EMS TRAINING INC. 2003 ©
Assessment ofAssessment ofthe Traumathe Trauma
PatientPatientChapter 10Chapter 10
EMS TRAINING INC. 2003 ©
TRAUMATRAUMA
EMS TRAINING INC. 2003 ©
The Trauma PatientThe Trauma Patient
!! Trauma means “injury”Trauma means “injury”!! Injuries can be internal or externalInjuries can be internal or external!! Patient can deny injuriesPatient can deny injuries!! The Golden HourThe Golden Hour
EMS TRAINING INC. 2003 ©
The Trauma PatientThe Trauma Patient!! Signs & symptoms may not be evidentSigns & symptoms may not be evident
immediatelyimmediately!! We must determine the appropriate facilityWe must determine the appropriate facility
to transport toto transport to!! We want to bring in viable patients …We want to bring in viable patients … ……
not dead packaged patientsnot dead packaged patients
EMS TRAINING INC. 2003 ©
What are you looking for?What are you looking for?
!! DCAP - BTLSDCAP - BTLS!!DeformitiesDeformities BurnsBurns!!ContusionsContusions TendernessTenderness!!AbrasionsAbrasions LacerationsLacerations!!Penetrations/Penetrations/ SwellingSwelling
PuncturesPunctures
EMS TRAINING INC. 2003 ©
The Trauma PatientThe Trauma Patient
!! We must have an organized assessmentWe must have an organized assessmentplan ….plan ….
Why? Why?
EMS TRAINING INC. 2003 ©
The Trauma PatientThe Trauma Patient!! We must have an organized assessmentWe must have an organized assessment
plan ….plan ….!!To find life threatening injuriesTo find life threatening injuries!!Prioritize the treatment of injuriesPrioritize the treatment of injuries!!Determine what patients are treatedDetermine what patients are treated
firstfirst
EMS TRAINING INC. 2003 ©
The Trauma AssessmentThe Trauma Assessment
Trauma Patient Medical patient
Initial Assessment
Scene Survey
EMS TRAINING INC. 2003 ©
Trauma PatientTrauma PatientAssessmentAssessment
!! Reconsider the MOIReconsider the MOI
WHY?WHY?
EMS TRAINING INC. 2003 ©
Reconsider the MOIReconsider the MOI
!! To help you determine how quickly youTo help you determine how quickly youmust transport the patient & whichmust transport the patient & whichassessment to use…assessment to use…
!!Significant MOISignificant MOI!!No Significant MOINo Significant MOI
EMS TRAINING INC. 2003 ©
The Trauma AssessmentThe Trauma Assessment
Significant MOI No Significant MOI
Trauma Patient Medical patient
Initial Assessment
Scene Survey
EMS TRAINING INC. 2003 ©
No Significant MOINo Significant MOI
!! No significant MOI & no lifeNo significant MOI & no lifethreatening injuriesthreatening injuries
EMS TRAINING INC. 2003 ©
No Significant MOINo Significant MOI!! Reconsider the MOIReconsider the MOI!! Determine the chief complaintDetermine the chief complaint!! Perform a “Focused Physical Exam”Perform a “Focused Physical Exam”!! Obtain baseline vital signsObtain baseline vital signs!! Take a SAMPLE historyTake a SAMPLE history!! TransportTransport!! Perform an “On-going Assessment”Perform an “On-going Assessment”
EMS TRAINING INC. 2003 ©
No Significant MOINo Significant MOI
!! Why reconsider the MOI?Why reconsider the MOI?Because when you 1st arrive you Because when you 1st arrive you are looking at many things and you are looking at many things and you
could miss something significantcould miss something significant
EMS TRAINING INC. 2003 ©
No Significant MOINo Significant MOI
!! Determine the chief complaintDetermine the chief complaint!!ASK them what hurtsASK them what hurts
EMS TRAINING INC. 2003 ©
No Significant MOINo Significant MOI!! Focused Physical examFocused Physical exam
!!make sure you INSPECT &make sure you INSPECT &PALPATEPALPATE
!!assess the areas of injuryassess the areas of injury!!you will need to expose the injuryyou will need to expose the injury
sitesite!!may lead you to assess other areasmay lead you to assess other areas
EMS TRAINING INC. 2003 ©
No Significant MOINo Significant MOI
!! Baseline Vital SignsBaseline Vital Signs!! SAMPLE history SAMPLE history
!! These are done after youThese are done after youassess injuriesassess injuries
EMS TRAINING INC. 2003 ©
The Trauma AssessmentThe Trauma Assessment
Significant MOI No Significant MOI
Trauma Patient Medical patient
Initial Assessment
Scene Survey
EMS TRAINING INC. 2003 ©
Examples of SignificantExamples of SignificantMOIMOI
!! Ejected from a vehicleEjected from a vehicle!! Death in the same passengerDeath in the same passenger
compartmentcompartment!! Falls > 15 feetFalls > 15 feet!! Falls > 3 times the patients heightFalls > 3 times the patients height!! Roll overRoll over
EMS TRAINING INC. 2003 ©
Examples of SignificantExamples of SignificantMOIMOI
!! High speed MVCHigh speed MVC!! Auto - pedestrian accidentAuto - pedestrian accident!! Motorcycle accidentsMotorcycle accidents!! Penetrating trauma Penetrating trauma
… shooting, stabbing… shooting, stabbing
EMS TRAINING INC. 2003 ©
Examples of SignificantExamples of SignificantMOIMOI
!! Special considerations for childrenSpecial considerations for children!!Falls from 10 feet or >Falls from 10 feet or >!!Bicycle collisionsBicycle collisions!!Medium speed vehicle collisionsMedium speed vehicle collisions!!Damaged car seatsDamaged car seats
EMS TRAINING INC. 2003 ©
Significant MOISignificant MOI!! C-spine stabilization, call for ALS,C-spine stabilization, call for ALS,
transport as soon as possibletransport as soon as possible!! “Rapid Trauma Assessment”“Rapid Trauma Assessment”!! Baseline vital signs & SAMPLEBaseline vital signs & SAMPLE!! TransportTransport!! “Detailed Physical Exam”“Detailed Physical Exam”!! “On-going Assessment”“On-going Assessment”
EMS TRAINING INC. 2003 ©
Rapid TraumaRapid TraumaAssessmentAssessment
!! HeadHead!! Neck & apply cervical collarNeck & apply cervical collar!! ChestChest!! AbdomenAbdomen!! PelvisPelvis!! ExtremitiesExtremities!! Posterior bodyPosterior body!! Immobilize patient on a LBBImmobilize patient on a LBB
EMS TRAINING INC. 2003 ©
Rapid Trauma AssessmentRapid Trauma Assessment
!! HeadHead!!check for DCAP - BTLScheck for DCAP - BTLS!!crepitationcrepitation!!massive bleedingmassive bleeding!!check for airwaycheck for airway
obstructionsobstructions
EMS TRAINING INC. 2003 ©
Rapid Trauma AssessmentRapid Trauma Assessment!! NeckNeck
!!check for DCAP - BTLScheck for DCAP - BTLS!!JVDJVD!!tracheal deviationtracheal deviation
!! Apply a cervical collar nowApply a cervical collar now!!what is the function of the cervicalwhat is the function of the cervical
collar?collar?
EMS TRAINING INC. 2003 ©
Applying the CervicalApplying the CervicalCollarCollar
!! It must be the right size … so measureIt must be the right size … so measurecorrectlycorrectly
!!size depends on the length of the necksize depends on the length of the necknot the widthnot the width
!! Assess the neck before applying the collarAssess the neck before applying the collar!! Explain what you are doing to the patientExplain what you are doing to the patient
EMS TRAINING INC. 2003 ©
Applying the Cervical CollarApplying the Cervical Collar!! Keep the head in neutral positionKeep the head in neutral position!! Try to remove necklaces, earrings, hair ifTry to remove necklaces, earrings, hair if
time permitstime permits!! Cervical collars do NOT provideCervical collars do NOT provide
adequate immobilization by themselvesadequate immobilization by themselves!! You must maintain stabilization untilYou must maintain stabilization until
secured to a LBBsecured to a LBB
EMS TRAINING INC. 2003 ©
Stabilize and measureStabilize and measure
EMS TRAINING INC. 2003 ©
Choose correct collar sizeChoose correct collar size
EMS TRAINING INC. 2003 ©
Prepare collarPrepare collar
EMS TRAINING INC. 2003 ©
Slide collar under chinSlide collar under chin
EMS TRAINING INC. 2003 ©
Secure collar; Secure collar; maintain in-line positionmaintain in-line position
EMS TRAINING INC. 2003 ©
Applying the cervical collar toApplying the cervical collar toa supine patienta supine patient
EMS TRAINING INC. 2003 ©
Supine PatientSupine Patient
EMS TRAINING INC. 2003 ©
Stabilize the headStabilize the head
EMS TRAINING INC. 2003 ©
Measure, slide the collar in placeMeasure, slide the collar in place
EMS TRAINING INC. 2003 ©
Secure the collarSecure the collar
EMS TRAINING INC. 2003 ©
Rapid Trauma AssessmentRapid Trauma Assessment!! ChestChest
!!check for DCAP - BTLScheck for DCAP - BTLS!!paradoxical movementparadoxical movement!!crepitationcrepitation!!listen for breath soundslisten for breath sounds
EMS TRAINING INC. 2003 ©
Assessing the ChestAssessing the Chest
EMS TRAINING INC. 2003 ©
AscultatingAscultating Breath Sounds Breath Sounds
EMS TRAINING INC. 2003 ©
Rapid Trauma AssessmentRapid Trauma Assessment
!! AbdomenAbdomen!!check for DCAP - BTLScheck for DCAP - BTLS!!distentiondistention!!rigidityrigidity!!eviscerationevisceration!!palpate a tender area lastpalpate a tender area last
EMS TRAINING INC. 2003 ©
Assessing the AbdomenAssessing the Abdomen
EMS TRAINING INC. 2003 ©
Rapid Trauma AssessmentRapid Trauma Assessment!! PelvisPelvis
!!check for DCAP - BTLScheck for DCAP - BTLS!!priapismpriapism!!instabilityinstability!!crepitationcrepitation
!! If the patient complains of pain doIf the patient complains of pain donot palpate the pelvisnot palpate the pelvis
EMS TRAINING INC. 2003 ©
Assessing the PelvisAssessing the Pelvis
EMS TRAINING INC. 2003 ©
Rapid Trauma AssessmentRapid Trauma Assessment
!! ExtremitiesExtremities!!check for DCAP - BTLScheck for DCAP - BTLS!!distal distal CSM’sCSM’s!!when would you splint a injuredwhen would you splint a injured
extremity in a high priorityextremity in a high prioritypatient? patient?
Page 215Page 215
EMS TRAINING INC. 2003 ©
Assessing the ExtremitiesAssessing the Extremities
EMS TRAINING INC. 2003 ©
Rapid Trauma AssessmentRapid Trauma Assessment
!! Posterior bodyPosterior body!!check for DCAP - BTLScheck for DCAP - BTLS!!check down to the buttockscheck down to the buttocks
!! Immobilize onto a LBBImmobilize onto a LBB
EMS TRAINING INC. 2003 ©
Assessing the Posterior Assessing the Posterior
EMS TRAINING INC. 2003 ©
Baseline Vital Signs &Baseline Vital Signs &SAMPLESAMPLE
!! Which vital signs should you be taking?Which vital signs should you be taking?
!! What are the SAMPLE questions?What are the SAMPLE questions?
EMS TRAINING INC. 2003 ©
TransportTransport
!! Make your decision to transport asMake your decision to transport assoon as you see:soon as you see:
!!significant MOIsignificant MOI!!life threatening conditionslife threatening conditions!!after you have completed yourafter you have completed your
“Rapid Trauma Exam”“Rapid Trauma Exam”
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam!! Repeat the “Initial Assessment”Repeat the “Initial Assessment”
!!list those steps list those steps
!! Complete all critical interventionsComplete all critical interventions!!what are critical interventionswhat are critical interventions
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam!! HeadHead!! NeckNeck!! ChestChest!! AbdomenAbdomen!! PelvisPelvis!! ExtremitiesExtremities!! Posterior bodyPosterior body!! Reassess vital signsReassess vital signs
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam
!! HeadHead!!check for DCAP - BTLScheck for DCAP - BTLS!!pupilspupils!!ears (blood & CSF)ears (blood & CSF)!!nose (blood & CSF)nose (blood & CSF)!!mouthmouth
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam!! NeckNeck
!!check for DCAP - BTLScheck for DCAP - BTLS!!JVDJVD!!tracheal deviationtracheal deviation!!crepitationcrepitation
!!c-collar should already be onc-collar should already be on
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam
!! ChestChest!!check for DCAP - BTLScheck for DCAP - BTLS!!listen to breath soundslisten to breath sounds!!crepitationcrepitation!!paradoxical movementsparadoxical movements
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam
!! AbdomenAbdomen!!check for DCAP - BTLScheck for DCAP - BTLS!!distentiondistention!!rigidityrigidity!!softnesssoftness!!rebound tendernessrebound tenderness
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam!! PelvisPelvis
!!check for DCAP - BTLScheck for DCAP - BTLS!!stabilitystability!!tendernesstenderness!!painpain!!priapismpriapism!!vaginal bleedingvaginal bleeding
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam
!! ExtremitiesExtremities!!Check for DCAP - BTLSCheck for DCAP - BTLS!!distal CSM’sdistal CSM’s
EMS TRAINING INC. 2003 ©
Detailed Physical ExamDetailed Physical Exam
!! Posterior bodyPosterior body!!check for DCAP - BTLScheck for DCAP - BTLS!!check down to the buttockscheck down to the buttocks
!! Patient should already be on LBBPatient should already be on LBB
EMS TRAINING INC. 2003 ©
On - Going AssessmentOn - Going Assessment
!! Repeat the “Initial Assessment”Repeat the “Initial Assessment”!! Reassess vital signsReassess vital signs!! Repeat the “Focused Assessment”Repeat the “Focused Assessment”
related to specific complaints orrelated to specific complaints orinjuriesinjuries
!! Check interventionsCheck interventions
EMS TRAINING INC. 2003 ©
General PrinciplesGeneral Principles
!! Tell the patient what you are doingTell the patient what you are doing!! Stress the importance of the assessment ifStress the importance of the assessment if
patient is reluctant to allow you topatient is reluctant to allow you toproperly assess themproperly assess them
!! Exposure injured areas before examiningExposure injured areas before examining!! Try to maintain eye contactTry to maintain eye contact
EMS TRAINING INC. 2003 ©
General PrinciplesGeneral Principles
!! Assume spinal injuries existAssume spinal injuries exist!! Apply the cervical collar during the “rapidApply the cervical collar during the “rapid
trauma exam”trauma exam”!! You should perform the “detailed physicalYou should perform the “detailed physical
exam” only after all critical interventions areexam” only after all critical interventions arecompletecomplete
EMS TRAINING INC. 2003 ©
General PrinciplesGeneral Principles!! The “detailed physical exam” is done mostThe “detailed physical exam” is done most
often on trauma patients with significantoften on trauma patients with significantMOIMOI
!! Practicing this often will help you performPracticing this often will help you performbetter when you have a critically injuredbetter when you have a critically injuredpatient!patient!
!! Know this assessment … someone’s life willKnow this assessment … someone’s life willdepend on your ability to do this!depend on your ability to do this!
EMS TRAINING INC. 2003 ©
The Trauma AssessmentThe Trauma Assessment
Significant MOI No Significant MOI
Trauma Patient Medical patient
Initial Assessment
Scene Survey
EMS TRAINING INC. 2003 ©
EMS TRAINING INC. 2003 ©
Questions aboutQuestions aboutTraumaTrauma
Assessment?Assessment?