Transcript Mosby`s EMT-Basic Textbook

Chapter 10
Focused History and
Physical Examination
of the
Trauma Patient
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 1
Case History
You respond to a 35-year-old male who has been in a
front-end, high-speed collision. He was the driver of
the car and there is a deformed steering wheel. You
take the appropriate BSI precautions and ensure that
the scene is safe, perform your initial assessment,
and begin your physical examination and history.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2
Reconsider Mechanism of Injury
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Ejection from vehicle
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Death in same passenger compartment
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Falls > 20 feet
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Rollover of vehicle
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High-speed vehicle collision
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 3
Reconsider Mechanism of Injury
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Vehicle-pedestrian collision
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Motorcycle crash
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Unresponsive or altered mental status
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Penetrations of the head, chest, or abdomen
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Type of instrument in blunt trauma
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 4
Hidden Injuries
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Seat belts and airbags can
prevent death/injury.
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Patients who use safety devices
may still have serious injuries.
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Shearing forces
Shoulder belt
Lap belt
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Hidden Injuries
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Airbags may not be effective without use of a
seat belt.
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Lift airbag and look at the steering wheel for
deformity
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 6
Infant and Child
Considerations
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Falls >10 feet
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Bicycle collision
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Vehicle in medium-speed collision
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 7
Elderly
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Subject to injury with a lesser mechanism
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May have a different response to an injury than
younger adults
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Carefully evaluate for bone injury, even with minor
mechanisms.
Do not compensate as well for serious injury
Tend to decompensate (become worse) more quickly
May be taking medications that affect vital signs
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 8
Rapid Trauma Assessment
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Performed on patients with significant mechanism of
injury to determine life-threatening injuries
In the responsive patient, symptoms should be sought
before and during the trauma assessment.
Maintain spinal stabilization.
Consider ALS request.
Reconsider transport decision.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 9
Assess Mental Status
AVPU
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Alert
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Verbal stimuli
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Painful stimuli
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Unresponsive
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10
Inspect and Palpate
DCAP/BTLS
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Deformities
Contusions
Abrasions
Punctures/penetrations
Burns
Tenderness
Lacerations
Swelling
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11
Rapid Trauma Assessment
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Head
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DCAP/BTLS
Crepitation
Careful palpation to
avoid injury to brain
Assume cervical spine
injury with blunt head
trauma
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Rapid Trauma Assessment
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Neck
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DCAP/BTLS
Crepitation
Subcutaneous emphysema
Jugular venous distention
Tracheal shift
Apply CSID
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13
Rapid Trauma Assessment
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Chest
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DCAP/BTLS
Breath sounds
Paradoxical breathing
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Rapid Trauma Assessment
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Abdomen
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DCAP/BTLS
Firm vs. soft
Distended
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Rapid Trauma Assessment
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Pelvis
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DCAP/BTLS
Crepitation
Tenderness
Motion
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16
Rapid Trauma Assessment
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Lower Extremities
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DCAP/BTLS
Distal pulse
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Rapid Trauma Assessment
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Lower Extremities
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Sensation
Motor function
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18
Rapid Trauma Assessment
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Upper Extremities
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DCAP/BTLS
Distal pulse
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19
Rapid Trauma Assessment
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Upper Extremities
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Sensation
Motor function
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Rapid Trauma Assessment
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Back
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DCAP/BTLS
Look for exit wounds with
penetrating trauma
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21
Assess Baseline Vital Signs
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Pulse
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Respirations
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Blood pressure
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Temperature
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22
Assess SAMPLE History
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Signs and symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading up to the incident
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23
Patients with No Significant
Mechanism of Injury
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Perform focused history.
Perform focused assessment on the specific
injury site.
Assess baseline vital signs.
Assess SAMPLE history.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24
Summary
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Reconsider the mechanism of injury.
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Perform rapid trauma assessment.
 Check for signs of injury (DCAP/BTLS) in all body regions.
 Maintain spinal stabilization.
 After assessing the head and neck, apply a cervical collar.
 Log roll the patient to assess the posterior body.
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Assess baseline vital signs.
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Collect a SAMPLE history.
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For patients with no significant mechanism of injury, physical examination
should be focused on the injured body part.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25