TRAUMA ASSESSMENT

TRAUMA ASSESSMENT Emergency Medical Technician – Basic Temple College

Scene Size-Up • Safety • Yourself • Your partner • Other responders • Bystanders • Patient

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

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

Initial Assessment • Find life threats • If life-threat is present, CORRECT IT! • If you can’t correct it: • Oxygenate • Ventilate • TRANSPORT

Initial Assessment • With critical trauma you may never get past the initial assessment • Most obvious or dramatic injury usually isn’t what’s killing the patient • Listen to patient’s chief complaint

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

Initial Assessment • Breathing • Is patient breathing • Is patient moving air adequately? • Is O2 getting to blood LOOK - LISTEN - FEEL

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!

Initial Assessment • Breathing • Assist ventilations if: • Rate is <12 • Rate is >24 • Decreased tidal volume • Increased respiratory effort If you can’t tell if ventilations are adequate,THEY AREN’T!

Initial Assessment • Breathing • If breathing is compromised: • Expose • Palpate • Auscultate Try to find, correct cause

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

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

Initial Assessment • Circulation • If circulation is compromised: • Expose • Palpate • Auscultate Try to find, correct cause

Initial Assessment • Circulation • If carotid pulse absent: • Extricate • CPR • MAST • Transport • Fewer than 1% of blunt trauma victims in cardiac arrest survive

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

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

Initial Assessment • Decreased LOC + Unequal Pupils = Epidural or Subdural Hematoma Until Proven Otherwise

Initial Assessment • Expose, Examine • You can’t treat what you don’t find • Remove clothing from critical patients ASAP • But do NOT delay resuscitation to remove clothing • Cover patient with blanket after exam is complete

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

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

Initial Resuscitation • Immobilize C-spine • Maintain airway • Oxygenate • Rapid extrication to long board • Assist ventilations • Expose • MAST (PASG) • Transport • Reassess - Report

Initial Resuscitation • Minimum Time On Scene • Maximum Treatment in Route Critical Trauma Goals

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 • DoNOT hold critical trauma in field for secondary history, physical exam

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

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

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

Head to Toe Exam • Extremity assessment must include: • Pulse • Skin color, temperature • Capillary refill • Motor, sensory function

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

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

Baseline Vital Signs • Quality • Weak (Thready) • Full • Bounding • Pulse • Rate • Rapid • Slow • Rhythm • Regular • Irregular

Baseline Vital Signs • Quality • Shallow • Full • Deep • Labored • Respirations • Rate • Inadequate • <10 or >24 • Rhythm • Regular • Irregular

Baseline Vital Signs • Blood Pressure • Hypotensive? • Hypertensive? • Narrow pulse pressure? • Wide pulse pressure?

Baseline Vital Signs • Pupils • Dilated? • Unequal? • Reaction to light • Normal? • Sluggish? • Unequal? • Unresponsive?

Baseline Vital Signs • Skin • Color • Temperature • Moisture • Turgor • Capillary refill

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

SAMPLE History • Allergies • ANY Allergies? • Don’t focus only on allergies to medication • All allergies could be significant • What are they? • Are you being treated for this condition?

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?

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

SAMPLE History • Last oral intake • Last foodor drink • Events leading up to incident

PowerPoint Source • http://www.templejc.edu/dept/ems/pages/powerpoint.html

TRAUMA ASSESSMENT