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Trauma Patient Assessment

Trauma Patient Assessment

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Trauma Patient Assessment

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  1. Trauma Patient Assessment

  2. Trauma Assessment

  3. Size-Up • Safety • BSI • MOI • Number of Patients • Additional Resources

  4. Safety • Traffic • Smoke • Electricity • Haz-Mat

  5. Safety • Hostile Persons • Weapons • Drugs • Silence

  6. BSI • Gloves • Goggles • Mask • Gown

  7. BSI • Gloves for minimal fluids • Add eye protection if there’s any chance of splatter • Add gown and mask for gross contamination

  8. Mechanism of Injury • Ejection • Death of another passenger in the same vehicle • Falls >15’ or 3X patients height (child = >10’) • Roll-over • High speed collision (child = moderate speed)

  9. Mechanism of Injury (cont.) • Pedestrian Involvement • Motorcycle (child = bicycle) • Altered mental status • Penetrating wounds to head, chest, abdomen)

  10. Number of Patients Call for additional resources ASAP

  11. Additional resources • Extrication • Traffic control • Utilities

  12. Initial Assessment • General Impression • Mental Status • Airway • Breathing • Circulation • Determine priority

  13. General Impression • Age, Weight, Gender • Position (relative to posture and surroundings) • Activity • Obvious Injuries/Bleeding

  14. Assess Mental Status • Take C-Spine control • A – Alert and immediately responsive • V – Responsive to verbal stimuli • P – Responsive to painful stimuli • U – Unresponsive

  15. Assess Airway • Open if necessary using jaw-thrust maneuver • Consider oro- or naso-pharyngeal airway • Note unusual sounds and correct cause • Snoring – oro-/naso-pharyngeal airway • Gurgling – suction • Stridor – consider intubation • Silence

  16. Correcting silence • Attempt ventilation • Reposition • Heimlich • Visualize and remove • Intubate • Trans-laryngeal jet insuflation

  17. Assess Breathing • Look, Listen, Feel • Rate, Rhythm, Depth (tidal volume) • Use of accessory muscles/retractions • Treat • Absent – ventilate x2, check pulse • < 12/min – assist ventilation • Decreased tidal volume – assist ventilation • Labored – oxygen 10 liters NRB • Normal or rapid – consider oxygen

  18. Compare radial and corotid Rate Normal Fast Slow Rhythm Regular Irregular Quality Weak Thready Bounding Assess Circulation - Pulses

  19. Assess Circulation - Skin • Color • Temperature • Moisture

  20. Assess Circulation - Bleeding • Direct pressure • Pressure dressing

  21. Determine priority • Poor general impression • Mental status changes • Difficulty breathing • Shock • Chest pain • Severe bleeding • Severe pain

  22. Rapid Trauma Assessment • Head to toe • Rapid sweep to identify major injuries which could prove life threatening • DCAP-BTLS

  23. D - deformities C - contusions/ crepitation A - abrasions P - penetrations/ paradoxical movement B - burns T - tenderness L - lacerations S - swelling Rapid Trauma Assessment (cont.)DCAP/BTLS

  24. Package and begin transport • Immediate – immobilize, load, go • Delayed – immobilize, treat as necessary, transport

  25. Focused History and Physical • Baseline vital signs • SAMPLE History • Focus on and treat injuries found during initial assessment and rapid trauma assessment as appropriate considering priority

  26. Focused History and PhysicalSAMPLE History • S – signs/symptoms • A – allergies • M – medications • P – past medical history • L – last oral intake • E – events leading up to the incident

  27. Detailed Physical Exam • As appropriate, considering priority • Repeat initial assessment • Complete critical interventions • Careful head to toe survey (DCAP/BTLS)

  28. Detailed Physical ExamHead to Toe • Head – DCAP/BTLS and creptiation • Ears – DCAP/BTLS and blood/fluid • Face – DCAP/BTLS and blood/fluid • Eyes – DCAP/BTLS and discoloration, pupils, foreign bodies, blood • Nose – DCAP/BTLS and blood/fluid • Mouth – DCAP/BTLS and teeth, foreign bodies, swelling, lacerations, odor

  29. Head to Toe

  30. Detailed Physical ExamHead to Toe • Neck – DCAP/BTLS and JVD, crepitation • Chest – DCAP/BTLS and palpate for paradoxical motion, symmetry, crepitation, and auscultate breath sounds • Abdomen – DCAP/BTLS and tenderness, rigidity, distention • Pelvis – DCAP/BTLS and pain, tenderness, motion, crepitation

  31. Head to Toe

  32. Detailed Physical ExamHead to Toe • Upper extremities – DCAP/BTLS and PMS • Lower extremities – DCAP/BTLS and PMS • Posterior – DCAP/BTLS

  33. On-Going Assessment • Reassess vital signs • Reassess injuries • Reassess interventions