ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT

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ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT

• Instructor Name
• Title
• Unit

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OVERVIEW

• SCENE SIZE-UP
• TRANSPORT DECISION AND CRITICAL INTERVENTIONS
• DETAILED EXAM
• ONGOING EXAM

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SCENE SIZE-UP

• BSI DECISION
• SCENE SAFETY
• TOTAL NUMBER OF PATIENTS
• ESSENTIAL EQUIPMENT
• ARE ADDITIONAL RESOURCES NEEDED
• MECHANISM OF INJURY

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Trauma Assessment A hands on approach
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What is Trauma?

• A serious injury or shock to the body by violence
  or accident!

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Trauma Assessment is a Basic life support skill!
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Touching the patient is a must to find possible
injuries!
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What are we looking for?

• Life threats that are going to kill the patient
  right now!
• Any obvious injuries that the patient has
• Any underlying injuries the patient may have we
  cant see
• Changes that may occur during transport

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How fast do patients die?
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Now lets take a look at how the assessment
should go!
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Scene size-up

• This is the overall picture of the scene to
  ensure the safest environment for yourself, your
  crew, other responding personnel, patient, and
  bystanders in that order.

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Scene size-up

• BSI (body substance isolation)
• Scene safety
• Number of victims
• Other help or equipment needed
• Mechanism of injury

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Mechanism of Injury

• Predictable pattern of injuries caused by forces
  applied to the body
• Helps you key in on possible injuries

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Initial assessment

• General impression- your gut feeling on patient
  status and priority of transport
• LOC- AVPU on patient with simultaneous initiation
  of c-spine immobilization
• Airway- open/clear if not fix it
• Breathing- rate/quality
• interventions to airway- oxygen by NRB or BVM
• Circulation- compare radial vs. carotid pulses,
  skin color/temp/condition
• Control any major bleeding!

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Decisions, decisions, decisions

• Load and Go or Stay and play
• Rapid trauma survey
• Focused trauma survey

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Rapid Trauma assessment

• Should take less than two minutes to perform
• A quick scan of whole body
• Identifies any life threats
• Used to mentally note injuries to fix later

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DCAP-BLS-TIC

• Deformities
• Contusions
• Abrasions
• Punctures/penetrations
• Burns
• Lacerations
• Swelling
• Tenderness
• Instability
• crepitation

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HEAD

• Palpate the head looking for DCAP-BLS-TIC
• Examine the facial bones
• Look at ears , nose, and mouth for any fluids
  coming from them
• Check for Battle signs or raccoon eyes

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Neck

• Visualize neck for DCAp-bls-tic
• Check neck for tracheal deviation
• Check neck for Jugular vein distention
• Palpate the back of the neck
• Consider applying the c-collar

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Chest

• Visualize chest for DCAP-bls-tic
• Listen to breath sounds(this is a bls skill)
• Palpate the chest
• IF a open wound or flail chest is found have a
  partner place a gloved hand over area till you
  finish rapid trauma survey

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Abdomen

• Visualize the abdomen for dcap-bls-tic
• Palpate abdomen for rigidity, guarding, or
  tenderness
• If patient alert and tells you where pain is feel
  that area last

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Pelvis

• Palpate the pelvis for dcap-bls-tic
• It is a in and down motion
• Do not rock the pelvis
• If you find a unstable pelvis do not mess with it
  again

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Lower extremities

• Visualize lower extremities for dcap-bls-tic
• Palpate down one leg at a time
• Check for pulse, motor, sensory function to both
  feet
• Check for capillary refill

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Upper extremities

• Visualize upper extremities for dcap-bls-tic
• Palpate both arms
• Feel for pulse, motor, and sensory
• Check capillary refill

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Back

• Log roll the patient with c-spine stabilization
• Visualize back for dcap-bls-tic
• Palpate back from neck to legs

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Secure patient to board

• Secure body first
• Then secure head
• Reassess PMS after moving patient
• Securing head first or not securing body could be
  a major problem if patient becomes sick and you
  have to roll patient to maintain airway!

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Attempt to obtain sample history

• Signs/symptoms
• Allergies
• Medicines including OTC and herbal
• Pertinent past medical history
• Last oral intake not just eating
• Events leading to trauma

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Now the patient is in the ambulance enroute to
the hospital!
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Baseline Vitals

• Pulse
• Respirations
• Blood pressure
• O2 sat
• Skin color/condition

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Neurological exam

• LOC
• Pupils
• Motor
• sensory

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Detailed exam

• Do a slower exam of body
• Touch the whole body looking for injuries
• Fix problems as you find them
• Fix problems that you noted in rapid trauma
  assessment
• Looking for dcap-bls-tic again

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Maintain body temperature during exam and
transport
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PERFORM ONGOING ASSESSMENT

• PERFORM REASSESSMENT OF ABCS
• REASSESS VITALS EVERY THREE TO FIVE MINUTES
• REASSESS INTERVENTIONS AND EFFECTIVENESS

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Give oral report

• Give short concise report
• Use the mint pneumonic
• Mechanism of injury
• Injuries from head to toe
• Neurological exam including gcs score
• Treatments performed and vital signs

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Transfer patient out of your care!
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PITFALLS

• Approaching the patient before performing a Scene
  Size-Up
• Trying to do too much on-scene
• Attempting to stabilize the patient in the field

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SUMMARY

• Scene Size-Up
• BTLS Primary Survey
• Initial Assessment
• Rapid Trauma Survey or Focused Exam
• Critical interventions and transport decision
• Detailed Exam
• Ongoing Exam

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We are finished now

• Question?
• Comments
• Snide remarks
• If not thank you

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QUESTIONS?