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TRAUMA ASSESSMENT

Date post: 11-Feb-2016
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TRAUMA ASSESSMENT. Emergency Medical Technician - Basic. Scene Size-Up. Safety Yourself Your partner Other responders Bystanders Patient. Scene Size-Up. Scene Location? Appearance? Where is patient? What is condition of vehicle? Were seatbelts used? - PowerPoint PPT Presentation
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1 TRAUMA ASSESSMENT Emergency Medical Technician - Basic
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Page 1: TRAUMA ASSESSMENT

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TRAUMA ASSESSMENT

Emergency Medical Technician - Basic

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Scene Size-Up Safety

– Yourself– Your partner– Other responders– Bystanders– Patient

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Scene Size-Up Scene

– Location?– Appearance?– Where is patient?– What is condition of vehicle?– Were seatbelts used?– Mechanism of Injury? Amount of force?

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Scene Size-Up Situation

– Additional support?– Critical vs. Non-critical patient?

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

– Oxygenate– Ventilate– TRANSPORT

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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

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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

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Initial Assessment Breathing

– Is patient breathing– Is patient moving air adequately?– Is O2 getting to blood

LOOK - LISTEN - FEEL

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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!

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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!

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Initial Assessment Breathing

– If breathing is compromised:» Expose» Palpate» Auscultate

Try to find, correct cause

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Initial Assessment Circulation

– Is heart beating?– Is patient perfusing?– Serious external hemorrhage ?

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Initial Assessment Circulation

– Pulses present?» Radial => BP > 80 systolic» Femoral => BP > 70 systolic» Carotid => BP > 60 systolic

– Skin color, temperature» Cool» Pale» Moist

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Initial Assessment Circulation

– If circulation is compromised:» Expose» Palpate» Auscultate

Try to find, correct cause

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Initial Assessment Circulation

– If carotid pulse absent:» Extricate» CPR» MAST» Transport

Fewer than 1% of blunt trauma victims in cardiac arrest survive

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Initial Assessment Disability

– Level of consciousness = Best indicator of brain perfusion

– Pupils--Eyes are windows of CNS– Decreased LOC

» Head injury» Hypoxia» Hypoglycemia» Shock

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Initial Assessment Level of Consciousness (LOC)

– A - Alert– V - Verbal– P - Painful– U - Unresponsive

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Initial Assessment Decreased LOC + Unequal Pupils = Epidural

or Subdural Hematoma Until Proven Otherwise

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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

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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

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

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Initial Resuscitation Immobilize C-spine Maintain airway Oxygenate Rapid extrication to

long board Assist ventilations

Expose MAST (PASG) Transport Reassess - Report

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Initial Resuscitation

Minimum Time On Scene Maximum Treatment in Route

Critical Trauma Goals

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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

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History, Physical Exam

Significant mechanism of injury, multiple injuries, possible unknown injuries?– Rapid head-to-toe assessment– Baseline vital signs– SAMPLE history

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History, Physical Exam NO significant mechanism of injury, isolated

trauma only– Focused assessment of injury site– Baseline vital signs– SAMPLE History

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

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Head to Toe Exam Extremity assessment must include:

– Pulse – Skin color, temperature– Capillary refill– Motor, sensory function

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

injuries unlikely

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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

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Baseline Vital Signs Pulse

– Rate» Rapid» Slow

– Rhythm» Regular» Irregular

– Quality» Weak (Thready)» Full» Bounding

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Baseline Vital Signs Respirations

– Rate» Inadequate» <10 or >24

– Rhythm» Regular» Irregular

– Quality» Shallow» Full» Deep» Labored

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Baseline Vital Signs Blood Pressure

– Hypotensive?– Hypertensive?– Narrow pulse pressure?– Wide pulse pressure?

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Baseline Vital Signs Pupils

– Dilated?– Unequal?– Reaction to light

» Normal?» Sluggish?» Unequal?» Unresponsive?

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Baseline Vital Signs Skin

– Color– Temperature– Moisture– Turgor– Capillary refill

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SAMPLE History Signs, Symptoms

– Signs» Objective findings» What you perceive

– Symptoms» Subjective» What patient experiences

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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?

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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?

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SAMPLE History Past, Pertinent Medical History

– Have you had any recent illnesses?– Have you been receiving medical care for any

conditions?

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SAMPLE History Last oral intake

– Last food or drink Events leading up to incident


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