

• Commonly Used Prehospital Trauma Score

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Revised Trauma Score

• RTS component scores based on
• Glasgow scale
• Respiratory rate
• Systolic BP
• Add component scores to determine RTS

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Glasgow Coma Scale

• Motor Response
• 1 No response
• 2 Abnormal extension
• 3 Abnormal flexion
• 4 Withdrawal
• 5 Localizes pain
• 6 Follows instructions

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Glasgow Coma Scale

• Verbal Response
• 1 No response
• 2 Incomprehensible sounds
• 3 Inappropriate words
• 4 Confused, disoriented
• 5 Oriented

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Glasgow Coma Scale

• Eye Response
• 1 No response
• 2 To pain
• 3 To verbal command
• 4 Spontaneous

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Glasgow Coma Scale
Motor Verbal Eye Glasgow Score
What is lowest possible GCS Score?
20
Revised Trauma Score

• Glasgow Coma Scale
• 0 1 - 3 GCS
• 1 4 - 5 GCS
• 2 6 - 8 GCS
• 3 9 - 12 GCS
• 4 13 - 15 GCS

21
Revised Trauma Score

• Respiratory Rate
• 0 0 Respirations
• 1 1 to 5 Respirations
• 2 6 to 9 Respirations
• 3 gt29 Respirations
• 4 10 to 29 Respirations

22
Revised Trauma Score

• Systolic BP
• 0 0
• 1 1 to 49
• 2 50 to 75
• 3 76 to 89
• 4 gt89

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Revised Trauma Score
GCS score Respiratory score Systolic BP score
Revised Trauma Score