Assessment of the Trauma Patient

1

CHAPTER 10
Assessment of the Trauma Patient
2

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
3

Assessing the Trauma Patient
Is there a significant mechanism of injury?
4

Mechanism of Injury
5

Significant Mechanism of Injury (Always
reconsider or do a double check it is easy
to miss things)
6

Significant Mechanism of Injury

• Ejection from vehicle/vehicle with intrusion
• Death in same passenger compartment
• Fall of greater than 20 feet or 3 times the
  patients height

7

Significant Mechanism of Injury

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

8

Significant Mechanism of Injury

• Motorcycle crash
• Unresponsive or altered mental status
• Penetrating injury of head, chest, or abdomen

9

Significant Mechanism of Injury
Infants and Children

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

10

Mechanism of Injury Interior of Vehicle
Deformities to a vehicles interior may show
where person struck the surface and reveal a
mechanism of injury.
11

Bent Steering Wheel
12

Broken Mirror
13

Distorted Pedals
14

Spider-Webbed Windshield
15

Deformed Dashboard
16

Consideration of Mechanism of Injury

• Mechanism of injury often results in specific
  hidden injuries
• Seat Belts
• If buckled, may have produced injuries
• If patient had seat belt on, it doesn't mean
  they do not have injuries
• Should injury resulting from harness
• Airbags
• May not be effective without the seatbelt
• Patient can hit wheel after deflation
• Arm injury from holding the steering wheel wrong
• Lift the deployed airbag and look at the
  steering wheel
• Lift and look under the bag after the patient
  has been removed
• Any visible deformation of the steering wheel
  should be regarded as an indicator of potentially
  serious internal injury, and appropriate action
  should be taken
• Damage to car body

17

If Significant Mechanism of Injury

• Reconsider mechanism of injury/priority of
  transport.
• Assess mental status.
• Continue spine stabilization.
• Perform a rapid trauma assessment.

18

Rapid TraumaAssessment
19

Terminology

• Rapid trauma assessment a rapid assessment of
  the head, neck, chest, abdomen, pelvis,
  extremities, and posterior of the body to detect
  signs and symptoms of injury
• Platinum ten minutes optimum time at a scene
  with a patient who has serious injuries
• Golden hour time for time of injury and surgery
  at the hospital

20
Rapid Trauma Assessment

• Perform rapid trauma assessment 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.
• The rapid trauma assessment is important in
  order to
• Estimate the severity of injuries
  (life-threatening)
• Make a CUPS status determination
• Make transport decision, which is dependent upon
  CUPS determination
• Consider ALS intercept
• Consider platinum ten minutes and golden hour

21
Rapid Trauma Assessment

• The rapid trauma assessment should be
  interrupted to provide life saving interventions
• Airway
• Breathing
• Circulation
• These always come 1st in this order
• Life before limb

22

Performing a Rapid Trauma Assessment

• Continue spinal stabilization somebody holds
  head
• Consider ALS request
• Reconsider transport decision (CUPS)
• Assess mental status (AVPU)
• As you inspect and palpate, look, and feel for
  DCAP-BTLS

23
Inspect and Palpate for DCAP-BTLS

Deformities Contusions Abrasions Punctures/Penetr
ations

D C A P
Symptoms of injury found by inspection or
palpation during the patient assessment.
24

Deformities
25

Contusions
26

Abrasions
27

Punctures/Penetrations
28

Burns
29

Tenderness
30

Lacerations
31

Swelling
32

Rapid Trauma Assessment

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

33

Head DCAP-BTLS Crepitation
Do not apply significant pressure to the head if
fluid is found coming from ears, nose and mouth
(cerebrospinal fluid) Crepitation the grating
sound or feeling of broken bones rubbing together
34

Neck DCAP-BTLS Jugular Vein Distention and
Crepitation
Jugular vein distention is the bulging of the
neck veins Look for stoma, tracheostomy and
tracheal deviation You can apply a cervical
collar at this point (be sure to check the back
of the neck first)
35
Chest DCAP-BTLS Crepitation and Breath Sounds
(Presence, Absence and Equality)

Look for paradoxical motion (movement of part of
the chest in the opposite direction from the rest
of the chest Listen to breath sounds at the
apices, mid-clavicular line, bilaterally and at
the bases, mid-axillary line bilaterally
36

Listen to both sides of the chest. Is air entry
present? Absent? Equal on both sides? Compare
left side to right side.
Mid-axillary
Mid-clavicular
37
Abdomen DCAP-BTLS Firmness and Distention

Divide the abdomen into four quadrants right
upper quadrant (RUQ), right lower quadrant (RLQ),
left upper quadrant (LUQ), and left lower
quadrant (LLQ) Coleostomy/Ileostomy surgical
opening in the wall of the abdomen with a bag in
place to collect excretions from the digestive
system Look also for softness and distention
(appearing larger than normal)
38

Pelvis DCAP-BTLS (Compress gently.)
If no pain is noted, gently compress the pelvis
to determine tenderness or motion (press in and
down on pelvic wings) DO NOT ROCK AND
ROLL Priapism persistent erection of the penis
that can result from spinal cord injury or
certain medical problems
39

Extremities DCAP-BTLS Distal Pulse, Sensation,
Motor Function, and Crepitation
Pulse is it present Sensation can the
patient feel you touching his/her
extremities Motor Function can the patient
move his/her extremities
40

Posterior DCAP-BTLS
Roll patient with spinal precautions and assess
posterior body, inspect and palpate, examining
for injuries or signs of injury (check spine,
sides of spine/body, posterior of extremities
and buttocks for injuries
41

Significant Mechanism of Injury

• Assess baseline vital signs.
• Obtain SAMPLE history.
• Reconsider requesting ALS.
• Reconsider transport decision.

42

Transport
43
If No Significant Mechanism of Injury (i.e. cut
finger)

• Perform focused history and physical exam based
  on the component of the rapid assessment.
  Performing the focused history and physical
  examination permits
• Assessment and treatment of injuries not
  identified in the initial assessment (DCAP-BTLS
  for the injured area)
• Reconsideration of mechanism of injury
• Assess baseline vital signs
• Assess SAMPLE history

44

Vital Signs

• Respirations
• Pulse
• Skin color, temperature, condition
• Pupils
• Blood Pressure

45

SAMPLE History
S Signs and symptoms
A Allergies
M Medications
P Pertinent past history
L Last oral intake
E Events leading to injury or illness
46

Rules of Assessment

• Explain to the patient what you are doing.
• Expose areas before assessing.
• Assume spinal injury.

47

Cervical Collar Sizing andApplication
48

Cervical Collars
STIFNECK TM Rigid Extrication Collar
Philadelphia Cervical Collar TM
49

STIFNECK TM Collar Seated Patient
Stabilize head and neck manually.
50

Sizing a Cervical Collar
2
Measure the collar.
1
Measure the patients neck.
51

STIFNECK TM Collar Seated Patient
Slide collar up toward patients chin.
52

STIFNECK TM Collar Seated Patient
Position front of collar under chin.
53

STIFNECK TM Collar Seated Patient
Wrap collar around back of neck.
54

STIFNECK TM Collar Seated Patient
Secure the collar.
55

STIFNECK TM Collar Seated Patient
Rearrange fingers to maintain support.
56

STIFNECK TM Collar Supine Patient
Kneel at patients head.
57

STIFNECK TM Collar Supine Patient
Stabilize the head and neck.
58

STIFNECK TM Collar Supine Patient
Maintain stabilization.
59

STIFNECK TM Collar Supine Patient
Slide back of collar under patients neck.
60

STIFNECK TM Collar Supine Patient
Secure collar.
61

STIFNECK TM Collar Supine Patient
Maintain manual stabilization.