Trauma Patient Assessment

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TRAUMA ASSESSMENT

Emergency Medical Technician - Basic

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Scene Size-Up Safety

– Yourself– Your partner– Other responders– Bystanders– Patient

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Scene Size-Up

Scene– Location?– Appearance?– Where is patient?– What is condition of vehicle?– Were seatbelts used?– Mechanism of Injury? Amount of force?

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Scene Size-Up Situation

– Additional support?

– Critical vs. Non-critical patient?

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Initial Assessment

Find life threats If life-threat is present, CORRECT IT! If you can’t correct it:

– Oxygenate– Ventilate– TRANSPORT

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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

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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 - MAINTAINOPEN - CLEAR - MAINTAIN

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Initial Assessment Breathing

– Is patient breathing– Is patient moving air adequately?

– Is O2 getting to blood

LOOK - LISTEN - FEELLOOK - LISTEN - FEEL

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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!

If you think about giving O2, GIVE IT!

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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!

If you can’t tell if ventilations are adequate, THEY AREN’T!

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Initial Assessment Breathing

– If breathing is compromised:» Expose» Palpate» Auscultate

Try to find, correct causeTry to find, correct cause

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Initial Assessment

Circulation– Is heart beating?– Is patient perfusing?– Serious external hemorrhage ?

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Initial Assessment Circulation

– Pulses present?» Radial => BP > 80 systolic» Femoral => BP > 70 systolic» Carotid => BP > 60 systolic

– Skin color, temperature» Cool» Pale» Moist

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Initial Assessment

Circulation– If circulation is compromised:

» Expose» Palpate» Auscultate

Try to find, correct causeTry to find, correct cause

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Initial Assessment Circulation

– If carotid pulse absent:» Extricate» CPR» MAST» Transport

Fewer than 1% of blunt trauma victims in cardiac arrest survive

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Initial Assessment Disability

– Level of consciousness = Best indicator of brain perfusion

– Pupils--Eyes are windows of CNS– Decreased LOC

» Head injury» Hypoxia» Hypoglycemia» Shock

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Initial Assessment

Level of Consciousness (LOC)– A - Alert– V - Verbal– P - Painful– U - Unresponsive

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Initial Assessment Decreased LOC + Unequal Pupils = Epidural or

Subdural Hematoma Until Proven Otherwise

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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

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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

If the patient looks sick, he is sick

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

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Initial Resuscitation Immobilize C-spine Maintain airway Oxygenate Rapid extrication to

long board Assist ventilations

Expose MAST (PASG) Transport Reassess - Report

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Initial Resuscitation

Minimum Time On Scene Maximum Treatment in Route

Critical Trauma GoalsCritical Trauma Goals

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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

Do NOT hold critical trauma in field for secondary history, physical exam

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History, Physical Exam

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

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History, Physical Exam

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

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Head to Toe Exam

Organized, systematic Superior to Inferior Proximal to Distal Look - Listen - Feel - Smell

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Head to Toe Exam

Extremity assessment must include:– Pulse – Skin color, temperature– Capillary refill– Motor, sensory function

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Focused Exam

Isolated Injury No significant mechanism of Injury Head-to-toe not necessary since other

injuries unlikely

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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

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Baseline Vital Signs Pulse

– Rate» Rapid» Slow

– Rhythm» Regular» Irregular

– Quality» Weak (Thready)» Full» Bounding

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Baseline Vital Signs Respirations

– Rate» Inadequate» <10 or >24

– Rhythm» Regular» Irregular

– Quality» Shallow» Full» Deep» Labored

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Baseline Vital Signs Blood Pressure

– Hypotensive?– Hypertensive?– Narrow pulse pressure?– Wide pulse pressure?

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Baseline Vital Signs Pupils

– Dilated?– Unequal?– Reaction to light

» Normal?» Sluggish?» Unequal?» Unresponsive?

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Baseline Vital Signs Skin

– Color– Temperature– Moisture– Turgor– Capillary refill

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SAMPLE History Signs, Symptoms

– Signs» Objective findings» What you perceive

– Symptoms» Subjective» What patient experiences

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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?

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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?

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SAMPLE History Past, Pertinent Medical History

– Have you had any recent illnesses?– Have you been receiving medical care for any

conditions?

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SAMPLE History

Last oral intake

– Last food or drink Events leading up to incident