TRAUMA ASSESSMENT Emergency Medical Technician Basic 1 Scene Size-Up Safety – Yourself – Your partner – Other responders – Bystanders – Patient 2 Scene Size-Up Scene – – – – – – Location? Appearance? Where is patient? What is condition of vehicle? Were seatbelts used? Mechanism of Injury? Amount of force? 3 Scene Size-Up Situation – Additional support? – Critical vs. Non-critical patient? 4 Initial Assessment Find life threats If life-threat is present, CORRECT IT! If you can’t correct it: – Oxygenate – Ventilate – TRANSPORT 5 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 6 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 OPEN - CLEAR - MAINTAIN 7 Initial Assessment Breathing – Is patient breathing – Is patient moving air adequately? – Is O2 getting to blood LOOK - LISTEN - FEEL 8 Initial Assessment Breathing – Give O2 immediately if: » Change in LOC » Possible shock » Possible severe hemorrhage » Chest pain » Chest Trauma » Dyspnea » Respiratory Distress If you think about giving O2, GIVE IT! 9 Initial Assessment Breathing – Assist ventilations if: » Rate is <12 » Rate is >24 » Decreased tidal volume » Increased respiratory effort If you can’t tell if ventilations are adequate, THEY AREN’T! 10 Initial Assessment Breathing – If breathing is compromised: » Expose » Palpate » Auscultate Try to find, correct cause 11 Initial Assessment Circulation – Is heart beating? – Is patient perfusing? – Serious external hemorrhage ? 12 Initial Assessment Circulation – Pulses present? » Radial => BP > 80 systolic » Femoral => BP > 70 systolic » Carotid => BP > 60 systolic – Skin color, temperature » Cool » Pale » Moist 13 Initial Assessment Circulation – If circulation is compromised: » Expose » Palpate » Auscultate Try to find, correct cause 14 Initial Assessment Circulation – If carotid pulse absent: » Extricate » CPR » MAST » Transport Fewer than 1% of blunt trauma victims in cardiac arrest survive 15 Initial Assessment Disability – Level of consciousness = Best indicator of brain perfusion – Pupils--Eyes are windows of CNS – Decreased LOC » » » » Head injury Hypoxia Hypoglycemia Shock 16 Initial Assessment Level of Consciousness (LOC) – A - Alert – V - Verbal – P - Painful – U - Unresponsive 17 Initial Assessment Decreased LOC + Unequal Pupils = Epidural or Subdural Hematoma Until Proven Otherwise 18 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 19 Initial Assessment Vitals signs are not necessary to determine whether patient is critical Regardless of your findings If the patient looks sick, he is sick 20 Initial Resuscitation Treat as you go! Aggressively correct hypoxia, hypovolemia 21 Initial Resuscitation Immobilize C-spine Maintain airway Oxygenate Rapid extrication to long board Assist ventilations Expose MAST (PASG) Transport Reassess - Report 22 Initial Resuscitation Critical Trauma Goals Minimum Time On Scene Maximum Treatment in Route 23 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 24 History, Physical Exam Significant mechanism of injury, multiple injuries, possible unknown injuries? – Rapid head-to-toe assessment – Baseline vital signs – SAMPLE history 25 History, Physical Exam NO significant mechanism of injury, isolated trauma only – Focused assessment of injury site – Baseline vital signs – SAMPLE History 26 Head to Toe Exam Organized, systematic Superior to Inferior Proximal to Distal Look - Listen - Feel - Smell 27 Head to Toe Exam Extremity assessment must include: – Pulse – Skin color, temperature – Capillary refill – Motor, sensory function 28 Focused Exam Isolated Injury No significant mechanism of Injury Head-to-toe not necessary since other injuries unlikely 29 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 30 Baseline Vital Signs Pulse – Rate » Rapid » Slow – Rhythm – Quality » Weak (Thready) » Full » Bounding » Regular » Irregular 31 Baseline Vital Signs Respirations – Rate » Inadequate » <10 or >24 – Rhythm » Regular » Irregular – Quality » Shallow » Full » Deep » Labored 32 Baseline Vital Signs Blood Pressure – Hypotensive? – Hypertensive? – Narrow pulse pressure? – Wide pulse pressure? 33 Baseline Vital Signs Pupils – Dilated? – Unequal? – Reaction to light » Normal? » Sluggish? » Unequal? » Unresponsive? 34 Baseline Vital Signs Skin – – – – – Color Temperature Moisture Turgor Capillary refill 35 SAMPLE History Signs, Symptoms – Signs » Objective findings » What you perceive – Symptoms » Subjective » What patient experiences 36 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? 37 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? 38 SAMPLE History Past, Pertinent Medical History – Have you had any recent illnesses? – Have you been receiving medical care for any conditions? 39 SAMPLE History Last oral intake – Last food or drink Events leading up to incident 40