TRAUMA ASSESSMENT

1. 1 TRAUMA ASSESSMENT Emergency Medical Technician - Basic

2. 2 Scene Size-Up Safety Yourself Your partner Other responders Bystanders Patient

3. 3 Scene Size-Up Scene Location? Appearance? Where is patient? What is condition of vehicle? Were seatbelts used? Mechanism of Injury? Amount of force?

4. 4 Scene Size-Up Situation Additional support? Critical vs. Non-critical patient?

5. 5 Initial Assessment Find life threats If life-threat is present, CORRECT IT! If you can’t correct it: Oxygenate Ventilate TRANSPORT

6. 6 Initial Assessment With critical trauma you may never get past the initial assessment Most obvious or dramatic injury usually isn’t what’s killing the patient Listen to patient’s chief complaint

7. 7 Initial Assessment Airway with C-Spine Control Manual stabilization of C-Spine Noisy breathing = Obstructed breathing But all obstructed breathing is NOT noisy Assume airway problems with: Decreased LOC Head, face, neck, thorax trauma

8. 8 Initial Assessment Breathing Is patient breathing Is patient moving air adequately? Is O2 getting to blood

9. 9 Initial Assessment Breathing Give O2 immediately if: Change in LOC Possible shock Possible severe hemorrhage

10. 10 Initial Assessment Breathing Assist ventilations if: Rate is <12 Rate is >24 Decreased tidal volume Increased respiratory effort

11. 11 Initial Assessment Breathing If breathing is compromised: Expose Palpate Auscultate

12. 12 Initial Assessment Circulation Is heart beating? Is patient perfusing? Serious external hemorrhage ?

13. 13 Initial Assessment Circulation Pulses present? Radial => BP > 80 systolic Femoral => BP > 70 systolic Carotid => BP > 60 systolic Skin color, temperature Cool Pale Moist

14. 14 Initial Assessment Circulation If circulation is compromised: Expose Palpate Auscultate

15. 15 Initial Assessment Circulation If carotid pulse absent: Extricate CPR MAST Transport

16. 16 Initial Assessment Disability Level of consciousness = Best indicator of brain perfusion Pupils--Eyes are windows of CNS Decreased LOC Head injury Hypoxia Hypoglycemia Shock

17. 17 Initial Assessment Level of Consciousness (LOC) A - Alert V - Verbal P - Painful U - Unresponsive

18. 18 Initial Assessment Decreased LOC + Unequal Pupils = Epidural or Subdural Hematoma Until Proven Otherwise

19. 19 Initial Assessment Expose, Examine You can’t treat what you don’t find Remove clothing from critical patients ASAP But do NOT delay resuscitation to remove clothing Cover patient with blanket after exam is complete

20. 20 Initial Assessment Vitals signs are not necessary to determine whether patient is critical Regardless of your findings

21. 21 Initial Resuscitation Treat as you go! Aggressively correct hypoxia, hypovolemia

22. 22 Initial Resuscitation Immobilize C-spine Maintain airway Oxygenate Rapid extrication to long board Assist ventilations

23. 23 Initial Resuscitation Minimum Time On Scene Maximum Treatment in Route

24. 24 History, Physical Exam You will get to this with MOST trauma patients Perform only after: Initial assessment is completed, and All life-threats are corrected Do NOT hold critical trauma in field for secondary history, physical exam

25. 25 History, Physical Exam Significant mechanism of injury, multiple injuries, possible unknown injuries? Rapid head-to-toe assessment Baseline vital signs SAMPLE history

26. 26 History, Physical Exam NO significant mechanism of injury, isolated trauma only Focused assessment of injury site Baseline vital signs SAMPLE History

27. 27 Head to Toe Exam Organized, systematic Superior to Inferior Proximal to Distal Look - Listen - Feel - Smell

28. 28 Head to Toe Exam Extremity assessment must include: Pulse Skin color, temperature Capillary refill Motor, sensory function

29. 29 Focused Exam Isolated Injury No significant mechanism of Injury Head-to-toe not necessary since other injuries unlikely

30. 30 Focused Exam Assess isolated injury only Be prepared to perform head-to-toe exam if other injuries identified Be prepared to manage as critical trauma patient if condition deteriorates

31. 31 Baseline Vital Signs Pulse Rate Rapid Slow Rhythm Regular Irregular

32. 32 Baseline Vital Signs Respirations Rate Inadequate <10 or >24 Rhythm Regular Irregular

33. 33 Baseline Vital Signs Blood Pressure Hypotensive? Hypertensive? Narrow pulse pressure? Wide pulse pressure?

34. 34 Baseline Vital Signs Pupils Dilated? Unequal? Reaction to light Normal? Sluggish? Unequal? Unresponsive?

35. 35 Baseline Vital Signs Skin Color Temperature Moisture Turgor Capillary refill

36. 36 SAMPLE History Signs, Symptoms Signs Objective findings What you perceive Symptoms Subjective What patient experiences

37. 37 SAMPLE History Allergies ANY Allergies? Don’t focus only on allergies to medication All allergies could be significant What are they? Are you being treated for this condition?

38. 38 SAMPLE History Medications Do you take any medications? What are they? Are you taking them as prescribed? Are you taking any over-the-counter meds? May we see the medications?

39. 39 SAMPLE History Past, Pertinent Medical History Have you had any recent illnesses? Have you been receiving medical care for any conditions?

40. 40 SAMPLE History Last oral intake Last food or drink Events leading up to incident