Transcript TRAUMA ASSESSMENT

TRAUMA ASSESSMENT
Emergency Medical Technician Basic
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Scene Size-Up
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Safety
– Yourself
– Your partner
– Other responders
– Bystanders
– Patient
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Scene Size-Up
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Scene
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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
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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
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Airway with C-Spine Control
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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
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Initial Assessment
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Breathing
– Is patient breathing
– Is patient moving air adequately?
– Is O2 getting to blood
LOOK - LISTEN - FEEL
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Initial Assessment
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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!
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Initial Assessment
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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!
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Initial Assessment
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Breathing
– If breathing is compromised:
» Expose
» Palpate
» Auscultate
Try to find, correct cause
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Initial Assessment
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Circulation
– Is heart beating?
– Is patient perfusing?
– Serious external hemorrhage ?
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Initial Assessment
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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
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Circulation
– If circulation is compromised:
» Expose
» Palpate
» Auscultate
Try to find, correct cause
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Initial Assessment
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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
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Disability
– Level of consciousness = Best indicator of brain
perfusion
– Pupils--Eyes are windows of CNS
– Decreased LOC
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Head injury
Hypoxia
Hypoglycemia
Shock
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Initial Assessment
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Level of Consciousness (LOC)
– A - Alert
– V - Verbal
– P - Painful
– U - Unresponsive
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Initial Assessment
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Decreased LOC + Unequal Pupils =
Epidural or Subdural Hematoma Until
Proven Otherwise
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Initial Assessment
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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
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Vitals signs are not necessary to determine
whether patient is critical
Regardless of your findings
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
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Immobilize C-spine
Maintain airway
Oxygenate
Rapid extrication to
long board
Assist ventilations
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Expose
MAST (PASG)
Transport
Reassess - Report
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Initial Resuscitation
Critical Trauma Goals
Minimum Time On Scene
 Maximum Treatment in Route
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History, Physical Exam
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You will get to this with MOST trauma patients
Perform only after:
– Initial assessment is completed, and
– All life-threats are corrected
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Do NOT hold critical trauma in field for
secondary history, physical exam
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History, Physical Exam
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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
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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
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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
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Pulse
– Rate
» Rapid
» Slow
– Rhythm
– Quality
» Weak (Thready)
» Full
» Bounding
» Regular
» Irregular
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Baseline Vital Signs
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Respirations
– Rate
» Inadequate
» <10 or >24
– Rhythm
» Regular
» Irregular
– Quality
» Shallow
» Full
» Deep
» Labored
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Baseline Vital Signs
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Blood Pressure
– Hypotensive?
– Hypertensive?
– Narrow pulse pressure?
– Wide pulse pressure?
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Baseline Vital Signs
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Pupils
– Dilated?
– Unequal?
– Reaction to light
» Normal?
» Sluggish?
» Unequal?
» Unresponsive?
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Baseline Vital Signs
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Skin
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Color
Temperature
Moisture
Turgor
Capillary refill
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SAMPLE History
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Signs, Symptoms
– Signs
» Objective findings
» What you perceive
– Symptoms
» Subjective
» What patient experiences
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SAMPLE History
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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
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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
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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
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