Trauma Assessment: The 20 Commandments

1
Trauma AssessmentThe 20 Commandments

• Paul A. Werfel, NREMT-P
• Director, Paramedic Program
• Clinical Assistant Professor of Health Science
• Assistant Professor of Clinical Emergency
  Medicine
• School of Health Technology Management
• Department of Emergency Medicine
• Stony Brook University, New York

2
For copies of this presentation, feel free to
email me atpaul.werfel_at_stonybrook.edu
3
There are dilemmas in life
4
Some patient injuries/illnesses are obvious
5
1. GENERAL PATIENT ASSESSMENT

• WE ARE IN THE INFORMATION BUISNESS

6
2. GENERAL PATIENT ASSESSMENT

• THERE ARE MORE ILLNESSES THAN PROTOCOLS TO TREAT
  THEM

7
3. GENERAL PATIENT ASSESSMENT

• DIABETICS, WOMEN, AND THE ELDERLY HAVE ATYPICAL
  MI PRESENTATIONS

8
4. GENERAL PATIENT ASSESSMENT

• ASSESSING PATIENTS THAT HAVE
• CONSUMED ADULT BEVERAGES OR RECREATIONAL
  DRUGS MAY BE DIFFICULT

9
WHILE WE ARE ON THE SUBJECT OF MEDICATIONS
10
You will learn the language of EMS and the names
of many disease entities

• The baby has screaming meemmee Jesus
• I have pileups in my Eucharist
• I am afraid that she has old-timers disease
• My wife is taking Latex
• My wife is not an epileptic, she is catholic
• I have very close veins
• I have a ferocious liver

11
5. TRAUMA PATIENT ASSESSMENT

• WOMEN WITH ABDOMINAL PAIN MUST GO TO THE HOSPITAL
  FOR EVALUATION

12
Some people hurt themselves bad enough to
dieAnonymous Trauma Surgeon
13
6. TRAUMA PATIENT ASSESSMENT

• HYPOTENSION IS A LATE SIGN OF SHOCK

14
7. TRAUMA PATIENT ASSESSMENT

• ADULTS CANNOT BECOME HYPOTENSIVE EXCLUSIVELY DUE
  TO CLOSED HEAD TRAUMA

15
8. TRAUMA PATIENT ASSESSMENT

• SHORT BOARDS, KEDs AND HARE TRACTION SPLINTS WORK
  WELL FOR STABLE TRAUMA VICTIMS--NOT FOR UNSTABLE
  ONES
• SAGER SPLINTS CAN BE PLACED VERY QUICKLY

16
9. TRAUMA PATIENT ASSESSMENT

• THE MULTI-TRAUMA PATIENT WITH HEAD TRAUMA AND
  SHOCK NEEDS TO BE TREATED LIKE ANY OTHER
  MULTI-TRAUMA VICTIM

17
In life, its always later than you think
18
10. TRAUMA PATIENT ASSESSMENT

• GERIATRIC PATIENTS MAY NEVER EXHIBIT TACHYCARDIA,
  PALLOR OR HYPOTENSION FROM BLOOD LOSS

19
11. TRAUMA PATIENT ASSESSMENT

• FALL OR DRUNK?

THE 4 STAGES OF LIFE
20
12. TRAUMA PATIENT ASSESSMENT

• THE ELDERLY CAN HAVE CATASTROPHIC ABDOMINAL
  TRAUMA WITH LITTLE OR NO PAIN

21
Language of EMS-Its not always the patients

• Patient has a burning sensation in his penis,
  which goes to his feet
• The patient must have internal injuries, because
  there were no outernal ones
• I started an ivy on the patient
• 3 liters of nasal oxygen by mask
• Patient pregnant, having benson and hedges
  contractions
• Briggs and Stratton contractions
• The patient has Cozumels breathing

22
The two things that children wear out are
clothes and parents
23
DADDYS IDEA OF BABYSITTING
24

25
13. TRAUMA PATIENT ASSESSMENT

• CHILDREN ARE NOT ADULTS THAT HAVE BEEN LEFT IN
  THE DRYER TOO LONG

26
14. TRAUMA PATIENT ASSESSMENT

• CRYING, SCREAMING CHILDREN ARE USUALLY STABLE

27
15. TRAUMA PATIENT ASSESSMENT

• BLOOD PRESSURE IS AN UNRELIABLE SIGN OF PEDIATRIC
  SHOCK

28
16. TRAUMA PATIENT ASSESSMENT

• LETHARGY AND MINIMAL RESPONSE TO PAINFUL STIMULI
  IN CHILDREN IS AN OMINOUS FINDING

29
17. TRAUMA PATIENT ASSESSMENT

• In EMS, it is the mechanism, not the injury that
  we are treating

30
18. TRAUMA PATIENT ASSESSMENT

• If the news media gets footage of you treating a
  trauma patient that is not trapped, you have been
  on scene too long

31
19. TRAUMA PATIENT ASSESSMENT

• Dont miss things because they are not obvious

32
20. TRAUMA PATIENT ASSESSMENT

• Patients with unexplained hypotension frequently
  have abdominal bleeds

33
CONCLUSIONS

• Keep yourself out of trouble
• "Be careful The toes you step on today may be
  connected to the butt you'll be kissing
  tomorrow."
• Stay up to date
• Role of experience
• So, I see that you have 20 years of EMS
  experience, is that really 20 years or 1 year of
  experience that you repeated 20 times?

34
Questions?
35
THANK YOU