Patient Assessment

1. Patient Assessment Trauma

2. Scene Size-Up An assessment of the scene and surroundings that will provide valuable information to the EMT

3. Personal Protective Equipment/Body Substance Isolation • PPE for BSI • Scene Safety • Fire • HAZMAT • Car Accidents • Domestic Violence – shootings/stabbings/assaults YOUR SAFETY COMES FIRST!!!!

4. Number of Patients • Triage – French meaning “to sort” • Triage officer does not treat patients – just tags them • Cardiac arrest patients considered low triage because they are already dead • Need for Additional Resources • Multiple patients = more responders • ALS back-up • Police/Fire Dept.

5. Mechanism of Injury or Nature of Illness • Medical – 90% of all calls • Trauma – 10% of all calls What is causing the problem? What does that tell you?

6. Car Crashes Where were they sitting? Were they wearing a seat belt? • Head-on collision Types of injuries: • Hip • Knee & leg • Head & neck • Chest • Abdominal injuries

7. Head-on Collision

10. 2. Rear-end collision Types of Injuries • Head & neck • Chest injuries 3. Side-impact collision Types of Injuries • Head & neck • Chest • Abdomen • Pelvis • Thighs

11. Rear-end Collision

13. Side-impact Collision

14. Penetrating trauma – passes through the skin and/or body tissues • Low velocity • Propelled by hand – ex. Knives • Injury limited to area penetrated • Medium velocity • Handguns or shotguns • High velocity • High powered assault rifle Blunt force trauma – blow that does not break the skin but causes injury • Steering wheel, baseball bat

15. Nature of Illness • Sources of Information are: • Patient • Family members or bystanders • Information found at the scene

16. Significant Mechanism of Injury • Ejection from the vehicle • Death in same passenger compartment • Fall of more than 15ft or 3 times the patient’s height • Rollover • High speed vehicle collision • Vehicle-pedestrian collision • Motorcycle • Unresponsive or altered mental status (AMS) due to the incident • Penetration of head, chest, abdomen

22. Significant Mechanism of Injuryspecifically for children • Falls more than 10ft. • Bicycle collision • Vehicle in medium speed collision

23. Initial Assessment(Quick Look) • The purpose of the initial assessment is to identify and treat any life threatening conditions.

24. Initial Assessment • Consider C-spine stabilization – have your partner stabilize the head if sufficient manpower available. • General impression of the patient: • How are they laying • Skin color • Respirations • Any blood?

25. Initial Assessment • Assess patient’s mental status (AVPU) • Alert • Verbal • Painful • Unresponsive Ask questions such as: * What is your name? * Where are you? * What day is it?

26. ABC’s TREAT AS YOU GO!!!

27. Initial Assessment • Assess patient’s AIRWAY status and maintain airway. • In unresponsive patients always do a jaw thrust.

28. Initial Assessment • Assess patient’s BREATHING – look, listen and feel. • Respirations • Quality • Bilateral chest expansion • Sucking chest wound • Flail chest – 3 or more ribs broke in 2 or more places. The pt. will have paradoxical chest movement. ***INITIATE APPROPRIATE OXYGEN THERAPY AND ASSURE ADEQUATE VENTIALATION***

29. Initial Assessment • Assess patient CIRCULATION • Pulse – radial most reliable distal pulse in an adult. Brachial in a child. • Quality • Control major bleeding – pat down the body. Bright red blood (arterial) is an emergency situation and requires immediate attention. • Skin color, temperature and condition • Perfusion • Capillary Refill (INFANTS AND CHILDREN ONLY – up to age 5) <2 seconds is normal

30. ABC’s should take 60 – 90 seconds!!!!

31. Initial Assessment • Identify priority patients and make transport decision • CUPS • Critical – CPR/arrest patient • Unstable patient • Potentially Unstable patient • Stable patient

33. Rapid Trauma Assessmentvs.Detailed Physical Exam • Rapid trauma assessment should be performed on patients with significant mechanism of injury to determine life threatening injuries. • Important in order to: • Make CUPS determination • Consider ALS intercept • Consider platinum ten minutes and golden hour

34. Focus History & Physical Exam • Reconsider mechanism of injury • Trauma protocols • Consider hidden injuries due to mechanism of injury.

35. Perform Rapid Trauma Assessment • DCAP-BTLS • Deformities • Contusions • Abrasions • Punctures/penetrations • Burns • Tenderness • Lacerations • Swelling

36. Deformities

37. Contusions

38. Abrasions

39. Punctures/penetrations

40. Burns

41. Tenderness

42. Lacerations

44. Swelling

45. Focus History & Physical Exam 1. Assess the Head

46. 2. Assess Neck • Jugular venous distention (JVD) – Flat veins in a supine trauma patient can be an indication of blood loss. • Tracheal deviation-moves to uninjured lung side • Stoma/tracheostomy

47. ** Apply Cervical Collar** 3. Assess the Chest – crepitus (bone ends rubbing together) a. listen for breath sounds – high on both sides. Under arm pits b. check for equal chest rise and expansion – paradoxical breathing

48. 4. Assess Abdomen a. Palpate all 4 quadrants – press gently hand over hand. Do spot where the pain is last. b. Do they have a colostomy or ileostomy?

49. 5. Assess the Pelvis • If no pain is noted, press gently in and down on the wings. DO NOT log roll someone with a suspected pelvic injury. • Assess males for priapism 6. Assess the Lower Extremities • Check pulses • Check neurological function – PMS • Pulse • Movement • Sensation

50. 7. Assess the Upper Extremities • Check pulses • Check neurological function - PMS • Pulse • Movement • Sensation 8. Assess the Back & Buttocks • Do this when you log roll the patient to place them on the long board