Detailed Assessment

Detailed Assessment

• What:• Deliberate head-to-toe assessment• Encompasses ALL aspects of physical exam • Seeks information not previously obtained

• Why:• Assess secondary injuries

• When:• After critical decisions and treatment have been made

• Who:• Medical pt based on NOI• Unresponsive pt (med/trauma)

• Rule in/out trauma• Trauma pt –Injury specific

• i.e. baseball player struck in eye- exam eyes, ears, nose, mouth, etc.

Detailed AssessmentHead

• Inspect/Palpate• DCAP-BTLS • Crepitation

Detailed AssessmentFace

• Inspect/Palpate• DCAP-BTLS • Crepitation

• Battle’s Signs• Bruising immediately

behind the ears• Suggestive of basal skull

fracture • Raccoon eyes

• Bilateral black eyes• Suggestive of a basal skull

fracture

Detailed AssessmentEars

• Inspect/Palpate• DCAP-BTLS

• Drainage• Apply loose dressing

• Halo test• If fluid is present draining out of nose/ears• Collect small sample with gauze pad• If CSF is present in the blood it will separate out• A halo is created

• Blood in the center• CSF in the periphery

• Battle’s Signs• Bruising immediately behind the ears• Suggestive of basal skull fracture

Detailed AssessmentEyes

• Inspect• DCAP-BTLS

• Discoloration• Unequal pupils• Foreign material • Blood in anterior

chamber

Blood in anterior chamber

Foreign Body

Jaundice Constricted

Unequal

Dilated

Detailed AssessmentNose

• Inspect/Palpate• DCAP-BTLS

• Drainage• Bleeding

Detailed AssessmentMouth

• DCAP-BTLS • Drainage• Bleeding • Teeth• Obstructions• Swollen/lacerated tongue

• Seizure?• Odors

• DKA?• Discoloration

Detailed AssessmentNeck

• Inspect/Palpate• DCAP-BTLS • Crepitation• C-Spine “Step Off”

• Jugular Vein Distention • Indicates increased venous

pressure • Assessed at 45O

• Trachea• Midline • Deviation…

• Subcutaneous Emphysema • APPLY C-COLLAR!!!!!!!!!!!!!!!

JVD

Detailed AssessmentChest

• Inspect/Palpate• DCAP-BTLS • Crepitation

• Paradoxical Motion• Movement of part of the chest

wall that is opposite that of the rest of the chest

• Flail Segment • Breath sounds

• Mid clavicular lines bilaterally• Mid axillary lines bilaterally • Present or Absent• Equal or diminished

Detailed AssessmentAbdomen

• Inspect/Palpate• DCAP-BTLS • Crepitation

• Rebound Tenderness• Distention • Resistance

• Firm• Tender• Soft

Rapid Trauma AssessmentPelvis

• Inspect/Palpate• DCAP-BTLS • Crepitation

• Stability • If no pain • Gently compress pelvis

posteriorly and medially

• Priapism • Painful erection of the penis indicative of spinal injury • Loss of sympathetic tone

Rapid Trauma Assessment Extremities

• Inspect/Palpate• DCAP-BTLS • Crepitation

• Work bilaterally at the same time• Makes comparison easy• 1 L of blood from femur Fx

• ONLY 1-2 Cm swelling• Start at top and work your way down• Palpate entirely around the part• Assess for PMS!!!!!!!!

• Pulse• Motor• Sensation

Rapid Trauma AssessmentPosterior

• Use C-Spine Control!!!!• Log-roll pt to lateral position

and inspect for• DCAP-BTLS • Crepitation• Vertebral “step offs”

• !!!DON’T FORGET THE PT HAS A BACK!!!!

Detailed Assessment

• Treat minor injuries found. • Reassess vitals!!!!!!!!