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Trauma Patient Assessment - PowerPoint PPT Presentation


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Trauma Patient Assessment. Trauma Assessment. Size-Up. Safety BSI MOI Number of Patients Additional Resources. Safety. Traffic Smoke Electricity Haz-Mat. Safety. Hostile Persons Weapons Drugs Silence. BSI. Gloves Goggles Mask Gown. BSI. Gloves for minimal fluids

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Presentation Transcript
size up
Size-Up
  • Safety
  • BSI
  • MOI
  • Number of Patients
  • Additional Resources
safety
Safety
  • Traffic
  • Smoke
  • Electricity
  • Haz-Mat
safety5
Safety
  • Hostile Persons
  • Weapons
  • Drugs
  • Silence
slide6
BSI
  • Gloves
  • Goggles
  • Mask
  • Gown
slide7
BSI
  • Gloves for minimal fluids
  • Add eye protection if there’s any chance of splatter
  • Add gown and mask for gross contamination
mechanism of injury
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)
mechanism of injury cont
Mechanism of Injury (cont.)
  • Pedestrian Involvement
  • Motorcycle (child = bicycle)
  • Altered mental status
  • Penetrating wounds to head, chest, abdomen)
number of patients
Number of Patients

Call for additional resources ASAP

additional resources
Additional resources
  • Extrication
  • Traffic control
  • Utilities
initial assessment
Initial Assessment
  • General Impression
  • Mental Status
  • Airway
  • Breathing
  • Circulation
  • Determine priority
general impression
General Impression
  • Age, Weight, Gender
  • Position (relative to posture and surroundings)
  • Activity
  • Obvious Injuries/Bleeding
assess mental status
Assess Mental Status
  • Take C-Spine control
  • A – Alert and immediately responsive
  • V – Responsive to verbal stimuli
  • P – Responsive to painful stimuli
  • U – Unresponsive
assess airway
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
correcting silence
Correcting silence
  • Attempt ventilation
  • Reposition
  • Heimlich
  • Visualize and remove
  • Intubate
  • Trans-laryngeal jet insuflation
assess breathing
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
assess circulation pulses
Compare radial and corotid

Rate

Normal

Fast

Slow

Rhythm

Regular

Irregular

Quality

Weak

Thready

Bounding

Assess Circulation - Pulses
assess circulation skin
Assess Circulation - Skin
  • Color
  • Temperature
  • Moisture
assess circulation bleeding
Assess Circulation - Bleeding
  • Direct pressure
  • Pressure dressing
determine priority
Determine priority
  • Poor general impression
  • Mental status changes
  • Difficulty breathing
  • Shock
  • Chest pain
  • Severe bleeding
  • Severe pain
rapid trauma assessment
Rapid Trauma Assessment
  • Head to toe
  • Rapid sweep to identify major injuries which could prove life threatening
  • DCAP-BTLS
rapid trauma assessment cont dcap btls
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
package and begin transport
Package and begin transport
  • Immediate – immobilize, load, go
  • Delayed – immobilize, treat as necessary, transport
focused history and physical
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
focused history and physical sample history
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
detailed physical exam
Detailed Physical Exam
  • As appropriate, considering priority
  • Repeat initial assessment
  • Complete critical interventions
  • Careful head to toe survey (DCAP/BTLS)
detailed physical exam head to toe
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
detailed physical exam head to toe30
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
detailed physical exam head to toe32
Detailed Physical ExamHead to Toe
  • Upper extremities – DCAP/BTLS and PMS
  • Lower extremities – DCAP/BTLS and PMS
  • Posterior – DCAP/BTLS
on going assessment
On-Going Assessment
  • Reassess vital signs
  • Reassess injuries
  • Reassess interventions