Brady2, Emergency Care Slides

1
Chapter
10
Assessment of the Trauma Patient
2
Chapter
10

• Focused History and Physical Exam (No
  Significant MOI)
• Focused Physical Exam
• Vital Signs and SAMPLE History
• Cervical Collar Application

3
Chapter
10

• Focused History and Physical Exam
  (Significant MOI)
• Rapid Trauma Assessment
• Vital Signs and SAMPLE History
• Detailed Physical Exam

4
Chapter
10
Overall Assessment Scheme
Scene Size-Up
Initial Assessment
Trauma
Medical
Physical Exam
SAMPLE History
Vital Signs SAMPLE History
Physical Exam Vital Signs
HOSP
Detailed Physical Exam
Ongoing Assessment
5
Significant Mechanism of Injury
6
Significant Mechanism of Injury

• Ejection from vehicle
• Death in same passenger

compartment

• Fall of greater than 20 feet

(Continued)
7
Significant Mechanism of Injury

• Rollover of vehicle
• High-speed vehicle collision
• Vehicle-pedestrian collision

(Continued)
8
Significant Mechanism of Injury

• Motorcycle crash
• Unresponsive, or altered

mental status

• Penetrating injury of head,

chest, or abdomen
9
Hidden Injuries
10
Significant Mechanism of Injury
Differences with Infants and Children

• Falls greater than 10 ft.
• Bicycle collision
• Vehicle in medium-

speed collision
11
If Significant Mechanism of Injury

• Reconsider mechanism of
• Continue spine stabilization.
• Consider requesting ALS.

injury.

• Reconsider transport decision.

(Continued)
12
If Significant Mechanism of Injury

• Assess mental status.
• Do rapid physical exam.
• Assess baseline vital signs.
• Obtain SAMPLE history.

13
Mechanism of Injury Interior of Vehicle
Deformities to a vehicles interior may show
where person struck the surface and reveal a
mechanism of injury.
(Continued)
14
Bent Steering Wheel
15
Broken Mirror
16
Distorted Pedals
17
Spider-Webbed Windshield
18
Deformed Dashboard
19
Rapid Trauma Assessment
20
Rapid Trauma Assessment

• Head
• Neck
• Chest
• Abdomen
• Pelvis
• Extremities
• Posterior

21
Inspect and Palpate for DCAP-BTLS

Deformities Contusions Abrasions Punctures/
D C A P
Penetrations
22
Deformities
23
Contusions
24
Abrasions
25
Punctures/Penetrations
26
Burns
27
Tenderness
28
Lacerations
29
Swelling
30
Mechanism of Injury
31
Head DCAP-BTLS Crepitation
32
Neck DCAP-BTLS Jugular Vein Distention and
Crepitation
33
Chest DCAP-BTLS Crepitation and Breath Sounds
(Presence and Equality)
34
Listen to both sides of the chest. Is air
entry present? Absent? Equal on both
sides? Compare left side to right side.
Mid-clavicular
Mid-axillary
35
Abdomen DCAP-BTLS Firmness and Distention
36
Pelvis DCAP-BTLS (Compress Gently)
37
Extremities DCAP-BTLS Distal Pulse, Sensation,
Motor Function
38
Posterior DCAP-BTLS
39
Vital Signs

• Respirations
• Pulse
• Skin color, temperature, condition

• Pupils
• Blood Pressure

40
SAMPLE History
Signs and symptoms Allergies
Medications Pertinent past history Last
oral intake Events leading to problem
S A M P L E

41
Interventions and Transport
42
Cervical Collar Sizing and Application
43
Cervical Collars
STIFNECK TM Rigid Extrication Collar
Philadelphia Cervical Collar TM
44
Sizing a Cervical Collar
2
Measure the collar.
1
Measure the patients neck.
45
STIFNECK TM Collar Seated Patient
Stabilize head and neck manually.
46
STIFNECK TM Collar Seated Patient
Slide collar up toward patients chin.
47
STIFNECK TM Collar Seated Patient
Position front of collar under chin.
48
STIFNECK TM Collar Seated Patient
Wrap collar around back of neck.
49
STIFNECK TM Collar Seated Patient
Secure the collar.
50
STIFNECK TM Collar Seated Patient
Rearrange fingers to maintain support.
51
STIFNECK TM Collar Supine Patient
Kneel at patients head.
52
STIFNECK TM Collar Supine Patient
Stabilize the head and neck.
53
STIFNECK TM Collar Supine Patient
Maintain stabilization.
54
STIFNECK TM Collar Supine Patient
Slide back of collar under patients neck.
55
STIFNECK TM Collar Supine Patient
Secure collar.
56
STIFNECK TM Collar Supine Patient
Maintain manual stabilization.
57
No Significant Mechanism of Injury

• Reconsider mechanism of injury.
• Perform focused physical exam

based on

• Chief complaint
• Mechanism of injury

(Continued)
58
No Significant Mechanism of Injury

• Assess baseline vital signs.
• Obtain SAMPLE history.

59
Detailed Physical Exam
60
Who Needs a Detailed Physical Exam?
61
Who Needs a Detailed Physical Exam?

• Patient's condition determines

whether a detailed physical exam is needed.
(Continued)
62
Who Needs a Detailed Physical Exam?

• A patient with minor injury

and
no significant mechanism
of injury probably does not.
(Continued)
63
Who Needs a Detailed Physical Exam?

• A patient who has a significant

mechanism of injury.

• If unsure, do a detailed

physical exam.
64
Steps in the Detailed Physical Exam
65
The Detailed Physical Exam

• Assess areas examined in rapid

trauma assessment plus

• Face
• Ears
• Eyes
• Nose
• Mouth

(Continued)
66
The Detailed Physical Exam

• Examine more slowly than

trauma assessment.

• Reassess vital signs.

67


Deformities Contusions Abrasions Punctures/
Burns Tenderness Lacerations Swelling
D C A P
B T L S
Penetrations
68
Head DCAP-BTLS
69
Ears DCAP-BTLS Drainage
70
Eyes

• Discoloration
• Unequal pupils
• Foreign bodies
• Blood in anterior

DCAP-BTLS
chamber
71
Nose and Mouth

• Teeth
• Obstructions
• Swollen or

DCAP-BTLS
lacerated tongue
(Continued)
72
Nose and Mouth
DCAP-BTLS

• Odors
• Discoloration
• Drainage
• Bleeding

73
Neck DCAP-BTLS Jugular Vein Distention and
Crepitation
74
Chest DCAP-BTLS Crepitation and Breath Sounds
(Presence and Equality)
75
Listen to both sides of the chest. Is air
entry present? Absent? Equal on both
sides? Compare left side to right side.
Mid-clavicular
Mid-axillary
76
Abdomen DCAP-BTLS Firmness and Distention
77
Pelvis DCAP-BTLS (Compress Gently)
78
Extremities DCAP-BTLS Distal Pulse, Sensation,
Motor Function
79
Posterior DCAP-BTLS
80
Perform the steps of the Rapid Trauma Assessment
-- BUT MORE SLOWLY.
81
Reassess Vital Signs
condition
82
REVIEW QUESTIONS
1. When should you perform a
2. Explain the letters DCAP-BTLS.
83
REVIEW QUESTIONS
3. What do you assess in the detailed
physical exam that you dont assess in the rapid
trauma assessment?
84
REVIEW QUESTIONS

• 4. List some significant mechanisms
• 5. List the steps of the focused history

of injury.
and physical exam for the trauma patient with a
significant mechanism of injury.
85
REVIEW QUESTIONS
6. List the steps of the rapid trauma
assessment.
7. List the signs and symptoms that
correspond to DCAP-BTLS.
8. Tell what each of the letters in SAMPLE
stands for.
86
REVIEW QUESTIONS
9. Describe how to apply a STIFNECK TM
collar to a seated patient. To a supine
patient.
10. List the steps in the focused history
and physical exam for the trauma patient
with no significant mechanism of injury.
87
STREET SCENES

• What is the priority of this patient?
• What should be done next?
• When should vital signs be taken?
• What should you do next?
• What should be done for the detailed assessment
  if there is time before reaching the trauma
  center?